Some Aspects of Urogenital Tuberculsis

Background and Aims: Urogenital tuberculosis (UGT) is a worldwide disease with non-typical and misleading clinical features, resulted in late diagnosis. Late diagnosed complicated forms of renal tuberculosis (TB) are poor for standard chemotherapy, the additional pathogenetic therapy is necessary. The aims of the current study were to estimate the epidemiological situation on UGT in the region with high incidence rate and to value the efficiency of the complex etiopathogenetic therapy for bladder TB.

Methods: Estimates of extrapulmonary tuberculosis incidence and its structure in Siberia have been made on the basis of the data available in official reporting forms No 8 (approved by Resolution No 175 of the Russian Statistics Agency 11 November, 2005).

In addition, 102 patients with bladder TB were enrolled in study: 76 were treated with standard tetrad (isoniazid + streptomycin + pyrazinamid + rifampicin), and 26 received modified tetrad in combination with trospium chloride.

Results: During the last 5 years the incidence of TB maintains stable high in Siberia, and in 2008 it raised up to 139.6 per 100000 habitants. UGT was the prevalent form (46.0 - 33.5%); TB of bone and joints was in the second place (20.1 - 32.7%), this was followed by lymphonodal TB (14.7 - 14.9%).

Standard chemotherapy had poor efficiency for bladder TB: only 42.1% could be cured, 57.9% developed complications such as posttuberculous cystalgia (36.8%) and microcystis (21.1%). In patients received the combined treatment outcome was favourable: urinary frequency reduced about 75%, bladder capacity increased an average of 4.7 fold. None of these patients developed true microcystis.

 Conclusions: In Siberia, there is an epidemic of TB. UGT is the most common form among extrapulmonary TB. Standard chemotherapy for bladder TB demonstrated poor results, but combination chemodrug plus trospium chloride was more effective and should be recommended to all patients with bladder TB grade 2-3.