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Tuberculosis of the kidney and the genitourinary tract – a review of the literature
The incidence of human tuberculosis (TB) is increasing worldwide, mainly because of the spread of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and the emergence of drug resistance. Pulmonary TB occurs more commonly than genitourinary TB (GUTB). Symptoms of GUTB are vague and are frequently go undetected. This review serves as a reminder that GUTB exists and, if undiagnosed, may cause unnecessary morbidity. GUTB occurs in 4–20% of patients with pulmonary TB. Onset of GUTB is insidious, and with pyuria and microscopic haematuria in 90% of patients. Diagnosis is achieved by the demonstration of tubercle bacilli in urine. Imaging features include calcifications, calyceal distortion and infundibular and ureteral strictures. Early changes include erosion and blunting of the calyces, narrowing of collecting system infundibula, overt papillary necrosis and parenchymal scarring/calcification. Prostatic involvement is nodular and non-tender. Genital TB presents with superficial ulcers in both males and females. Obstruction of the vas deferens causes infertility. Tuberculous orchitis may mimic other testicular mass lesions. Treatment is with antituberculous therapy. Early endourological decompression of ureteric strictures improves the salvage rate of the kidney.