Urogenital tuberculosis

Classification according to ICD-10
A18.1	Tuberculosis of the genitourinary system
N74.0 *	Tubercular infection of the cervix uteri
N74.1 *	Tuberculous inflammation in the female pelvis, tuberculous endometritis
N33.0 *	Tubercular cystitis
N51 *	Diseases of the male genital organs classified elsewhere
N29.1 *	Other diseases of kidney and ureter in infectious and parasitic diseases classified elsewhere
ICD-10 online (WHO version 2019)

In the urogenital tuberculosis is a secondary or even organ tuberculosis . The primary focus is often in the lungs. Urogenital tuberculosis is not a sexually transmitted disease , but a disease that must be reported by name .

Epidemiology

Urogenital tuberculosis is extremely rare in Central Europe. Today it usually occurs between the ages of 25 and 40 and in old age, especially in old people's homes. In 2006, 1,091 cases of extrapulmonary tuberculosis (organ involvement outside the lungs) were reported in Germany. 2.5% of these extrapulmonary tuberculosis diseases affected the genitourinary system.

Pathogenesis

The tuberculosis pathogens ( Mycobacterium tuberculosis , rarely Mycobacterium bovis ) usually get hematogenously , i.e. via the blood, from the primary focus to the kidneys , adrenal glands , the urinary tract and the bladder as well as to the genitals .

Kidney, lower urinary tract and urinary bladder

Initially, so-called minimal lesions of tuberculosis arise in the kidneys or other urogenital organs. A calcified area emerges from the developing caseating tuberculoma. The patient's immune situation then determines the further course. As the disease progresses, central necrosis and calcifications increase in the kidney. A close spatial relationship between the necrosis and the cavity system of the kidneys leads to deformities of the calyx, calyx caverns, papillary necrosis, calyx stenosis and narrowing of the renal pelvis. The final stage of kidney tuberculosis is a so-called cement kidney, which consists almost entirely of casing necrosis and no longer has any function. Scars of the ureters quickly lead to urinary stasis , which can progress to hydronephrosis with loss of function of the kidneys.

Female genital organs

There is almost always bilateral fallopian tube lining in the ampullary part, from where the infection spreads via the fallopian tubes to the uterus . If the uterine cavity is invaded, septum formation often occurs and, as a result, infertility. This is considered to be one of the most common causes of female infertility in developing countries such as B. India, Bangladesh etc. Genital tuberculosis is categorized as "open" TB because there is up to 90% pathogen detection in menstrual blood.

Male reproductive organs

The disease can spread to the epididymis through the bloodstream . Kidney involvement is not absolutely necessary. The pathogen can also spread via the seminal ducts into the testes and prostate .

Symptoms

20% of the urogenital manifestations of tuberculosis are completely symptom-free. Symptoms of urogenital tuberculosis are rather uncharacteristic. Possible symptoms are pain, discomfort when urinating, flank pain, blood in the urine or pyuria , constipation, flatulence, bleeding disorders up to and including the absence of menstruation. If the epididymis is affected, swelling, pain and redness occur. In the past, genital tuberculosis in women was more of an incidental finding in the context of sterility diagnostics .

Diagnosis

Tuberculin test (not conclusive)
Quantiferon test (blood test)
Chest x-ray (primary tuberculosis in the lungs )
cultural evidence of TB pathogens in urine (duration approx. four weeks)
Polymerase chain reaction (PCR) as detection of pathogens in urine
Urography
Detection of pathogens in menstrual blood
Biopsy of the endometrium
laparoscopy
Polymerase chain reaction (PCR) as proof of the pathogen directly in the histological preparation

therapy

Urogenital tuberculosis is treated with a combination therapy consisting of isoniazid , rifampicin and pyrazinamide , if necessary with ethambutol as well . Treatment usually lasts six months. If the therapy does not work, or if a putty kidney or hydronephrosis occurs, a surgical resection is usually necessary. If the genital organs are affected, the disease leads to sterility in 90% of cases .

literature

Manfred Stauber, Thomas Weyerstahl: Gynecology and Obstetrics. 2nd Edition.
The surgery of tuberculosis. Primary Surgery: Volume One: Non-trauma. Chapter 16 Rheinische Friedrich-Wilhelms-Universität Bonn
H. Bergstermann, K. Häußlinger: Tuberculosis. In: Internist. Volume 43, 2002, pp. 861-871.
S. Lenk, J. Schroeder: Genitourinary tuberculosis. In: Curr Opin Urol. Volume 11, 2001, pp. 93-98.
L. Petersen, S. Mommsen, G. Pallisgaard: Male genitourinary tuberculosis. Report of 12 cases and review of the literature. In: Scand J Urol Nephrol. Volume 27, 1993, pp. 425-428.
G. Wise, VK Marella: Genitourinary manifestations of tuberculosis. In: Urol Clin North Am. Volume 30, 2003, pp. 111-121.