重新評估泌尿道結核菌治療之臨床經驗
林祖鋒1、蔡維恭1、陳建志1、林文榮1、張奐光1、林文州1、邱文祥1,2
馬偕紀念醫院 泌尿科1；馬偕醫學院1；陽明醫學院2
Clinical experience for the Treatment of Urinary Tuberculosis - Reappraisal
Tsu-Feng Lin1, Wei-Kung Tsai1, Marcelo Chen1, Wun-Rong Lin1, Huang-Kuang Chang1, Wen-Chou Lin1, Allen W. Chiu1,2
Department of Urology, MacKay Memorial Hospital1; Mackay Medical College1;
School of median, National Yang-Ming University2
Purpose: Urinary tuberculosis is one of extrapulmonary tuberculosis (TB). Globally, in 2014, there were about 880 thousand patients diagnosed with extrapulmonary TB. Urinary TB, called great imitator, had variant symptom. It is hard to diagnose properly or timely. Delay-treatment relates to renal function loss and structure destroyed. We report urinary tuberculosis clinical manifestation, diagnosis, and the relationship between treatment duration and outcomes.
Patient and Method: Chart for all patients with urinary tuberculosis from 1978 to 2014 were reviewed, patient’s symptom, diagnosed method, image study, duration of diagnosis, treatment, and follow up condition were analyzed.
Result: Twenty-one patients were reviewed, and 18 were upper urinary tract TB. Median age was 49 year old, 2 patients had pulmonary TB history, and 1 patient had history of BCG bladder instillation. 9 patients had concomitant infection including lung. Urinary tract symptom happened in 16 (76%) patients, 18 (95%) patient had hydronephrosis and hydroureter. 6 (33%) patients had renal calcification. No bilateral kidney involvement was noted. 3 patients had Gr. III obstruction and were improved to Gr. II or Gr. I after D-J insertion. 2 patients received nephrectomy, and 2 patients had persisted Gr. IV obstruction. Symptom-to-treatment and pre-treatment hydronephrosis grading had linear relationship (Pearson’s r = 0.667, p = 0.03 <0.05). Symptom-to-treatment and post-treatment hydronephrosis showed linear relationship of Pearson’s r = 0.710, p = 0.007). There was no significant relationship between duration of diagnosis and post-treatment eGFR change (p > 0.05). Median duration from symptom to diagnosis was 46.7 days.
Conclusion: Urinary tuberculosis has vague clinical manifestation, and easy to delay diagnosis. There was no bilateral Tb urinary tract involvement. No patient received hemodialysis after TB treatment, but 5 patients had non-function kidney over infected side. Therefore, early TB treatment improved hydronephrosis severity and protect renal loss.