RESUMEN
@#Genitourinary tuberculosis (GUTB) represents a critical aspect of extra‑pulmonary tuberculosis (TB). While it is the second most common form of this disease, its diverse clinical presentations pose a substantial challenge. This report, titled “Varied Clinical Presentations of Genitourinary Tuberculosis: A Case Series from a Tertiary Philippine Hospital,” aims to shed light on the intricacies of GUTB diagnosis, treatment, and its broader implications. In this case series, we present five unique clinical scenarios. Cases 1, 2, and 3, having completed TB treatment, developed spontaneous genitourinary fistulae. Case 4 was initially managed as interstitial cystitis, while Case 5 underwent diverticulectomy for a urethral diverticulum. The diagnosis of GUTB as the underlying cause in these cases, despite conventional treatment, highlights the diagnostic challenges posed by this disease. All five patients, experienced irritative voiding symptoms and recurrent urinary tract infections with limited improvement following antibiotic therapy. Imaging studies consistently revealed upper urinary tract involvement. Importantly, only one case exhibited histologic evidence of granuloma suggestive of GUTB, and microbiologic confirmation of Mycobacterium tuberculosis infection was obtained in only two cases. This underscores the need for a multidimensional diagnostic approach. The findings in this case series emphasize that GUTB diagnosis, often reliant on clinical findings supported by imaging studies and suggestive cystoscopy findings, remains critical for prognosis, even in the absence of microbiologic confirmation. Beyond the individual cases, this series offers insights into the complexity of GUTB, raising questions about the overall management and implications for TB control.
Asunto(s)
TuberculosisRESUMEN
Globally, about 3.5 million women are living with genitourinary fistula, a miserable condition. Obstetric Vesicovaginal fistula (VVF) is exceptionally rare in developed part of the world, where it is mostly due to gynaecological cause. The study was conducted to provide baseline data on vitamin A and vitamin E levels among Vesico - Vaginal Fistula (VVF) patients and to establish their socio-demographic characteristics. Some selected vitamin levels in patients with Vesico - Vaginal Fistula (VVF) in Jos, Northern Nigeria were investigated using spectrophotometric method. Samples were collected from VVF patients undergoing treatments at the Evangel Hospital, Jos and the controls were non pregnant but parous women of similar social status who were willing to participate in the study. A total of 97 participants made up of 67 VVF patients and 30 controls were involved in the study. The results revealed that only 1 clients (1.49%) was mulliparous, 50 (74.64%) and 16 (23.88%) clients were multiparous and grand multiparous respectively out of 67 (100%) clients. The results of social class distribution in both clients and control is in the order of 5>4>3, 2>1. The levels of vitamin A in VVF clients showed no significant change (p>0.05) when compared to control while that of vitamin E showed significant change (p<0.05). The results of viatamin A and E in respect to age, social class and parity showed significant difference (p<0.05) in the VVF patients than the control except for those with age 25 - 29 and 40 - 44 years as well as social class 1 and 5. The study therefore highlights need for determination of reference values of vitamins levels among African population
A nivel mundial, alrededor de 3,5 millones de mujeres viven con fístula genitourinaria. La fístula vesicovaginal (FVV) obstétrica es excepcionalmente rara en el mundo desarrollado, donde se debe principalmente a causas ginecológica. Este estudio se realizó para proporcionar datos de referencia sobre los niveles de vitamina A y vitamina E entre los pacientes con FVV y para establecer sus características sociodemográficas. Los niveles de vitamina A y E en pacientes con VVF en Jos, norte de Nigeria se investigaron mediante el método espectrofotométrico. Se recogieron muestras de pacientes con FVV que se sometieron a tratamientos en el Evangel Hospital, Jos y un grupo control de paciente, no embarazadas del mismo estatus socioeconómico que estaban dispuestas a participar en el estudio. Un total de 97 participantes formados por 67 pacientes con FVV y 30 controles participaron en el estudio. Los resultados revelaron que solo 1 paciente (1.49%) era nulípara, 50 (74.64%) y 16 (23.88%) de las pacientes eran multíparas y multíparas grandes, respectivamente. Los resultados de la distribución socioeconómica en el grupo de embarazadas y el control fue en orden de 5> 4> 3, 2> 1. Los niveles de vitamina A en paciente con FVV no mostraron diferencias significativas (p>0.05) en comparación con el control, mientras que los niveles de vitamina E sí mostraron diferencias significativas (p<0.05). Los resultados de la vitamina A y E con respecto a la edad, clase socioeconómica y paridad mostraron una diferencia significativa (p<0.05) en los pacientes con FVV respecto control, excepto para los de 25-29 y 40-44 años, así como para la clase social 1 y 5. Por lo tanto, el estudio destaca la necesidad de determinar los valores de referencia de los niveles de vitaminas en la población africana.