Surgical treatment of upper urinary tract obstruction in tuberculosis of the urinary system

Introduction. Currently, the basis for effective treatment of urinary tuberculosis (UT) is a combination of specific chemotherapy with reasonable surgical intervention and strict follow-up of the patient. Materials and methods. This literature review presents the evolution of methods of surgical treatment of renal and upper urinary tract tuberculosis over of 127 sources found for the review, 63 were selected. Results. Since UT is a very slowly progressive disease with minimal and imperceptible symptoms, often leading to irreversible organ damage, up to 75% of patients with this pathology undergo surgery. As follows from the results of recent studies, the emphasis of surgical treatment is increasingly shifting from ablative and organ-carrying techniques to reconstructive operations. Surgery for upper urinary tract tuberculosis continues to develop, but its results in advanced cases of destruction of renal tissue often remain unsatisfactory. Conclusions. The search for new methods of reconstructive interventions, the purpose of which is to preserve functioning renal-ureteral units and improve the quality of life of patients, remains relevant.

Gen X-Pert MTB/Rif Assay with the Ziehl Nielsen, and Florescence Microscopy Detection Rate of Urinary Tuberculosis Among Suspected and Pulmonary MTB Positive Patients Visiting University of Gondar Specialized Referral Hospital, Northwest Ethiopia.

Background Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis remains a major global public health concern. Extra-pulmonary tuberculosis accounts for 15% of the global tuberculosis burden. Urinary tract tuberculosis is one of the most common and severe forms of extra-pulmonary tuberculosis in clinical practice. Diagnosis of urinary tract tuberculosis by Gen X-pert MTB/RIF assay from developing countries including Ethiopia is limited. Thus, this study was aimed to compare Gene X-pert MTB/RIF assay with the convectional diagnosis methods. Methods A hospital-based cross-sectional study was conducted among confirmed pulmonary tuberculosis and suspected for urinary tract tuberculosis patients at University of Gondar Specialized Referral Hospital from February 2020 to June 2020 G.C. Non-randomized purposive sampling technique was used to select study participants. To detect Mycobacterium tuberculosis, a urine sample was collected. Then, Ziehl Nielsen and fluorescence microscope, Gene X-pert Real-time PCR were performed to detect the Mycobacterium tuberculosis. Sociodemographic, clinical data, and laboratory data were collected and entered into EPI-Info version 3.5.3 and then transferred to SPSS version-20 for analysis. Descriptive statistics were summarized as percentages, means, and standard deviations. Results A total of 64 study participants were enrolled in this study, 64.2% (41/64) were males and 30% (19/64) were in the age group of 31–45 years. Moreover, 71.9% (46/64) and 57.8% (37/64) study participants were rural residences and illiterate respectively. Among the 64 study participants, 4.69% (3/64) were positive for urinary tuberculosis by Gene X-expert. However, 1.56% (1/64) was positive by fluorescence microscopy, and there was no urinary tuberculosis detected by Ziehl Nielsen examination method. Conclusion and recommendation: The prevalence of urinary tract Mycobacterium tuberculosis using Gene X-pert and fluorescence microscopy was 4.69% (3/64) and 1.56% (1/64), respectively. Gene X-pert has higher detection rate than the conventional methods. Therefore, it is better to develop a guideline on how to use Gen x-pert for the diagnosis for urinary tract tuberculosis in urine samples.

Imaging of endometrial osseous metaplasia—an uncommon but treatable cause of infertility

Background Endometrial osseous metaplasia (EOM) is an uncommon condition characterised by metaplastic transformation of endometrial tissue into osteoblasts (mature or immature bone in the endometrium). Etiopathogenesis of EOM is explained by multiple putative mechanisms like dystrophic calcification, metaplastic ossification, retained foetal bones after abortions and genito-urinary tuberculosis. EOM has varied clinical presentation ranging from patient being asymptomatic to secondary infertility. Although hysteroscopy is the gold standard for its diagnosis and treatment, non-invasive imaging comprising chiefly of ultrasonography (USG) is increasingly becoming the mainstay of diagnosis. We aim to present the imaging findings in EOM to acquaint radiologists and gynaecologists with this condition to avert misdiagnosis of this uncommon yet treatable cause of infertility. Results Mean age of patients was 31.4 ± 5.4 (S.D) years. USG revealed linear or tubular densely echogenic endometrium with posterior acoustic shadowing in all the 14 patients. MRI in 3 patients revealed diffuse or patchy areas of T1W and T2W hypointense signal intensity with unilateral (n = 2) and bilateral (n = 1) ovarian cysts. One patient who underwent CT scan revealed dense endometrial calcification. Histopathologic examination (HPE) revealed lamellar (n = 6) or trabecular (n = 4) bone within endometrium (EOM) and inflammatory cells with calcification in four patients (calcific endometritis). Twelve patients conceived after dilatation and curettage within 15 months. Conclusion Familiarity with the imaging appearances of EOM is indispensable to clinch this diagnosis and avert misdiagnosis of this rare but potentially treatable cause of infertility. USG is usually sufficient for diagnosis. MRI and CT are only supplementary tools in difficult clinical scenarios.

Transitional cell carcinoma of the upper urinary tract: a puzzle

Transitional cell carcinoma (TCC) of the upper urinary tract has a puzzling presentation. This is a case report of a 44 year old male with history for smoking 20 pack years presenting with cough, haemoptysis and microscopic haematuria. His sputum was positive for acid fast bacilli. He was treated as pulmonary tuberculosis (PTB) but had gross haematuria a month after initiation of anti-tubercular drugs (ATD). He was investigated with computed tomography (CT) imaging and was found to have thickened renal pelvis and ureter. It was initially thought as a case of genito-urinary tuberculosis (GUTB). Expectant management for gross haematuria failed. The patient was stabilised and taken up for open nephroureterectomy under general anaesthesia (GA). Histopathological report suggested it to be high grade TCC of the left renal pelvis extending to upper ureter. He did well with completion of ATD. He was not started on adjuvant chemotherapy for fear of exacerbation of PTB. He is under regular and uneventful follow up in the outpatient department (OPD).

Recurrent urinary tract infection as presenting feature of genito-urinary tuberculosis: reports of two cases

Genito-urinary tract is one of the most common extra-pulmonary sites of involvement by tuberculosis. Genitourinary tuberculosis poses significant diagnostic difficulty; not only because of non-specific symptoms, but also because of lack of diagnostic facility, specially, in resource constrain settings. We report two cases of genito-urinary tuberculosis occurring among Bangladeshi adult females, who presented with recurrent urinary tract infection. Along with other supportive tests, acid fast bacilli were identified on urine examinations. Birdem Med J 2020; 10(3): 212-214