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B22. Specific infections of the genitourinary tract

Genitourinary tuberculosis

Genitourinary tuberculosis refers to tuberculosis which has spread to urinary tract. Genitourinary TB is the second most common extrapulmonary manifestation of TB after lymph node. The bacteria spreads haematogenously to kidney -> bacteria descend. It's very rare.

  • A potential very rare complication of intravesical BCG
  • Genitourinary TB presents 5 – 25 years after initial infection
  • Clinical features
    • Dysuria
    • Flank pain
    • Haematuria
    • Pyuria
    • Low-grade fever
    • Gender-specific
      • Male – prostatitis
      • Female – amenorrhoea, discharge
  • Diagnosis
    • Apparent sterile pyuria
      • Pyuria with negative bacterial culture
      • PCR or special culture will show TB
    • Imaging: calcifications, strictures, parenchymal destruction
  • Treatment
    • Normal TB therapy
    • Surgery to remove adhesions, strictures
  • Complications
    • Ureteropelvic junction obstruction
    • Bladder fibrosis
    • Ureteral stricture
    • Adhesions of fallopian tube
      • Can cause infertility

Schistosomiasis

Schistosomiasis is a tropical parasitic infection caused by Schistosoma parasite. Schistosoma haematobium causes urogenital/genitourinary schistosomiasis while other Schistostoma species cause intestinal schistosomiasis. The parasite lives in contaminated water. The parasite penetrates the skin and enters the circulation, from where it may infect the bladder or the intestines. It may take years for symptoms to appear. Urogenital schistosomiasis notably increases the risk of squamous cell carcinoma of the bladder, a non-urothelial form of bladder cancer.

  • Epidemiology
    • Endemic in Africa and Middle east
  • Clinical features
    • Haematuria
    • Hydronephrosis
  • Pathology
    • Cause granulomatous inflammation
  • Diagnosis
    • Eosinophilia on labs
    • Calcified bladder on imaging
    • Observation of eggs in urine
  • Complications
    • Infertility (women)
    • SCC of the bladder
  • Treatment
    • Praziquantel

Lymphatic filariasis

Lymphatic filariasis is a tropical parasitic infection caused by nematode parasites of the family Filariodidea, also called simply filarial parasites. The disease is also called elephantiasis due to the typical symptoms where severe lymphoedema causes severe swelling of the extremities. The filarial parasites are transmitted to humans through mosquitoes.

  • Epidemiology
    • Endemic in tropical countries
  • Pathogenesis
    • Caused by the parasite Wuchereria bancrofti
    • Transmitted by mosquito bite
    • Larvae migrate to lymphatic vessels and lymph nodes and mature there
  • Clinical features
    • Lymphangitis and lymphadenitis
    • Elephantiasis (severe lymphoedema of the legs)
    • Hydrocele causing swelling of the scrotum
    • Swelling of the genitals
  • Diagnosis – blood smear taken at night
    • Parasite is released from the lymph vessels to the blood at night
  • Treatment – Diethylcarbamazine (DEC)