Genitourinary tuberculosis in pediatric urological practice

Abstract

Objective: Genitourinary tuberculosis is a form of secondary tuberculosis with vague symptoms and presentation, and is rare in children. Antitubercular therapy is the cornerstone of treatment, although surgical intervention is required in a minority of the cases. We retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery.

Materials and methods: Case records of 17 children diagnosed and admitted with genitourinary tuberculosis at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied.

Results: There were 11 male and six female children with a mean age of 11.6 years, admitted during the period July 1990 to June 2005. The most common presentation was storage lower urinary tract symptoms. The most commonly involved organ was the ureter in seven (41%) cases. Mycobacterium tuberculosis was identified on urinary examination in only five (29%) cases. A total of 28 procedures, including 15 endoscopic, four ablative and five reconstructive, were performed with some children requiring more than one procedure. Renal functional parameters stabilized or improved in four of five children (80%) in whom they were deranged at presentation.

Conclusions: Genitourinary tuberculosis presents with a wide variety of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of surgery achieve satisfactory results in the majority of cases. With improved drug therapy and experience with the use of bowel segments in the urinary tract, more reconstructive procedures are being performed with satisfactory outcomes. Children undergoing surgical procedures and reconstruction in particular need to be followed up rigorously.