Urogenital tuberculosis

Urogenitaltuberculosis comprises one third of extrapulmonary cases and only about 5% of new cases. Primary or reactivated tuberculosis spreads to the urogenital tract by way of the blood stream. Depending on the virulence of the causative organism or the state of the immune system the disease either heals spontaneously or persists and after an asymptomatic latency period of 15 - 20 years the disease can break through into the kidney collecting system. At this point the disease has developed into an open kidney tuberculosis. Typical lesions such destruction of the papilla, caverns, stenosis of the calyceal neck and amputation of the calyces are then seen.

Urogenital tuberculosis is primarily treated medically, the same as lung tuberculosis. Surgical intervention is only necessary when adequate consevative medical therapy does not achieve stable conversion or if scarring prevents adequate urine drainage with potential irreversible damage to the kidney. The initial phase commences with a triple combination of antibiotics usually for 2 to 4 months until urine cultures become constantly negative (stable conversion). The next phase is to stabilize the situation and prevent recurrence of the disease. If during this phase no resistance develops and the patient has not been previously treated for tuberculosis, 6 months of treatment should be adequate. Otherwise the phase of stabilization should be 9 to 12 months. First choice medications are rifampicin, isoniazid and pyrazinamid. Ethambutol is less efficient. All medications should be given as a daily single dose. Shortening the treatment duration to 1 year or less probably not only lowers costs, but also leads to better patient compliance.