Genitourinary Tuberculosis (GUTB)

Page 1 2 3

What is Genitourinary Tuberculosis?

Genitourinary Tuberculosis is a disease of the genitourinary system. This includes the entire urinary tract and reproductive system. This is an extrapulmonary form of tuberculosis infection.

Who gets Genitourinary Tuberculosis?

Tuberculosis is primarily a medical problem of third world, affecting between 3.5 and 4 million people per year worldwide, 90% of them within developing countries. In 1998, an incidence rate of 6.8 per 100,000 was reported in the US. In the western world, the condition is most common among HIV infected individuals, marginalised ethnic groups and immigrant populations.

Genitourinary tuberculosis accounts for around 15% all extrapulmonary cases of tuberculosis.

Predisposing Factors

1. Primary infection with tuberculosis: Pulmonary or extrapulmonary. The development of genitourinary tuberculosis usually arises from the spread of pulmonary tuberculosis.

2. Previous exposure to patients infected with tuberculosis: People in close contact with tuberculosis may develop dormant infection which may activate in later life with deterioration of the immune system.

3. Immunosupression: Acquired (e.g. HIV infection) or congenital.

4. Demographic: Tuberculosis is more common in migrants and others disadvantaged or marginalised groups of society.

5. Location of residence: Tuberculosis is more common in the Asian subcontinent and Africa than the Western nations of the US, UK and Australia.

Progression

Genitourinary tuberculosis results from the spread of pulmonary tuberculosis through the blood to the genitourinary tract. The bacteria lodge within the tissues of the genitourinary tract and form caseating granulomas. Local urinary symptoms usually predominate (dysuria, haematuria, flank pain) but the patient may be completely asymptomatic until large destructive granulomas have formed. Large abscesses and fistulae may form if the condition is allowed to continue untreated. Severe ureteric strictures may result in urinary tract obstruction and permanent renal damage. Without treatment, the condition will progress and may spread to other parts of the body resulting in widespread miliary tuberculosis. The condition responds well to antimicrobial therapy, which is the mainstay of therapy outlined below.

Page 1 2 3