ABSTRACT
Background: Tuberculosis can affect any organ system of the body, including the genitourinary tract. Genitourinary TB is the most common form of extra pulmonary TB accounting for 27% (14- 41%) worldwide. Aim and objectives: To study distribution of GU TB in relation to age, sex, anatomical site, signs and symptoms and to study various diagnostic modalities, treatment and role of surgery in GU TB. Materials and methods: This study was a cross sectional study done at department of Urology, King George hospital, Visakhapatnam. The study was done over a period of 30 months, which was from September 2014 to February 2017. All the patients reporting to the hospital with proven genitourinary tuberculosis or diagnosed after coming to the hospital were included in the study. Total number of cases was 35. 10 were males and 25 were females. History, physical examination, laboratory and radiological investigations were done on the patients and the primary focus of the disease and organs involved are determined. All the patients received treatment as indicated. Results: Most of the patients (33 out of 35) belonged to low socio-economic status and came from rural settings. Of them 10(28.57%) were males and 25(71.43%) were females. The mean age of patients was 36 years (range 16-60years). 2 patients were <20 years, 11 patients were between 21-30 years, 11 patients were between 31-40 years, 8 patients were between 41-50 years and 3 were above 50 years. In this study, kidney was involved in 19 cases and was the most common organ involved, followed by bladder (14 cases) and ureter(10 cases). Irritative voiding symptoms were the most common symptom seen in 23 cases. Flank pain was noted in 20 cases, sterile pyuria in 22 cases and hematuria in 7 cases. Six(17.14%) out of thirty five patients had renal failure at the time of presentation and diagnosis. Nephrectomy was done in 12 cases. Nephrectomy with augmentation Immadi Chandrasekhar, Pasalapudi Anurag Jose. Clinical study and management of genitourinary tuberculosis. IAIM, 2019; 6(1): 48-57. Page 49 cystoplasty and ureteric reimplantation was done in another 6 cases. Ileal conduit was done in 6 cases. Ureteric reimplantation with psoas hitch was done in 3 cases. Conclusion: Genitourinary tuberculosis is often silent and has nonspecific clinical features. Irritative voiding symptoms are the common presentation. Kidney is the most commonly affected organ in GU TB. GU TB is a disease of young adults, with majority affected in the 3rd and 4th decades. CT scan is replacing IVU as an imaging modality of choice in GU TB. Diagnosis of GU TB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens and the difficulty to isolate or grow TB bacilli. Hence a strong clinical suspicion is necessary for correct diagnosis. Anti-tubercular therapy is the mainstay of treatment. Genitourinary tuberculosis results in sequel which may require major organ removing and reconstructive surgeries
ABSTRACT
Background: Uric acid nephrolithiasis is characteristically a manifestation of a systemic metabolic disorder. It has a prevalence of about 10% among all stone formers, the third most common type of kidney stone. Uric acid stones form primarily due to an unduly acid urine; less deciding factors are hyperuricosuria and a low urine volume. Aim and objectives: To study and analyze the age and sex distribution of uric acid urolithiasis, to study and identify the predisposing and causative factors and treatment of uric acid urolithiasis. Methods and materials: The materials for the clinical study on radiolucent (uric acid) stones were selected from the cases presenting with pain in loin attended to urology department in King George Hospital, Visakhapatnam from October 2015 to December 2017. The selection of cases was based on clinical symptoms and radiological findings. The number of cases studied was 50. A detailed history, physical examination, blood and urinary examination were done. X-ray KUB, ultrasound KUB, plain CT KUB was done. Patients were treated either medically or surgically depending upon their condition. Results: Out of the 50 patients enrolled, there were 36(72%) male and 14 (28%) female patients. Most of the patients (40%) were in the age group 41-50 years. Pain was the most common symptom (100%) followed by nausea and vomiting. Serum creatinine was normal in 84% of cases. Serum uric acid and Serum electrolytes were normal in all the 50 patients. Urine volume was normal (> 2 litres/24 hrs) in 44% of cases. Urine pH was < 5.5 in 92% and urine uric acid is normal in 100% of cases. In the present study, out of 50 patients, 38(76%) were managed conservatively with potassium citrate and 12 patients were treated with various surgical interventions. Conclusions: Uric acid calculi are more common in men (M: F ratio 2.5:1). Uric acid calculi are caused mostly due to low urinary pH and low urine volume. Type 2 diabetes mellitus and high body Dandamudi Vijay Krishna, Immadi Chandrasekhar. A clinical study on radiolucent (uric acid) stones in tertiary care centre. IAIM, 2019; 6(1): 89-95. Page 90 mass index (BMI) are independent risk factors for uric acid stones. Most of the uric acid calculi can be treated conservatively with potassium citrate (30-40 meq/day) in two divided doses.