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1.
Nat Rev Urol ; 16(10): 573-598, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31548730

RESUMO

Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.


Assuntos
Tuberculose Urogenital , Humanos , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/etiologia
2.
Hinyokika Kiyo ; 59(7): 457-60, 2013 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-23945329

RESUMO

An 82-year-old man who had undergone transurethral resection (TUR) for superficial bladder cancer (pT1 G3) in June and Luly 2011 received intravesical Bacillus Calmette-Guerin therapy (80 mg weekly for 6 weeks) in September 2011. Seven months later, a follow-up cystoscopy revealed a slowly growing torose lesion at the site of the previous TUR. The lesion was removed by TUR in June 2012. Pathological examination showed an inflammatory response with small granulomatous lesions. The specimen stained positive for TB DNA-RTPCR. Mycobacterium bovis was detected from the bladder specimen and urine. He was administered antituberculous agents, isoniazid 300 mg and rifampicin 450 mg daily, for 3 months. He is well with no recurrence of bladder carcinoma and urinary cultures were negative during the follow-up.


Assuntos
Mycobacterium bovis , Tuberculose Urogenital/etiologia , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Idoso de 80 Anos ou mais , Humanos , Masculino
4.
Nat Rev Urol ; 8(12): 678-88, 2011 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-22157940

RESUMO

Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary tuberculosis, with more than 90% of cases occurring in developing countries. Postmortem studies--from before anti-TB therapy was available--have provided insight into the prevalence and natural history of the disease. In GUTB, the kidneys are the most common sites of infection and are infected through hematogenous spread of the bacilli, which then spread through the renal and genital tract. Diagnosis of TB is often delayed owing to the nonspecific nature of its presentation; therefore, a high degree of suspicion should be exercised and a systematic approach should be taken during investigation. Appropriate culture samples should be obtained to tailor treatment. Standard treatment should be administered for 6 months; quadruple therapy for 2 months and dual therapy for 4 months. However, additional drugs and prolonged treatment are required if drug resistance occurs. Although the role of surgery in GUTB has decreased since the advent of anti-TB therapy, it can still have a role as an adjunct to drug treatment. Today, the challenges of GUTB and other forms of TB include increasing rates of drug-resistant cases and co-infection with HIV.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Urogenital/etiologia , Tuberculose Urogenital/terapia , Animais , Ensaios Clínicos como Assunto/métodos , Países em Desenvolvimento , Gerenciamento Clínico , Humanos , Tuberculose Urogenital/epidemiologia
5.
BJU Int ; 107(10): 1592-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21166754

RESUMO

OBJECTIVE: • To report a late bacille Calmette-Guérin (BCG) complication previously not described in the literature. PATIENTS AND METHODS: • We reviewed our database with 858 patients treated with BCG from 1986 to 2008 and identified 13 male patients (1.8% of all male patients) who had a large tuberculous-like bladder ulcer. RESULTS: • All patients had high-grade tumours and seven had tumours invading lamina propria before BCG treatment. A solitary ulceration or inflammatory lesion, 10-50 mm in diameter, was seen at routine follow-up cystoscopy 2-34 months (median 8 months) after the first instillation. Significantly more patients had been treated with BCG-RIVM than with BCG-Tice (10/320 vs. three of 454, P < 0.01). BCG was cultured from urine 3-34 months (median 14 months) after the last instillation. • So far, eight patients have been successfully treated with rifampicin and isoniazid. Nine patients are still tumour-free 15-66 months (median 44 months) after the last transurethral resection before BCG treatment. • Another three patients had one to two non-invasive recurrences. One patient had an invasive recurrence and underwent cystectomy. The present study is limited by biases associated with its retrospective design. CONCLUSIONS: • This is the first report on persisting BCG infections with large inflammatory lesions in the bladder. Treatment is effective and the oncological outcome is good. • Mycobacterial cultures of the urine should be performed in BCG-patients with unclear inflammatory lesions in the bladder since a delayed diagnosis of a persistent BCG infection could result in a permanently reduced bladder capacity. • Large studies are warranted to study differences in efficacy and side-effects between different BCG strains.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Antineoplásicos/efeitos adversos , Vacina BCG/efeitos adversos , Tuberculose Urogenital/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Idoso de 80 Anos ou mais , Cistectomia , Métodos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium bovis/isolamento & purificação , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/urina , Bexiga Urinária/microbiologia , Neoplasias da Bexiga Urinária/cirurgia
6.
Aktuelle Urol ; 41(6): 372-4, 2010 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-21082517

RESUMO

HISTORY AND ADMISSION FINDINGS: A 71-year-old patient with a superficial carcinoma of the urinary bladder and high risk of recurrence was treated with intravesical instillation of Bacillus Calmette-Guérin (BCG) after transurethral resection. As a complication of the catheterization during BCG-instillation therapy the patient suffered from tuberculosis. The patient received a tuberculosis triple-therapy including rifampicin 600 mg once daily, isoniazid 300 mg once daily and ethambutol 400 mg thrice daily. The existing arterial hypertension had successfully been controlled by 3.75 mg bisoprolol medication once daily for the last 15  years. An increase of blood pressure and cardiac arrhythmia were seen after combining the ß (1)-receptor blocker treatment with the triple-therapy. INVESTIGATIONS AND DIAGNOSIS: The blood pressure was 160 / 90 mmHg. The heart rate reflected a value of 98  beats per minute. In the resting ECG monotopic ventricular extrasystoles could be diagnosed. TREATMENT AND COURSE: The dosage of bisoprolol was changed to 3.75 mg in the morning and additional 1.875 mg in the evening. Due to this increase of dosage the blood pressure could be controlled sufficiently. CONCLUSION: Rifampicin is one of the best known potent enzyme inducing drugs. It strongly induces the expression of cytochrome P450 3A4 in the liver. The enzyme induction enhance the hepatic bisoprolol metabolism, hence the metabolic clearance of the drug increased. The maximal plasma level of bisoprolol decrease and in our use the arterial hypertension could not be treated sufficiently. It is well known that half the dose of bisoprolol undergoes oxidative metabolism in the liver and the rest eliminated unchanged in the kidney. A dosage adjustment of bisoprolol is necessary if the clinical status of the patient requires treatment with the antituberculosis drug rifampicin.


Assuntos
Anti-Hipertensivos/farmacocinética , Anti-Hipertensivos/uso terapêutico , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Bisoprolol/farmacocinética , Bisoprolol/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Hipertensão/tratamento farmacológico , Rifampina/efeitos adversos , Rifampina/uso terapêutico , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/etiologia , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Idoso , Carcinoma de Células de Transição/cirurgia , Quimioterapia Adjuvante , Terapia Combinada , Citocromo P-450 CYP3A/metabolismo , Relação Dose-Resposta a Droga , Esquema de Medicação , Interações Medicamentosas , Quimioterapia Combinada , Indução Enzimática/efeitos dos fármacos , Humanos , Masculino , Neoplasias da Bexiga Urinária/cirurgia
7.
Dtsch Med Wochenschr ; 135(40): 1968-70, 2010 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-20922637

RESUMO

HISTORY AND ADMISSION FINDINGS: A 71-year-old patient with a superficial carcinoma of the urinary bladder and high risk of recurrence was treated with intravesical instillation of Bacillus Calmette-Guérin (BCG) after transurethral resection. As a complication of the catheterization during BCG-instillation therapy the patient suffered from tuberculosis. The patient received a tuberculosis triple-therapy including rifampicin 600 mg once daily, isoniazid 300 mg once daily and ethambutol 400 mg thrice daily. The existing arterial hypertension had successfully been controlled by 3.75 mg bisoprolol medication once daily for the last 15 years. An increase of blood pressure and cardiac arrhythmia were seen after combining the ß1-receptor blocker treatment with the triple-therapy. INVESTIGATIONS AND DIAGNOSIS: The blood pressure was 160/90 mm Hg. The heart rate reflected a value of 98 beats per minute. In the resting ECG monotopic ventricular extrasystoles could be diagnosed. TREATMENT AND COURSE: The dosage of bisoprolol was changed to 3.75 mg in the morning and additional 1.875 mg in the evening. Due to this increase of dosage the blood pressure could be controlled sufficiently. CONCLUSION: Rifampicin is one of the best known potent enzyme inducing drugs. It strongly induces the expression of cytochrome P450 3A4 in the liver. The enzyme induction enhance the hepatic bisoprolol metabolism, hence the metabolic clearance of the drug increased. The maximal plasma level of bisoprolol decrease and in our use the arterial hypertension could not be treated sufficiently. It is well known that half the dose of bisoprolol undergoes oxidative metabolism in the liver and the rest eliminated unchanged in the kidney. A dosage adjustment of bisoprolol is necessary if the clinical status of the patient requires treatment with the antituberculosis drug rifampicin.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Antituberculosos/efeitos adversos , Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Bisoprolol/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Etambutol/efeitos adversos , Isoniazida/efeitos adversos , Recidiva Local de Neoplasia/tratamento farmacológico , Rifampina/efeitos adversos , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/etiologia , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Anti-Hipertensivos/farmacocinética , Anti-Hipertensivos/uso terapêutico , Antituberculosos/uso terapêutico , Bisoprolol/farmacocinética , Bisoprolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Carcinoma de Células de Transição/cirurgia , Complexos Cardíacos Prematuros/induzido quimicamente , Terapia Combinada , Citocromo P-450 CYP3A/efeitos dos fármacos , Relação Dose-Resposta a Droga , Esquema de Medicação , Interações Medicamentosas , Quimioterapia Combinada , Eletrocardiografia/efeitos dos fármacos , Indução Enzimática/efeitos dos fármacos , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Masculino , Taxa de Depuração Metabólica/efeitos dos fármacos , Recidiva Local de Neoplasia/cirurgia , Rifampina/uso terapêutico , Neoplasias da Bexiga Urinária/cirurgia
10.
Curr Urol Rep ; 10(4): 313-8, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19570494

RESUMO

Tuberculosis remains an epidemic that affects one third of the world's population. The persistence of this disease is caused by a large pool of immune-compromised and lower socioeconomic populations. The advent of rapid transportation and migration has contributed to the persistence of this disease in developed and less developed nations. The emergence of drug-resistant strains has added an additional factor for the pervasiveness of tuberculosis. The genitourinary system is a primary target for hematogenous infections. This paper reviews the contemporary issues that affect the diagnosis and treatment of urinary tuberculosis.


Assuntos
Tuberculose Urogenital , Infecções Urinárias , Humanos , Tuberculose Urogenital/etiologia , Tuberculose Urogenital/terapia , Infecções Urinárias/etiologia , Infecções Urinárias/terapia
11.
Actas urol. esp ; 33(6): 706-711, jun. 2009. ilus
Artigo em Espanhol | IBECS | ID: ibc-74249

RESUMO

Introducción: La tuberculosis genitourinaria representa el 3,2% del total de las localizaciones posibles de la enfermedad. La ausencia de tratamiento o su manejo inadecuado, puede desencadenar complicaciones severas. Presentamos un caso clínico y realizamos una revisión bibliográfica de una paciente con tuberculosis genitourinaria que requirió una reconstrucción vésico ureteral completa. Caso clínico: Mujer de 39 años con antecedentes personales de tuberculosis pulmonar, que debuta con dolor lumbar y ureterohidronefrosis izquierda que precisa derivación urinaria percutánea con diagnóstico de tuberculosis en urocultivo. A los 18 meses del diagnóstico presentó una anulación renal derecha por la que se decidió nefrectomía derecha y estenosis ureteral distal izquierda en cuyo intento de corrección quirúrgica se produjo desinserción de uréter un cm por debajo de la unión pieloureteral que obligó a nefrostomía en raqueta definitiva. A todo ello se sumó en los meses siguientes, retracción progresiva vesical. Debido a la edad de la paciente y el deterioro de su calidad de vida se realizó una reconstrucción completa de la vía urinaria izquierda mediante una neovejiga y neoureter con ileon. Discusión y conclusiones: La reconstrucción de vejiga y uréter con íleon, es una buena opción en casos complejos en los que la vía urinaria está ausente o lesionada de forma irreversible. La reconstrucción vesicoureteral, permitiendo micción por uretra mejora sustancialmente la calidad de vida de estos pacientes (AU)


Introduction: Genitourinary tuberculosis represent 3,2% of the possible sites of the disease. The lack of treatment or an inadecuate one may lead to severe complications. We report a case and review thoroughly the literature of genitourinary tuberculosis which needed a complete vesico-ureteral reconstruction. Clinical case: A 39 year old female patient with history of pulmonary tuberculosis who had lumbar pain and left ureterohydronephosis. She required a percutaneous urinary derivation and was diagnosed of tuberculosis by means of the urine culture. 18 months afterwards she had a right renal annulation and a left distal ureteral stenosis. A right nephectomy was performed and the left proximal ureter was desinserted accidentally, 1 cm below the pielo-ureteral junction, which required a permanent nephostomy. Then her bladder became gradually retractile. Because she was a young patient and had bad quality of life a complete reconstruction of her left urinary way was performed with an ileum made neobladder and neoureter. Discussion and Conclussions: Bladder and ureter reconstruction with ileum is a good option in difficult cases of lack or irreversible damage of the urinary way. Vesico-ureteral reconstruction letting urethral miction improves quality of life (AU)


Assuntos
Humanos , Feminino , Adulto , Tuberculose Urogenital/complicações , Tuberculose Urogenital/etiologia , Tuberculose Urogenital/terapia , Bexiga Urinária/cirurgia , Ureter/cirurgia , Íleo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida
12.
Pneumonol Alergol Pol ; 77(1): 61-5, 2009.
Artigo em Polonês | MEDLINE | ID: mdl-19308911

RESUMO

Renal transplant recipients carry a relatively high risk of developing tuberculosis (TB). In most cases, active TB is the result of reactivation of a latent infection and is located in the lungs. In these patients, clinical presentation of TB can often be atypical and there is a high risk of dissemination and high mortality rates. Therefore, the use of invasive procedures for proper diagnosis is recommended, as well as anti-tuberculosis therapy instituted whenever there is a strong suspicion of TB on clinical grounds, even without microbiological evidence. The treatment of active TB in renal transplant recipients should be the same as in the general population. To avoid graft rejection, blood levels of calcineurin inhibitors should be monitored closely. Prophylaxis is recommended for high-risk patients.


Assuntos
Transplante de Rim/efeitos adversos , Tuberculose/epidemiologia , Tuberculose/etiologia , Antituberculosos/uso terapêutico , Saúde Global , Rejeição de Enxerto/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Incidência , Prognóstico , Fatores de Risco , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/etiologia , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/etiologia
14.
Actas urol. esp ; 28(9): 683-687, oct. 2004. ilus
Artigo em Es | IBECS | ID: ibc-044555

RESUMO

Describimos un caso de tuberculosis urogenital que debutó clínicamente con hematuria y una tumoración vesical visible en la cistoscopia. Las imágenes radiológicas del conjunto del aparato urinario permitieron sospechar desde un principio el diagnóstico de tuberculosis, pero la naturaleza de la presentación clínica obligó a descartar una neoplasia urotelial mediante el análisis histopatológico de la tumoración


We describe here in a case of genitourinary tuberculosis presenting with a haematuria and a bladder tubercle. Thouh imaging studies made genitourinary tuberculosis diagnostic feasible, the clinical presentation made runing out malignancy mandatory. Bladder tubercle was endoscopicary removed and histopathological analysis performed


Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Tuberculose Urogenital/complicações , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/cirurgia , Hematúria/complicações , Hematúria/diagnóstico , Tuberculose Urogenital/etiologia , Tuberculose Urogenital/patologia , Tuberculose Urogenital , Sistema Urinário/patologia , Sistema Urinário/cirurgia , Sistema Urinário , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Epididimo/patologia , Epididimo
17.
Hinyokika Kiyo ; 44(2): 117-20, 1998 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-9546134

RESUMO

A case of prostatic tuberculosis is reported. A 61-year-old male visited our clinic complaining of urinary retention. On digital rectal examination, the prostate was found to be enlarged, hard, and uneven. Transrectal ultrasound revealed a large hypoechoic lesion in the posterior aspect of the prostate. Transrectal ultrasound guided systematic biopsies of the prostate were performed. The specimens obtained from the hypoechoic lesion, were diagnosed histopathologically as prostatitis with epithelioid granuloma, Langhans' type giant cells, and caseous necrosis. Mycobacterium tuberculosis was detected in the physiological saline solution injected into the urethra after prostatic massage. The patient was diagnosed as having prostatic tuberculosis and underwent antituberculotic therapy with INH and RFP. Transrectal ultrasound seemed to be useful in detecting histopathological changes associated with tuberculosis in the prostate.


Assuntos
Doenças Prostáticas/diagnóstico por imagem , Tuberculose Urogenital/diagnóstico por imagem , Anemia Refratária com Excesso de Blastos/complicações , Anemia Refratária com Excesso de Blastos/patologia , Antibióticos Antituberculose/administração & dosagem , Antituberculosos/administração & dosagem , Humanos , Isoniazida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Doenças Prostáticas/tratamento farmacológico , Doenças Prostáticas/etiologia , Rifampina/administração & dosagem , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/etiologia , Ultrassonografia/métodos
18.
J Urol ; 134(3): 565-6, 1985 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-3897578

RESUMO

A patient is described in whom Mycobacterium bovis genitourinary tuberculosis occurred initially 25 years after childhood scrofula and then recurred 29 years later despite apparently successful therapy. A review of the literature indicated that this 29-year interval between successive bouts of clinical genitourinary tuberculosis is among the longest described. This case also is a reminder that, although rare, Mycobacterium bovis infection and genitourinary tuberculosis still occur. To avoid nonrecognition of this disease and its potentially serious consequences, clinicians should remain vigilant for tuberculosis even in unusual clinical circumstances.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Urogenital/diagnóstico , Cistite/diagnóstico , Cistite/tratamento farmacológico , Cistite/etiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium bovis , Prostatite/diagnóstico , Prostatite/tratamento farmacológico , Prostatite/etiologia , Recidiva , Fatores de Tempo , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/etiologia
20.
Urologe A ; 23(4): 204-9, 1984 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-6236596

RESUMO

For the urologist who works as a consultant in the German "Social Compensation Law" tuberculosis of the urogenital tract is of current interest. The assessment of a causal connection represents no difficulty, when the existence of a pleuritis exsudativa is proven or when tuberculosis is accepted as being military service connected. For the assumption of a causal connection in the so called compensation law the probability is sufficient and it should be considered, that long term latencies are typical. The consultant must realize that today tuberculosis is a curable infection because of the effective chemotherapy. One must be aware of this by the determination of the MdE. In the future a term of recovery will not be justified as a whole. The final decision will be made only according to the extent of the remaining functional disturbances. On the basis of 358 examinations of the Compensation board in Giessen an outline of present evaluation of tuberculosis of the urogenital tract is presented.


Assuntos
Pessoas com Deficiência , Prova Pericial/legislação & jurisprudência , Tuberculose Urogenital/diagnóstico , Indenização aos Trabalhadores/legislação & jurisprudência , Idoso , Feminino , Alemanha Ocidental , Humanos , Masculino , Pessoa de Meia-Idade , Pleurisia/complicações , Tuberculose Urogenital/etiologia
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