Can tissue PCR augment the diagnostic accuracy in genitourinary tract tuberculosis?

A new nomogram based on ultrasound and clinical features for distinguishing epididymal tuberculosis and nontuberculous epididymitis

Using ultrasound findings and clinical characteristics, we constructed and validated a new nomogram for distinguishing epididymal tuberculosis from nontuberculous epididymitis, both of which share similar symptoms. We retrospectively examined data of patients with epididymal tuberculosis and nontuberculous epididymitis hospitalized between January 1, 2013, and March 31, 2023. Eligible patients were randomly assigned to derivation and validation cohorts (ratio, 7:3). We drew a nomogram to construct a diagnostic model through multivariate logistic regression and visualize the model. We used concordance index, calibration plots, and decision curve analysis to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively. In this study, 136 participants had epididymal tuberculosis and 79 had nontuberculous epididymitis. Five variables-C-reactive protein level, elevated scrotal skin temperature, nodular lesion, chronic infection, and scrotal skin ulceration-were significant and used to construct the nomogram. Concordance indices of the derivation and validation cohorts were 0.95 and 0.96, respectively (95% confidence intervals, 0.91-0.98 and 0.92-1.00, respectively). Decision curve analysis of this nomogram revealed that it helped differentiate epididymal tuberculosis from nontuberculous epididymitis. This nomogram may help clinicians distinguish between epididymal tuberculosis and nontuberculous epididymitis, thereby increasing diagnosis accuracy.

Diagnostic nomogram to differentiate between epididymal tuberculosis and bacterial epididymitis

PURPOSE

We developed and validated a diagnostic nomogram for differentiating epididymal tuberculosis (TB) from bacterial epididymitis.

METHODS

In this retrospective study, we developed a prediction model based on demographics and clinical characteristics. Eligible patients were randomly divided into derivation and validation cohorts (ratio 7:3). Univariate and multivariate regression analyses were used to filter variables and select predictors. Multivariate logistic regression was used to construct the nomogram. Concordance index (C-index), calibration plots, and decision curves analysis (DCA) were used to assess the discrimination, calibration, and clinical usefulness of the nomogram.

RESULTS

We included 147 patients (epididymal TB, 93; bacterial epididymitis, 54). The derivation cohort included 66 patients with epididymal TB and 38 with bacterial epididymitis; the validation cohort included 27 patients with epididymal TB and 16 with bacterial epididymitis. One regression model was built from three differential variables: body mass index, purified protein derivative, and chronic infection. Accordingly, one nomogram was developed. The model had good discrimination and calibration. C-indexes of the derivation and validation cohorts were 0.89 and 0.98 (95% confidence intervals, 0.83-0.95 and 0.94-1.01), respectively. DCA showed that the proposed nomogram was useful for differentiation.

CONCLUSION

The nomogram can differentiate between epididymal TB and bacterial epididymitis.

Application of core needle biopsy in the diagnosis of epididymal tuberculosis: a retrospective analysis of 41 cases

OBJECTIVE

We aimed to investigate the use of core needle biopsy (CNB) in epididymal tuberculosis (TB) diagnosis.

METHODS

We analyzed 41 samples collected between January 1, 2018, and January 31, 2021, from patients who underwent CNB for suspected epididymal TB. All specimens were examined using histopathological examination and the Xpert Mycobacterium tuberculosis bacilli/rifampicin (MTB/RIF) assay. We analyzed the examination results to determine the application value of CNB in epididymal TB diagnosis and evaluate its safety.

RESULTS

According to the comprehensive reference standard established in this study, 37 of the 41 patients had epididymal TB and four patients had chronic epididymitis. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of histopathological examination were 86.49% (71.23-95.46%), 100.00% (39.76-100.00%), 100.00% (89.11-100.00%), 44.44% (13.70-78.80%), and 0.93 (0.81-0.99), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the Xpert MTB/RIF assay were 62.16% (44.76-77.54%), 100.00% (39.76-100.00%), 100.00% (85.18-100.00%), 22.22% (6.41-47.76%), and 0.81 (0.66-0.92), respectively. No postoperative complication attained a Clavien-Dindo classification grade of >2.

CONCLUSION

CNB was useful in diagnosing epididymal TB. Therefore, we recommend using CNB as a sample collection tool for diagnosing epididymal TB.

Diagnosis and treatment of epididymal tuberculosis: a review of 47 cases

Objective

To analyze the clinical manifestations, diagnosis and treatment outcomes in a series of patients with epididymal tuberculosis.

Methods

This study is a retrospective data analysis of 47 cases of histologically-confirmed epididymal tuberculosis in patients treated at our hospital from November 2012 to December 2018.

Results

The average age of the patients was approximately 42 years. The epididymal lesion location was left-sided in 15 patients (31.9%), right-sided in 22 patients (46.8%) and bilateral in 10 patients (21.3%). The main symptoms were painless swelling of the scrotum in 21 cases (44.7%) and scrotal drop pain in 21 cases (44.7%). Scrotal physical examination revealed epididymal beaded enlargement in 12 patients (25.5%), testicular mass in one patient (2.1%), scrotal tenderness alone in seven patients (14.9%), ill-defined epididymal-testicular border in 21 patients (44.7%) and sinus formation in six patients (12.8%). After 2-4 weeks of anti-tuberculosis chemotherapy, the patients underwent a surgical procedure. We found that 10 (83.3%) of the 12 patients whose main symptom was epididymal beaded enlargement underwent simple epididymal surgery. Of the 21 patients whose main clinical manifestation was ill-defined testis-epididymis demarcation, 16 (72.2%) underwent epididymis-testicular surgery. All patients underwent postoperative chemotherapy for 3-6 months. Postoperative follow-up showed good response to treatment.

Conclusion

It is difficult to diagnose early-stage epididymal tuberculosis. Epididymal tuberculosis is likely to have invaded surrounding tissues when signs such as epididymal beaded changes and ill-defined epididymis-testis border are present. Surgical treatment combined with preoperative and postoperative chemotherapy is an effective approach to treating this condition.

The changing epidemiology of tuberculosis in a Spanish tertiary hospital (1995-2013)

Important epidemiological changes and improvement of new diagnostic approaches, mainly molecular tools, might have impacted the management and outcome of tuberculosis (TB) in the last years in industrialized countries. In order to describe the epidemiological trends, and changes in clinical, diagnostic, and therapeutic aspects in patients with TB, an observational study was performed in a tertiary hospital in Western Europe (Madrid, Spain).All adult patients (>16 years) with a diagnosis of TB in the period 1995 to 2013 were included in the study.TB was diagnosed in 1284 patients, including 304 (24%) foreign-born and 298 (23.2%) human immunodeficiency virus (HIV)-infected patients. The proportion of foreign-born patients increased significantly, from 7.4% (1995) to 40.3% (2013), P < .001, while the proportion of patients with HIV infection decreased (from 41% to 15%, P < .001). Extrapulmonary locations of TB increased (from 23.9% to 37.1%, P < .001), although the miliary forms were less frequent (from 16% to 5.6%, P < .001). Pulmonary involvement remained constant during the period of study (from 50% to 46%, P = .18). The yield of microbiological diagnostic methods in different clinical specimens has remained very similar. Only molecular techniques have improved the diagnosis in respiratory, urinary, and peritoneal samples. The global cure rate was 64.8% and mortality rate was 9.1% (6.5% directly attributable to TB). Mortality has decreased significantly during the years of study (from 11% to 2%, P < .001).There has been a significant decline in the number of patients with TB. Changes in HIV coinfection and immigration have conditioned other epidemiological and clinical aspects of the disease, including the clinical presentation, treatment response, and mortality. Only the use of molecular tests has provided an improvement in the diagnosis of pulmonary and extrapulmonary TB.

Genital tuberculosis: current status of diagnosis and management

Genitourinary Tuberculosis (GUTB) is the second most common extra-pulmonary manifestation of tuberculosis (Tb) and an isolated involvement of genital organs is reported in 5–30% of the cases. Genital involvement results from primary reactivation of latent bacilli either in the epididymis or the prostate or by secondary spread from the already infected urinary organs. The epididymis are the commonest involved organs affected primarily by a hematogenous mode of spread. Tb is characterized by extensive destruction and fibrosis, thus an early diagnosis may prevent function and organ loss. The gold standard for diagnosis is the isolation and culture of mycobacterium tuberculosis bacilli and in the cases of suspected GUTB, it is commonly looked for in the urinary samples. All body fluid specimens from possible sites of infection and aspirates from nodules must also be subjected to examination. Radiologic investigations including ultrasonography and contrast imaging may provide supportive evidence. Anti-tubercular chemotherapy is the first line of management for all forms of genital Tb and a 6 months course is the standard of care. Most patients with tubercular epididymo-orchitis respond to antitubercular therapy but may require open or percutaneous drainage. Infertility resulting from the tubercular affliction of the genitalia is multifactorial in origin and may persist even after successful chemotherapy. Multiple organ involvement with obstruction at several sites is characteristic and most of these cases are not amenable to surgical reconstruction. Thus, assisted reproduction is usually required. Post treatment, regular annual follow up is recommended even though, with the current multi drug therapy, the chances of relapse are low.

Best practice in the diagnosis and management of urogenital tuberculosis

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious diseases. Urogenital tuberculosis (UGTB) is the second most common form of extrapulmonary TB in countries with severe epidemic situations and the third most common form in regions with a low incidence of TB. In this article we present the terminology, epidemiology and classification of UGTB, as well as describing the laboratory findings and clinical features and approaches to chemotherapy as well as surgery.