October - LRS Institute of Tuberculosis & Respiratory Diseases

GENITO-URINARY TUBERCULOSIS IN PULMONARY TUBERCULOSIS PATIENTS 233
68% of the cases had bilateral pulmonary
lesions as compared to 32% unilateral lesions.
73% patients had cavitary lesions either unilateral
or bilateral, while 27% cases were noncavitary.
Maximum number of cases (68%) attended
the hospital within I year of their complaints
and this number gradually decreased as the
duration of complaints increased (Table II).
TABLE 2
Showing Duration of Pulmonary Lesion
SI. No. Duration of pulmonary
lesion (in years)
Number of patients
1. 0 1 68
2. 2 4 22
3. 5 7 4
4. 8 10 4
5. More than 10 2
Total 100
First hour ESR was found to be raised in
all cases. The range of ESR was 51-75 mm in
43% and more than 100 mm in 3% cases.
Frequency of urine was the commonest
symptom in 29 % cases. In one patient frequency
was 20-22 times in 24 hours and he was miserable
because of this. Hematuria was not a conspicuous
feature and was seen only in 4 %
of cases. History of renal colic was present in
13% cases. 18% cases had grossly turbid urine,
while red coloured urine was observed in only 8
cases. Acidic reaction of urine was present in
18 cases, while 82% had alkaline reaction.
Albuminuria was observed hi 15 cases. Microscopically,
pus cells were seen in 64% cases.
Microscopic hematuria was found in 15 cases.
Calcium oxalate and amorphous phosphate
crystals were seen in 15 cases.
The urinary smears of all the 100 cases were
examined for AFB and also cultured. None
of the smears was positive for AFB, whereas
culture could detect AFB in the urine of 6
cases. All these six cases were taking haphazard
anti-tubercular treatment.
Urine of 51 cases out of 100, who had
symptoms referrable to genito-urinary tract or
had pyuria, albuminuria etc., was subjected
to culture for pyogenic organism. 24 had sterile
urine and in 27 cases, culture was positive for
pyogenic organisms.
All the 6 cases with urine culture positive
for AFB had pyuria in acidic urine and the urine
was sterile for pyogenic organisms. 4 cases
were in the age group 15-45 years while two
cases were in the age group 50-60 years.
Bilateral pulmonary lesions were present in 4
cases, while two patients were unilateral.
Average duration of respiratory symptoms
was 1½ years. Commonest genito-urinary complaints
were burning sensation on micturition,
increased frequency and renal colic. Renal
angle tenderness was appreciable in 4 cases and
thick, craggy and tender epididymis was palpuble,
again in 4 cases. Out of these six cases,
two did not have radiological evidence of
G.U.T. on IVP. while the other 4 showed early
tubercular involvement of kidney as shown
in Table III.
Eighty seven patients were on triple-drug
therapy (SM, INH, PAS or TH), whereas 13
cases were on two drugs only. Isonex was being
taken by 87 cases at the time of study. Most of
the cases (88) had been under treatment for a
period of less than one year, while 12 cases were
such who had taken drugs for more than 1
year.
Discussion
In the present study, detection of AFB
in the urine by culture was taken as a conclusive
evidence of tubercular involvement of the genitourinary
system.
Regarding age and sex incidence of G.U.T.,
Borthwick (1956) noted that genito-urinary
involvement was rare in the extremes of age and
most of the cases were seen between 16-40 years.
Bayu et al (1976) had maximum number of
cases in the age group 30-40 years. The findings
in the present series is in consonance with the
above authors, 4 cases being between the ages
15-45 years and the other 2 above 45 years.
Out of the 6 cases having G.U.T., 5 were males
and 1 female. This finding is in conformity
with the findings of Borthwick (1956) who found
the male/female ratio to be 2:1.
Truly, tuberculosis of the genito-urinary
system cannot be a primary manifestation of
the disease and is usually secondary to the
Ind. J. Tub., Vol. XXIX, No. 4