Genitourinary TB is on the rise, but it is difficult to diagnose, leading to a delay in treatment that worsens renal damage, a urologist warns.

The infection manifests as pyelonephritis, renal colic, kidney stones, sepsis, or even renal failure. Symptoms are typical of conventional bacterial cystitis, with pyuria occurring in the absence of a positive culture. Back, flank, and suprapubic pain often occurs along with hematuria, frequent urination, and nocturia. Renal colic is present in some cases.

Mete Cek, MD, professor of urology at Taksim Teaching Hospital in Istanbul, told the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco that one third of the world’s population is infected with the TB bacterium. Although TB is curable, it kills 5,000 people a day worldwide.

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The global incidence is growing 1% a year, and cases are burgeoning in the United States because of international travel. Worldwide, 20%-73% of extrapulmonary TB is genitourinary; Mycobacterium tuberculosis is found in the urine of 15%-20% of patients with TB.

“These cases are often overlooked,” says Dr. Cek. “Most patients start off with lung disease and aren’t sent for consultation. They also have bladder dysfunction, passing water frequently with some pain. Many times the patients are thought to have cancer or just inflammation.” To diagnose the condition, clinicians should perform a tuberculin test followed by a urinalysis each day for three to five days. Polymerase chain reaction testing must be combined with culture and/or histopathology.

A six-month course of medication is effective for all forms of TB. The intensive initial phase often requires rifampicin, isoniazid, pyrazinamide, or streptomycin. The continuation phase requires rifampicin or isoniazid.