This document provides an introduction to genitourinary tuberculosis. It discusses the history of tuberculosis, including its first discovery in 1882 by Robert Koch. Genitourinary TB is the second most common form of extrapulmonary TB, affecting the kidneys, ureters, genital organs, and accounting for 27% of extrapulmonary cases. The document outlines the typical pathological lesions seen in genitourinary TB and how the disease spreads, most commonly through hematogenous spread from a primary pulmonary infection. It also lists some of the risk factors that can lead to reactivation of dormant tuberculosis infections.
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. HISTORY
▪ Tuberculosis is a Prehistoric Disease.
▪ Known as Consumption -- observed
in humans for over 7000 years
▪ Elimination theory ( Cohnheim , 1879 )
Tubercle bacilli in the blood were
eliminated in the urine.
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Dept of Urology, GRH and KMC, Chennai.
4. • Robert Koch – First discovered the
cause of tuberculosis in 1882.
• Medler – First to describe its
renal involvement in 1926
• Wildbolz - First person to use the term
genitourinary tuberculosis (GUTB) in 1937
HISTORY
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Dept of Urology, GRH and KMC, Chennai.
5. Streptomycin in 1944
Para-aminosalicylic acid in 1946
Isoniazid in 1952
Rifampicin in 1966
Milestones – Discovery of the Antituberculous drugs
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Dept of Urology, GRH and KMC, Chennai.
6. Two most common human pathogens
• Mycobacterium tuberculosis
• Mycobacterium bovis
Mycobacterium africanum –
Pulmonary TB in
Africa.
CAUSATIVE ORGANISM
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Dept of Urology, GRH and KMC, Chennai.
7. DEVELOPED COUNTRIES – 13 / Lakh .
DEVELOPING COUNTRIES – 400 / Lakh .
INDIA -- 168 /
Lakh .
10 Million new cases occur worldwide each
year.
Incidence of tuberculosis
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Dept of Urology, GRH and KMC, Chennai.
8. GENITOURINARY TB
• GUTB is considered as a severe form
of extra-pulmonary tuberculosis
• Second most common form of
extrapulmonary TB - 27% (14 -
41% ).
• 9% of patients with PTB Associated
infection
26% with Miliary disease in kidney,
ureter,
genital 8
Dept of Urology, GRH and KMC, Chennai.
9. Development of disease depends on
• Interaction between pathogen and
immune response of the host.
• A recent resurgence of TB is seen
with
growing number of AIDS.
• Incidence of GUTB is higher in
Dialysis
patients than general population. 9
Dept of Urology, GRH and KMC, Chennai.
10. 1% of infertile female in US Suffer
from
18% of infertile females in INDIA Genital
TB.
Female genital tract TB
Commonly affected genital organs
FALLOPIAN TUBE - 95-100%
ENDOMETRIUM - 50-60%
OVARIES - 20-30%
CERVIX - 5-15%
MYOMETRIUM - 2-5%
VULVA/VAGINA - 1%
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Dept of Urology, GRH and KMC, Chennai.
11. • Predominantly associated with KIDNE Y
PR OS TATE , S E MINALVE S IC LE S &
E PIDIDYMIS .
• TE S TE S and S C R OTUM –occasionally
affected.
Male Genital TB
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Dept of Urology, GRH and KMC, Chennai.
12. Tuberculosis and HIV infection
Among the new TB cases detected
in India ,5.2% are diagnosed to
have HIV
Tuberculosis in Post transplant
Patient prevalence varies from 1% in
Germany to 9.5% -14.7% in India
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Dept of Urology, GRH and KMC, Chennai.
13. Tuberculosis in children with
nephrotic syndrome
The Prevalence rate is 9.3%
ADRENAL TB
•C auses necrosis of the adrenal
gland
- Addison’s
disease.
•C linical findings - weight loss and
asthenia 13
Dept of Urology, GRH and KMC, Chennai.
14. PRIMAR
Y – Direct bacterial
invasion
of any organ in
the body .
SECONDAR
Y– By blood borne from
tuberculosis of Lung ,Hilar lymph
nodes.
MODE OF SPREAD
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Dept of Urology, GRH and KMC, Chennai.
15. • Involved site may be DOR MANT
for
many years → R eactivation → begin to
spread & develop caseation and
cavitation.
• GUTB reactivation of organisms
within
3-7 yrs following the primary infection
by
REACTIVATION…
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Dept of Urology, GRH and KMC, Chennai.
16. CAUSES OF REACTIVATION
DEBILITATING DISEASE
TRAUMA
STEROID THERAPY
DIABETES MELLITES
ANEMIA
IMMUNOSUPPRESSION
ACQUIRED IMMUNO DEFICIENCY SYNDROME
VITAMIN D DEFICIENCY- compromise cell mediated immunity
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Dept of Urology, GRH and KMC, Chennai.
17. Bacilli reaching the Genital
Tract
• Hematogenous - 90%
• Descending direct spread
• Lymphatic spread
• Inoculaton can occur during
sexual intercourse from the infected
male genital tract.
MODE OF SPREAD -- FEMALE
GENITAL TRACT TB
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Dept of Urology, GRH and KMC, Chennai.
18. MODE OF SPREAD -- MALE
GENITAL TRACT TB
Most Common Sites –
Epididymis followed by Prostate
• Epididymis
Infected urine theory
Lymphatic spread
Blood spread
• Prostate TB-- from antegrade infection
• Testes – usually from Epididymis
• Scrotum -- spread from epididymis
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Dept of Urology, GRH and KMC, Chennai.
19. GUTB –Pathological Lesions
Hematogenous spread to Kidney
• Involve R enal cortex and remain
dormant
Granulomatous lesions
• Glomeruli tubercles may heal or spill in to
the
PC T → caught in the narrow Loop of
Henle –
form more tubercles.
• Tubercles caseate and slough in to
calyceal 19
Dept of Urology, GRH and KMC, Chennai.
20. S pread in to Ureter , Bladder-
S trictures and segmental
obstruction
C ontraction
BC G in superficial bladder cancer -
TB Bladder, prostate, kidney
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Dept of Urology, GRH and KMC, Chennai.
