This document summarizes urinary tract tuberculosis (TB). It discusses that urinary TB is the third most common form of extrapulmonary TB, occurring in 2-20% of individuals with pulmonary TB. Symptoms are often non-specific and include abdominal pain, urinary issues, and hematuria. Diagnosis involves urine microscopy, culture, and imaging tests like ultrasound and CT. Treatment is a 6 month drug regimen of RHZE/RHE antibiotics. Surgery may be needed for structural complications like hydronephrosis or non-functioning kidneys. Long term monitoring of treated patients is important to watch for recurrence.

1. urinary tract
tuberculosis

2. • Urogenital tuberculosis (TB) is the
third most common form of
extrapulmonary TB (after lymph node
involvement and tuberculous pleural
effusion

3. • Urogenital TB occurs in 2 to 20
percent of individuals with pulmonary
TB
• Up to 50 percent of patients have
radiographic evidence of past
infection and 10 percent may have
active infection

10. Complications
• Hypertension
• (Super-infection (12 to 50%
• AS axis mediated
• Nephrolithiasis (7 to 18%)

11. Complications

12. Symptoms and signs
Classical TB symptoms like fever,
weight loss, and night sweats are
uncommon
Symptoms are often non-specific, with
>25% asymptomatic
Abdominal (particularly back and flank)
pain, LUTS, recurrent UTIs that are
poorly antibiotic- responsive, macro-
and microscopic hematuria,
incontinence (bladder fibrosis), infertility
in both sexes

14. Presumptive urinary TB
• A patient with lower urinary tract
symptoms (frequency, urgency and
nocturia) associated with dysuria
and/or haematuria for at least 2 weeks,
which has not responded to a 3–7 day
course of antibiotics

15. Chest X-ray
All patients presenting with symptoms
consistent with TB, to look for evidence
of previous or active pulmonary TB
30% may have an abnormal CXR

16. Urine microscopy and
culture for non-
mycobacterial organisms
• All patient to identify sterile pyuria
which may suggest urinary tb
• To diagnose active ,superaded
infection

17. Early morning urine
sampling
All patients
Three to five early morning urine
samples collected for staining and
microscopy for AFBs and culture for
Mtb
Although sensitivity is low, culture
remains the most reliable way to
confirm urinary TB and allows drug
susceptibility test

18. Ultrasound KUB
All patients
This scan may be normal in early
disease
Ultrasonography may reveal cystic or
cavitary lesions, cortical scarring,
hydronephrosis, and abscess in the
kidneys

19. Intravenous urography
Selected patients
It has low sensitivity for early lesions
Risks include contrast
nephropathy and contrast
reaction

20. IVU features

21. Contrast-enhanced CT
urography
Selected patients
This test is more sensitive than IV
urography
Risks include contrast nephropathy and
contrast reaction
The relatively high dose of ionizing
radiation involved, particularly for
children and women of childbearing
age
It is contraindicated in pregnant women

23. MR urography without
contrast
Selected patients
This test is also gives structural information
and is sensitive for identifying and
characterising TB lesions
The advantage of not requiring intravenous
contrast and not necessitating a dose of
radiation
Pregnant women, children and patients
with pre- existing renal function may

24. • FNAC
• Urethro-cystoscopy with/without
biopsy
• Biopsy

27. Treatment
•Aims of treatment are:
1.To achieve TB cure
2.To prevent the long term sequelae
3.To restore normal anatomy

28. Drugs : 2RHZE/4RHE
Duration : Six months

29. Longer courses of ATT
• Longer courses of ATT ranging from
9 months to 2 years are useful in
patients
• Who do not tolerate Pyrazinamide

31. Patients With Chronic
Kidney Disease

33. Treatment monitoring

35. • . In cases of renal calcification, the
patient should be evaluated yearly by
three early morning samples of urine
for culture of mycobacteria and by
plain radiography of the abdomen for
up to 10 years,

36. Referral
Structural urinary tract complications
Renal failure secondary to
bilateral hydronephrosis

37. SURGERY
NEPHRECTOMY
PARTIAL NEPHRECTOMY
NEPHROURETERECTOMY
ABSCESS DRAINAGE

38. Nephrectomy
•Indications
– nonfunctioning kidney with or without
calcification
– extensive disease involving the whole kidney,
together with hypertension and UPJ
obstruction
– coexisting renal carcinoma

39. Partial Nephrectomy
•Localized polar lesion containing
calcification that has failed to respond
after 6 weeks of intensive
chemotherapy
•Area of calcification slowly increasing
in size and may gradually destroy the
whole kidney

45. caliectasis and multifocal
strictures

46. putty kidney.”