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Based on more than 32 thousand autopsies performed at the Janos Hospital, Budapest, during the first sixty years of this century, in 835 cases attention has been focussed on the place of urogenital tuberculosis among other kinds of tuberculosis, on the kind of constellation and immunobiological condition it represents, as well as on its relationship to other forms of tuberculosis. These problems have been approached from several angles. p ]The observations tend to indicate that at least in postmortem material urogenital tuberculosis is one of the worst forms of organ tuberculoses and represents an unfavourable constellation in tuberculous disease.

Before 1969, urogenital tuberculosis (UGT) was not listed as a separate disease in the official medical statistics of Sweden. In 1969 and 1970 the number of new cases of active UGT was 1.7 and 1.5 per 100,000 inhabitants, respectively. These figures, which refer to Sweden, are among the lowest reported in the literature. The incidence of UGT in two Swedish counties during the 10-year period 1960–1969 was studied. In a northern county, an average of 4 new cases of active UGT per 100,000 inhabitants per year was registered; in a county in the central part of Sweden, the corresponding figure was about 2. During the whole period, the number of new cases was almost constant from year to year in both counties.

Trivalidin, marketed by Milanese firm BRACCO, has been tested at the Department of Urology of the Budapest Medical University for 2 years and found to have a high tuberculostatic potency. Receiving daily doses of 750 mg, 50 patients showed essential improvement both subjectively and objectively and objectively. Laboratory analyses, cystoscopic pictures and roentgenograms made the subsidence of tuberculosis evident. Treatment with Terivalidin is promising also in cases of bilateral and solitary kidney tuberculosis. The drug enables the urologists to resort to conservative surgery in cases in which Terivalidin is promising also in cases of bilatgeral and solitary kidney tuberculosis. The drug enables the urologists to resort to conservative surgery in cases in which the patient responds only to Terivalidin so that, the urine having become negative, it is possible to eliminate the tuberculous focus (pole resection, cavernotomy). A case is described where, owing to the tuberculostatic effect of the drug, some 45 per cent of the diseased left kidney could be saved by adquate heminephrectomy. In another case the disappearance of juxtavesical ureteral stricture and the resulting improvement of the right kidney made it possible to extirpoate he destroyed left kidney. Neither of the two patients had complaints 12 months after the intervention; urinalysis, cystoscopy and all laboratory examinations gave normal values.

Erythema nodosum is a common association of tuberculosis (TB), especially in this part of the world. Urogenital TB, although less common than other form of tuberculosis, may be associated with erythema nodosum along with other urinary complaints. Here we present a case of an old lady who presented with erythema nodosum with painless haematuria (microscopic) which was later found to be of tuberculous aetiology. Urine analysis yielded no acid-fast bacilli but culture on special media showed growth of Mycobacterium tuberculosis. Though erythema nodosum is usually associated with primary TB, our case revealed it can be found in cases where pulmonary focus is not the primary origin. The patient responded well to anti-tubercular drugs and is doing well on follow-up. Keywords: Erythema nodosum, Renal Tuberculosis, Urogenital Tuberculosis. doi: 10.3329/jom.v10i2.2831 J MEDICINE 2009; 10 : 132-134

Tuberculosis is a disease with myriad presentations and manifestations; it can affect any organ or tissue, excluding only hair and nails. Doctors who are not familiar with extrapulmonary tuberculosis often overlook this disease. Urogenital tuberculosis (UGTB) is the second most common form of TB in countries with severe epidemic situation and the third most common form in regions with low incidence of TB. The term “Urogenital tuberculosis” includes kidney tuberculosis; male and female tuberculosis and urinary tract tuberculosis as complication of kidney tuberculosis. We describe rarest case of tuberculosis of a placenta in young woman, suffered from genital tuberculosis, which was overlooked before delivery, as well as typical tubo-ovarian tuberculomas.

A clinical observation was made on 30 cases of urogenital tuberculosis diagnosed and treated at the urological department of our Hospital between January, 1976 and December, 1984. Furthermore, 20 of them were examined for drug resistance and investigated for this tendency. They accounted for 0.23% of the outpatients. Male to female ratio was 2 to 1, but on urological tuberculosis this ratio was even. The average age was 43.7 and 50% of the patients who had a history of tuberculosis. Mycobacterium tuberculosis could be detected in 24 of the 30 cases (80%) and 18 of the 21 cases (85.4%) of urological tuberculosis. Drug resistance was examined in 20 patients. The resistant ratio of M. tuberculosis against primary drugs such as SM, PAS, INAH was low and a high resistant ratio was observed on secondary drugs such as EB, RFP, TH. These clinical observations are reported and herein discussed.

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.

The functional sequelae of 131 patients with urogenital tuberculosis were examined. At the time of diagnosis, more than half of the patients already suffered from global renal failure which was moderate in 42.7 per cent and severe in 15.5 per cent. We believe that the' primary functional damage occurs at the medullary level with tubular and interstitial involvement. Indeed, the red phenol test for postglomerular blood flow was altered in a higher proportion than was the creatinine clearance (67.9 per cent). The maximum concentrating ability was altered even more frequently (84 per cent). When we compared various glomerular filtration levels with the grade of alteration of the maximum ability concentration test, we also saw clearly that the alteration of the tubular interstitial medullar function dominated the alteration of the glomerular global function. This proves at a functional level the predominantly medullary localization of the lesion in renal tuberculosis.

Of 628 patients with bacteriologically or histologically proven urogenital tuberculosis (UGT) treated from 1960 to 1985. 126 patients (20.1%) had additional urinary tract infection and 66 patients (10.5%) developed urolithiasis. In these 66 patients a simultaneous urinary tract infection occurred in 29 cases (43.9%). Twenty-eight calculi were analyzed by a combined crystal-optical and x-ray-diffraction method. A high incidence of struvite/carbonate apatite calculi (11/28) as well as of calcium phosphate calculi (6/28) was found. The texture of 15 calculi was investigated on thin sections by polarization microscopy and a high concentration of organic material was found in both calcium oxalate and struvite/carbonate apatite calculi probably due to the specific and nonspecific infection with deposition of cell and protein degradation products.

Treatment with the combination of cyanacetic acid hydrazide (CAH) and terramycin has been employed with 23 patients with urogenital tuberculosis. With the exception of one the follow-up time has been at least 5 years. Of major importance are the 15 patients who received this combined therapy for at least 6 months, all of whom showed positive guinea pig tests of the bladder urine when the therapy was instituted. Stable urine conversion occurred in 12 of these patients. The majority of these patients had earlier received long-term treatment with other chemotherapeutics without favourable results. Many of these patients had advanced tuberculous manifestations. Two of the 3 patients who did not convert on CAH and terramycin later received conventional chemotherapy and then stable urinary conversion was attained. The third patient showed stable conversion on CAH and terramycin but after 4 years regressed. This patient converted again on conventional chemotherapy and has continued bacillary negative.The observe...

As part of an experimental study of the routes of spread of urogenital tuberculosis, in which guinea pigs were inoculated with Mycobacterium tuberculosis (H37Rv), the efficacy of a standard staining method (haematoxylin-eosin), specific staining for tubercle bacilli (Ziehl-Neelsen and fluorescent staining) and culture for the demonstration of tuberculous infection were compared. By fluorescence microscopy of sections stained with auramine-rhoda-mine, tubercle bacilli were more clearly seen if epiillumination was used instead of transillumination at higher magnifications. Fluorescence microscopy gave a clearly larger proportion of positive findings than did the routine Ziehl-Neelsen technique, and the time required for examination was considerably reduced. Detection by fluorescence microscopy was generally equivalent to detection by culture.

SUMMARY It is our conviction that in B. 53 we have a valuable drug to be added to our present rich armamentarium in the fight against urogenital tuberculosis. It merits larger experimentation, eventually in cases of reflux, where by simple instillation into the bladder the kidney pelvis may be reached. This possibility has already been discussed by Lane. If we can get enough supplies of B. 53 we will not hesitate to use it for this indication.

Cases of genitourinary tuberculosis diagnosed at the Hospital Clínico Universitario between January 1978 and December 1989 were studied. Genitourinary tuberculosis was the most frequent type of extrapulmonary tuberculosis diagnosed, accounting for 81 (40.9%) of 198 cases. Fifty-one patients (63%) were men. The mean ages of male and female patients were 48.4 years and 51.1 years, respectively (range, 21-75 years). Cases were widely distributed among most age groups; patients were most often 30-69 years of age. Constitutional symptoms were less frequent than local, urinary tract-related symptoms. Only 23.5% of patients had a known history of tuberculosis. Pyuria plus hematuria with sterile cultures was the commonest urinary finding. The results of intravenous pyelography were abnormal in 95% of cases. Ziehl-Neelsen staining gave positive results in 48% of cases. Cultures became positive after a mean (ISD) of 2.3 +/- 1.5 weeks. Sequelae were documented in 42% of cases, but only one death due to genitourinary tuberculosis was recorded.

Quartz light therapy has been included in the treatment of urogenital tuberculosis for the past eight years. It is not used alone but is a part of the general plan of treatment. The general plan is to remove the active lesions by surgery, so far as this may be done advantageously, and then to follow the surgery by a long course of after care. The after care, as is also the treatment of inoperable patients, is based on the traditional method of treating tuberculosis; namely, rest, fresh air and proper diet. To these are added other measures and procedures that have been found useful and that seem indicated in the various kinds of patients. Among the useful measures is quartz light therapy. The air cooled mercury vapor quartz lamps of both the older and the newer types have been employed for the local irradiation of sinuses and for general irradiations

This case of tuberculosis of the bladder in a patient affected with tabes is reported, because the symptoms of the tabetic bladder are antithetical to those of tuberculous cystitis. A search through the files of the Surgeon General's Index Catalogue fails to disclose a report of a similar case. Similarly, no such case was noted in other indexes, or the Index Medicus of 1916. It may be that such a condition is frequently present but overlooked by the physician, owing to his hesitancy in doing a complete examination when a diagnosis of tabes is evident. Ockerblad1states that 30 per cent, of tabetic patients have disturbance of micturition at some time, and that 80 per cent, have bladder symptoms. The normal bladder capacity is from 300 to 400 c.c., while the tabetic bladder tolerates from 600 to 1,000 c.c. without discomfort. When a cystitis is present, however, we may

My paper is not a didactic or an authoritative scientific exposition of the subject from the point of view of the tuberculin therapist but rather a synopsis of personal experience and opinion from the point of view of the genito-urinary surgeon. It is sometimes stated that the modern surgeon is so filled with scientific enthusiasm that he loses sight of the human side of his work and only thinks of his patients as cases. I do not believe this is true except in very exceptional instances. I want to emphasize this fact because in tuberculosis, to an extent that is equaled in scarcely any other disease, the social, economic and human factors are of very great importance. This is so because tuberculous patients are, as a rule, young persons who are, or should be, doing each his or her share of the active work of the world. Also because of

This is a description of the methods of the treatment of inoperable and postoperative urologic tuberculosis as it is administered at the Urological Department (James Buchanan Brady Foundation) of the New York Hospital. During the spring of 1926 a special department was established for the investigation and treatment of inoperable and postoperative urologic tuberculosis. This department was established for the following reasons: It had been found that urogenital tuberculosis is an increasingly important part of urologic work. The modern methods of diagnosis, such as the determination of renal function, genito-urinary roentgenologic studies, the wider usage of guinea-pig inoculations, etc., have shown that the genito-urinary tract is a not infrequent site for tuberculosis. It has therefore followed that a larger number of these patients are appearing for care and treatment. The treatment of genito-urinary tuberculosis is essentially surgical when the tuberculous lesion can be entirely extirpated in an individual who is