Although tuberculosis (TB) is the most common cause of mortality from infectious diseases worldwide, genitourinary TB in North America is rare. We review 3 cases of genitourinary TB diagnosed within the last 5 years.
The first case is that of a 76-year-old African-Canadian woman who was referred for percutaneous nephrolithotomy of right lower pole renal stones Although renal TB was suspected, her initial urinary TB culture was negative On follow-up imaging, she developed bilateral ureteral thickening and ureteroscopic biopsy confirmed necrotizing granulomata Repeat urine cultures were positive for M tuberculosis The second case is a 73-year-old Italian-Canadian woman who was referred for ureteroscopic biopsy of left thickened ureter to rule out urothelial carcinoma Initial urine TB cultures were negative, despite biopsies confirming granulomatous inflammation She was closely followed with urine cytologies and TB cultures Repeat urine culture was positive for M tuberculosis Both patients were treated with a course of anti-tuberculous agents and indwelling ureteral stents to relieve ureteral obstruction The third case is a 70-year-old Cree woman who was referred for percutaneous nephrolithotomy of a left "staghorn stone" in an atrophic left kidney Thirty years earlier she had been treated for pulmonary TB in addition to ileocystoplasty for a "thimble" bladder A computed tomography scan showed autonephrectomized left kidney Her urine TB cultures were negative She was placed on prophylactic antibiotics for her recurrent bacterial urinary tract infections
Genitourinary TB may present in various subtle ways, and the astute clinician must have a high index of suspicion for this disease in patients with atypical clinical and radiologic findings In addition, TB urine cultures should be repeated when there is high index of suspicion
Canadian Urological Association journal = Journal de l'Association des urologues du Canada 0000 [Epub]
Michael W Sourial, Fadi Brimo, Ruth Horn, Sero Andonian
Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC;, Department of Pathology, McGill University Health Centre, Montreal, QC;, Department of Microbiology, McGill University, and Division of Infectious Diseases, McGill University Health Centre, Montreal, QC , Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC;