[Urinary tuberculosis today]

From our data urinary tuberculosis, clearly reduced as regards past decennia, now results constant in annual number of cases. The reduced frequency sometimes requires some problems of differential diagnosis. After a few considerations about anatomo-pathologic aspects, we examine the diagnostic procedures starting from that urinary tuberculosis has not pathognomic clinical signs, except identification of M. tuberculosis in urine. The medical treatment consists in administering three drugs (rifampin, isoniazid, ethambutol) for 3 months and then two drugs for 6-9 months, on the ground of clinical course. Surgical treatment can be divided in destroying and preserving surgery. At last, endoscopic treatment takes aim at dilating ureteral stenoses.

[A clinical observation on urogenital tuberculosis]

A clinical observation was made on 25 cases of urogenital tuberculosis experienced at the urological department of Chiba Prefectural Sawara Hospital between January 1973 and December 1982. They accounted for 0.28% of the 8,945 outpatients. There were 17 cases of urinary tuberculosis and 13 cases of genital tuberculosis. In urinary tuberculosis, the age distribution showed a peak in the fifties. There was a predominance in males. The patients in their twenties and fifties comprised 60% of the cases of genital tuberculosis. The kidney affected was predominantly the left kidney. Bladder tuberculosis was found in 7 cases. The majority of the epididymal tuberculosis were found in the right side. Bladder and renal symptoms were the chief complaints for 41.2% and 17.6%, of the cases, respectively. Thirty two percent of the patients had a history of tuberculosis. In cystoscopy, typical findings of tuberculosis were found in only 25% of the cases. Mycobacterium in urine could be detected in 33.3%. Accelerated blood sedimentation rate was detected in 65% of the cases. Pyelography revealed ureteral abnormality in the majority of the cases. Three of the 16 patients with renal tuberculosis underwent nephrectomy, and orchiectomy was performed on 6 of the 13 patients with epididymal tuberculosis.

Aging and tuberculosis

In the United States, an increasing proportion of all forms of reactivation tuberculosis occurs in patients over the age of 60 years. Atypical presentations and presence of chronic illness obscure the diagnosis of tuberculosis in the elderly. Prompt diagnosis requires a high index of suspicion and aggressive procedures for diagnostic microbiology. Short-course (9 months) chemotherapy with isoniazid and rifampin is the treatment of choice for elderly patients with uncomplicated pulmonary tuberculosis. Isoniazid chemoprophylaxis is recommended for selected elderly patients.

[20 years' treatment of urogenital tuberculosis with reference to the epidemiology and the general tuberculosis situation]

After introductory remarks on the historical development of the treatment of patients with UGT, the general tuberculosis situation in the GDR is referred to. With the steady decline in tuberculosis of the respiratory system, a clear reduction in the rate of new cases of UGT was registered from 1972 on, due to the well-known late manifestation of the disease. In 1980, 164 new cases of urological tuberculosis were registered, which represent a rate of less than 1 (0.97) new case per 100,000 head of population for the first time. It has been possible to reduce the total duration of medicinal treatment to 9 months from an original figure of 2 years. Despite the use of highly effective aggressive anti-tuberculosis agents the rate of nephrectomy in our patients is 27%, whereby in the last 6 years as many as 31% of all patients with UGT have undergone nephrectomy in the course of treatment. In 20 of these 54 patients the nephrectomy had already been performed elsewhere and UGT was diagnosed from histological examination of the surgical specimen. Neglected cases have become more common in the last 6 years. UGT has been diagnosed very late, whereby it has been observed that patients with pronounced tubercular changes have been little affected in their general state of health. In one case urotuberculosis appeared after a kidney allotransplantation from a dead donor.

Non-respiratory tuberculosis in Canada. Epidemiologic and bacteriologic features

Of the total cases of tuberculosis reported in Canada between 1970-1974, approximately one-sixth (3671 cases) involved primarily non-respiratory organs. Common diagnostic entities were genitourinary tuberculosis (1516 cases), lymphadenitis (1083 cases), bone and joint tuberculosis (555 cases), gastrointestinal tuberculosis (155 cases) and meningitis (138 cases). The remainder (224 cases) involved a wide variety of organs. Between 1967 and 1977 the morbidity rates of most non-respiratory manifestations steadily declined, the decline in meningitis being particularly marked. In contrast, lymphadenitis did not decline to the same extent, reflecting changing immigration patterns. The major diagnostic entities differed in their age and sex patterns and in their contribution to total cases by birthplace and ethnic group. In particular, the preponderance of lymphadenitis in females, and in the Asian-born was striking. Mycobacterium bovis was isolated infrequently and bacillary resistance to antituberculosis drugs was also uncommon. In a substantial proportion of cases, active tuberculosis was present concurrently at another site, or there was historical or radiologic evidence of previous active tuberculosis. Despite this additional evidence, delay and failure of diagnosis were common. An increased clinical awareness of tuberculosis is required, particularly in view of the often enigmatic presentation of non-respiratory disease.

[Extrapulmonary tuberculosis in Africans (author's transl)]

Extra pulmonary tuberculosis are frequent in Africa and have a special severity due to delayed diagnosis and multifocal forms. Various punctures and biopsies may be necessary to demonstate the tuberculous infection. Even with modern treatment it too often implies important risks of severe sequelae.

Extrapulmonary tuberculosis in the United States

In recent years, the decrease in reported tuberculosis in the United States has been due almost entirely to a drop in the number of cases of pulmonary disease. There has been little change in the average number of extrapulmonary cases reported. A retrospective survey of extrapulmonary tuberculosis has shown that it differs from pulmonary tuberculosis with regard to sex and race distribution, diagnosing physician's speciality and proportion of cases bacteriologically confirmed. There is variation within extrapulmonary cases according to specific anatomic site with regard to the above characteristics as well as age distribution. These epidemiologic differences in tuberculosis of different sites are unexplained.

Urogenital tuberculosis in Israel

Forty-four patients were treated for urogenital tuberculosis in our ward from 1956 to 1975. Four patients were Israeli born and all the others were immigrants, mostly from Eastern Europe. Immigration greatly influences local morbidity, and tuberculosis is no exception. The highly developed preventive and social medicine of Israel has excellent results, and prognosis is more than favorable. Only one death was registered in our material, and this was due to renal failure of long duration.