[Anthropomorphic features of patients with tuberculosis of the prostate].

INTRODUCTION: Modern TB patient has lost the physical appearance (habitus phtisicus) typical for the previous years. Moreover, patients with different tuberculosis localizations also have different anthropomorphic characteristics. MATERIAL AND METHODS: To determine anthropomorphic characteristics of patients with tuberculosis of the prostate, several parameters were compared between 95 male patients with pulmonary tuberculosis and 49 patients with prostatic tuberculosis. RESULTS: Compared to pulmonary tuberculosis patients, patients with prostatic tuberculosis were significantly more likely to be overweight and have greater waist circumference. Among patients with pulmonary tuberculosis, there were significantly more people of short or very tall stature, while patients with prostatic tuberculosis, on the contrary, were significantly more likely to be of average height (166-180 cm). CONCLUSIONS: The findings regarding body structure of a patient with tuberculosis of the prostate (fat stocky man) could possibly reflect the presence of the metabolic syndrome that may account for the greater susceptibility to urogenital infections.

[Tuberculous epididymitis after Bacillus Calmette-Guérin intravesical therapy : a case report].

We describe a case of tuberculous epididymitis following Bacillus Calmette-Guérin (BCG) instillation in a 79-year-old man. He had received transuretheral resection of bladder tumor in Sep 2009. Histopathological diagnosis was urothelial carcinoma, high grade, pTa and pTis. To prevent recurrence, he received maintenance therapy for Feb 2010-May 2011 after eight weekly intravesical instillation of BCG. Skin fistula with discharge in the left scrotum occurred in Sep 2011. Treatment with levofloxacin was not effective. Therefore, we performed bilateral orchiectomy (he had hormone therapy of prostate cancer) and left scrotal skin resection. Histopathological examine showed tuberculous epididymitis. He had no signs of recurrence 2 years postoperatively and has not received any anti-tuberculous chemotherapy.

Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

[Tubercular prostatic abscess following intravesical Bacillus Calmette-Guerin therapy].

We report a case of tubercular prostatic abscess in a male patient who had undergone intravesical Bacillus Calmette-Guerin therapy for bladder carcinoma in situ. The abscess was successfully treated with transurethral resection of the prostate for drainage and subsequent antituberculous regime of chemotherapy.

[A case of tuberculous epididymitis after Bacillus Calmette-Guérin intravesical instillation therapy for bladder cancer].

A 65-year-old male had undergone transurethral resection of bladder tumor (TUR-Bt) four times for recurrent bladder cancer, and each histopathological examination revealed non-invasive urothelial carcinoma, pTa, G2. To prevent further recurrence, he received eight weekly intravesical instillations of Bacillus Calmette-Guérin (BCG). Four months after the BCG therapy, he underwent cystoscopy. One week after the cystoscopy, he developed a painful and swollen left scrotum. Treatment with levofloxacin for acute epididymitis reduced the scrotal pain initially, but the pain increased and 3 months later, a fistula with suppurative discharge appeared at the bottom of the scrotum. A smear of the discharge revealed Gaffky 2, and a culture showed tubercle bacillus. Incisional drainage of the abscess and anti-tuberculosis chemotherapy for 2 months to treat tuberculous epididymitis was not completely effective. We performed a left orchiectomy with resection of the infected scrotal skin. Histopathological examination showed tuberculous epididymitis consisting of a caseating granuloma with epithelioid cells and Langhans giant cells. He received anti-tuberculosis chemotherapy for 4 months postoperatively and had no sign of recurrence 1 year postoperatively.

"BCGitis": A rare case of tuberculous epididymo-orchitis following intravesical Bacillus Calmette-Guérin therapy.

Tuberculous epididymo-orchitis is a rare complication of intravesical Bacillus Calmette-Guérin (BCG) therapy for urothelial cancer of the bladder. We present such a case, describe its sonographic appearance and review the literature. The difficulties in diagnosing this condition based on imaging alone, given the extensive overlap with the appearance of bacterial epididymo-orchitis, malignant testicular disease and testicular torsion, are discussed. Adequate knowledge of tuberculous epididymo-orchitis is of capital importance in order to ensure a proper diagnosis and treatment.

[Granuloma of epididymis of patient treated with intravesical BCG therapy--complication of BCG therapy or tuberculosis?]. / Ziarnina stwierdzona w najadrzu chorego leczonego dopecherzowymiwlewkami BCG--powiklanie leczenia BCG czy gruzlica?

We present a case of 72-year old man treated from 2007 for superficial bladder carcinoma. Patient had undergone surgical intervention for transitional cell carcinoma of the bladder, followed by BCG therapy. Two years later enlarged right testis and epididymis was observed. A resection was carried out. Histologic examination revealed in epididymis cauda granulomatous infiltration with eosinophilic necrosis. No bacteriologic tests of resected material were performed. Suspecting BCG infection or TB patient was referred to the Institute of Tuberculosis and Lung Diseases in Warsaw for pulmonary evaluation. Chest X-ray, chest CT scan and bronchoscopy were performed but beside revealing scars in bronchi suggesting a history of TB did not contribute to the diagnosis. Tuberculin skin test was 21 mm. Diagnosis was determinated by spoligotyping which found bacille of Mycobacterium tuberculosis in specimen preserved in paraffin block. Tuberculosis of right epididymis and past pulmonary tuberculosis was diagnosed. Patient was treated with rifampin, isoniazid and pirazynamide.

Orquitis tuberculosa aislada / Isolated tuberculous orchitis

Presentación de un caso poco frecuente de tuberculosis genital aislada, en un hombre de 28 años, no fumador, sin antecedentes clínicos significativos...

Orquitis tuberculosa aislada / Isolated tuberculous orchitis

Presentación de un caso poco frecuente de tuberculosis genital aislada, en un hombre de 28 años, no fumador, sin antecedentes clínicos significativos...(AU)

Tuberculous epididymitis following intravesical Bacillus Calmette-Guérin immunotherapy.

Intravesical Bacillus Calmette-Guérin (BCG) is widely used as an adjuvant therapy in the treatment of superficial bladder cancer. BCG is administered as a live, attenuated form of Mycobacterium bovis, and acts as an immunomodulary agent to delay tumor progression. BCG is generally well tolerated, though localized and systemic infectious complications may occur. A literature search revealed that tuberculous epididymitis is a rarely reported complication of intravesical BCG therapy. We report the case of an 82-year-old male who developed tuberculous epididymitis while undergoing intravesical BCG treatment for transitional cell carcinoma of the bladder. Right orchiectomy was performed, followed by rifampin and isoniazid therapy once M. bovis was identified as the infectious agent. The patient responded well to these treatments, and made a full recovery. Tuberculous epididymitis is an uncommon complication resulting from intravesical BCG therapy, which is likely explained by retrograde migration from the prostatic urethra in this case.

[Case of tuberculous epididymitis caused by intravesical BCG therapy].

Intravesical Bacillus Calmette-Guerin (BCG) therapy is commonly used against superficial urothelial carcinoma, especially carcinoma in situ (CIS). We report a case of tuberculous epididymitis that occurred during a course of intravesical BCG therapy. A 76-year-old man had received intravesical BCG therapy for multiple superficial bladder cancer and CIS in prostatic urethra after transurethral resection of bladder tumor (TUR-Bt). He recognized hard nodules in the left scrotum after 4 times intravesical BCG therapy. Skin fistula in scrotum occurred 5 months later. We performed left orchiectomy with scrotum skin resection. Histological diagnosis was tuberculous epididymitis. Postoperatively, he was administered chemotherapy consisting of isoniazid, refampin and ethambutol.

Case report. Tuberculous epididymo-orchitis: MRI findings.

A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.

Late occurrence of bilateral tuberculous-like epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma.

We report a case of bilateral tuberculous-like epididymo-orchitis occurring 3 years after intravesical bacille Calmette-Guérin instillation therapy in an 83-year-old patient with proven superficial bladder carcinoma. The patient had no previous history of tuberculosis. Because of persistent inflammation and painful swelling of the epididymides and testes, the patient underwent bilateral orchiectomy. This case demonstrates the late adverse effects that can occur after intravesical BCG therapy, which in our patient ended in surgical removal of both gonads.

[Bilateral tuberculous epididymitis after intravesical Bacillus Calmette-Guerin therapy].

We describe a case of bilateral tuberculous epididymitis that occurred two weeks after intravesical Bacillus Calmette-Guerin (BCG) instillation. A 72-year-old man received transuretheral resection of bladder transitional cell carcinoma in November 2000. Although he had no recurrence for about 4 years, cystoscopy revealed small papillary tumors in the bladder in September 2004. A course of 8 weekly intravesical instillations of BCG was started. After the second BCG instillation (160 mg) he had bilateral painful scrotal swelling. Although he was administered isoniazid (INH) and rifampicin (RFP), scrotal swelling got worse. Right orchiectomy and left epididymectomy was performed in December 2004. Histological diagnosis was bilateral tuberculous epididymitis. Postoperatively, he was administered INH and RFP and had no recurrence for 3 months.

[Scrotal abscess with inguinal lymph node swelling in an 86-year-old man]. / Skrotalabszess mit inguinaler Lymphknotenschwellung bei einem 86-jährigen Patienten.

HISTORY AND ADMISSION FINDINGS: An 86-year-old patient presented to our clinic with increasing redness and swelling of the right scrotum and inguinal lymphadenopathy. Five and a half years before admission carcinoma of the bladder (pT1,G2) had been diagnosed and was treated with several transurethral endoscopic resections as well as repeated instillations of Bacille Calmette-Guérin (BCG) into the bladder. INVESTIGATIONS: Orchiectomy on the right side was performed. Histological analysis revealed a granulomatous inflammation consistent with a mycobacteriosis. Mycobacterium bovis BCG could be isolated from several sputum and urine specimens of the patient. DIAGNOSIS, TREATMENT AND COURSE: Tuberculostatic therapy was started soon after surgery. After seven weeks of treatment no more mycobacteria could be detected in sputum and urine control specimens. At a follow up after twelve months there was no evidence of recurrent disease. CONCLUSION: We describe the late manifestation of a BCG infection including the lungs and the urogenital tract. This is a rare complication with potentially serious consequences and requires rapid diagnosis and urgent treatment by a multidisciplinary team.

[Tuberculous epididymitis following intravesical Bacillus Calmette-Guérin therapy].

Bacillus Calmette-Guérin (BCG) immunotherapy is increasingly being accepted for management of some bladder transitional cell neoplastic lesions. Mild adverse reactions occur frequently. However, an unusual complication of tuberculous epididymitis is reported. A 64-year old man presented with bilateral epididymal mass. Four months earlier he had seven treatments with intravesical BCG instillation (Tokyo 172 strain) for a grade 2 transitional cell carcinoma in situ. Bilateral epididymectomy was performed. Microscopic examination of the epididymis revealed chronic inflammation and necrosis with granulomas and Langhans' giant cells. After the operation, there were no further complications.

Preoperative diagnosis of bilateral tuberculous epididymo-orchitis following intravesical Bacillus Calmette-Guerin therapy for superficial bladder carcinoma.

We report a case of bilateral tuberculous epididymo-orchitis following intravesical Bacillus Calmette-Guerin (BCG) therapy for superficial bladder carcinoma in which the diagnosis was made by ultrasonography prior to surgery. The US findings include heterogeneous enlargement of the epididymis and testis, associated with scrotal-skin thickening and scrotal sinus track. Patients with bladder carcinoma treated with intravesical BCG therapy, the presence of scrotal swelling with scrotal-skin thickening and epididymal involvement suggests tuberculous epididymo-orchitis rather than testicular tumour. It is important to be aware of this rare complication and to be familiar with the ultrasonographic features so that appropriate treatment can be given.

Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer.

A seventy-two-year-old man with transitional cell carcinoma of the bladder received intravesical Bacillus Calmette-Guérin (BCG) following which he developed left testicular pain and swelling that partially resolved with conservative treatment. Six months later a second course of BCG was given for recurrent disease. Ten months later, he developed left testicular swelling and severe induration along with a draining scrotal sinus. Tuberculous orchitis was suspected and a left orchiectomy was performed. Pathology showed caseating granulomatous orchitis and epididymitis with numerous acid fast bacilli on Ziehl-Neelson stain. The patient received a six-month course of antituberculous therapy. This case highlights a rare but serious complication of intravesical BCG.