GENITOURINARY TUBERCULOSIS IN PEDIATRIC SURGICAL PRACTICE

Background: Genitourinary tuberculosis (GUTB) has been reported to acc ount for 20% to 73% of all cases of extrapulmonary tuberculosis in the general population but is much rarer in children, GUTS is a form of s econdary tuberculosis with vague symptoms. Surgical intervention is re quired in a minority of cases. Methods: Nine cases of genitourinary tu berculosis (GUTB) were diagnosed and treated from 1988 to 1995. The ag e of the patients ranged from 5 to 12 years. There were five boys and four girls. Presenting features were diverse and included gross hematu ria in 44% of cases and epididymoorchitis in 22% of cases. Rarer prese nting features included acute renal failure, staghorn calculus, and py onephrosis. Associated or past history of tuberculosis was present in three patients. Conclusive diagnosis was made on the basis of isolatio n of mycobacterium tuberculosis, histopathology, or cystoscopy in eigh t patients, whereas one patient was given a therapeutic trial based on clinical manifestations. Results: Response to antitubercular drug the rapy was gratifying. Excisional surgery in the form of nephrectomy was needed in one patient, whereas another underwent bilateral ureteric r eplacement with ileal loops for multiple ureteric strictures. Conclusi ons: The wide variety of presenting features and pathological lesions that result from GUTB are emphasized. The diagnosis of GUTS must be su spected in patients who present with hematuria (gross or otherwise), e pididymoorchitis, and patients with long segment or multiple ureteric strictures. in view of the anticipated resurgence in tuberculosis caus ed by the prevalence of aquired immunodeficiency syndrome the pediatri c urologist must be aware of the pathophysiology and clinical spectrum of this disease. Copyright (C) 1997 by W.B. Saunders Company.