Genitourinary tuberculosis in pediatric surgical practice.
BACKGROUND
Genitourinary tuberculosis (GUTB) has been reported to account for 20% to 73% of all cases of extrapulmonary tuberculosis in the general population but is much rarer in children. GUTB is a form of secondary tuberculosis with vague symptoms. Surgical intervention is required in a minority of cases.


METHODS
Nine cases of genitourinary tuberculosis (GUTB) were diagnosed and treated from 1988 to 1995. The age of the patients ranged from 5 to 12 years. There were five boys and four girls. Presenting features were diverse and included gross hematuria in 44% of cases and epididymoorchitis in 22% of cases. Rarer presenting features included acute renal failure, staghorn calculus, and pyonephrosis. Associated or past history of tuberculosis was present in three patients. Conclusive diagnosis was made on the basis of isolation of mycobacterium tuberculosis, histopathology, or cystoscopy in eight patients, whereas one patient was given a therapeutic trial based on clinical manifestations.


RESULTS
Response to antitubercular drug therapy was gratifying. Excisional surgery in the form of nephrectomy was needed in one patient, whereas another underwent bilateral ureteric replacement with ileal loops for multiple ureteric strictures.


CONCLUSIONS
The wide variety of presenting features and pathological lesions that result from GUTB are emphasized. The diagnosis of GUTB must be suspected in patients who present with hematuria (gross or otherwise), epididymoorchitis, and patients with long segment or multiple ureteric strictures. In view of the anticipated resurgence in tuberculosis caused by the prevalence of aquired immunodeficiency syndrome the pediatric urologist must be aware of the pathophysiology and clinical spectrum of this disease.
Chattopadhyay
A
A
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Bhatnagar
V
V
Agarwala
S
S
Mitra
D K
DK
D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004823:Epididymitis / Q000382:microbiology; D005260:Female; D006748:Hospital Departments; D006801:Humans; D008297:Male; D009920:Orchitis / Q000382:microbiology; D010372:Pediatrics; D013503:Surgery Department, Hospital; D014401:Tuberculosis, Urogenital / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014555:Urination Disorders / Q000382:microbiology
D000995:Antitubercular Agents