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This article is a very good read for any busy urologist. When in medical school, we were taught that tuberculosis (TB) was rare in the UK and other developed countries. We have come full circle; now there are increasing cases of TB due to a variety of factors, including poor housing, overcrowding, homelessness, increased migration and rising incidence of HIV. Mycobacterium TB was discovered by Robert Koch in 1882 and still poses a major health problem. According to the World Health Organization (WHO), in 2017 TB affected 10 million people and led to 1.3 million deaths. Extra-pulmonary TB accounts for 20% of all TB cases, while urogenital TB accounts for the third most common site. Autopsy findings of patients dying of miliary TB revealed renal involvement in 61% of cases, with the incidence being much higher in developing countries. Renal TB is of two types: 1) reactivation TB localised to the genitourinary (GU) system; and 2) renal involvement as part of miliary TB. Bacillemia in miliary TB involves organs with high blood supply e.g., lungs, liver, kidneys, adrenals. Diagnosis is by isolation of Mycobacterium TB in urine or histopathology of tissue samples. Acid fast bacilli are detected in Ziehl-Neelson staining and cultured on Lowenstein-Jensen medium or mycobacterium growth indicator tube (MGIT) detection system. In uncomplicated cases, medical therapy is the first line of approach. Streptomycin has been in use since 1950. More current drugs are isoniazid, rifampicin, pyrazinamide and ethambutol. It is preferable to use bactericidal drugs. Patients should be warned about side-effects. Surgical techniques are endoscopic, reconstructive and ablative. Minimally invasive approaches should be used first. Nephrectomy techniques are laparoscopic, retroperitoneal and single site. For vesical TB, augmentation cystoplasty and cystectomy are options. Some cases will need lifelong surveillance.

Urinary TB – still a challenge.
Mert A, Guzelburc V, Guven S.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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