生殖泌尿道結核菌感染— 台北榮總之臨床經驗報告
黃烱焜1 郭俊逸1,2,3黃逸修1,2,3、張延驊1,2,3、黃志賢1,2,3、鍾孝仁1,2,3、吳宏豪1,2,3、盧星華1,2,3、林子平1,2,3、林志杰1,2,3、范玉華1,2,3、黃子豪1,2,3、魏子鈞1,2,3、黃奕燊1,2,3林登龍1,2,3
台北榮民總醫院外科部泌尿外科1
國立陽明大學醫學系泌尿學科2
書田泌尿科學研究中心3
Genitourinary tuberculosis– clinical experience of Taipei Veterans General Hospital
Chiung-Kun Huang1, Junne Yih Kuo 1,2,3 Eric Yi-Hsiu Huang1,2,3, Yen-Hwa Chang1,2,3, William J.S. Huang1,2,3, Hsiao-Jen Chung1,2,3, Howard H.H Wu1,2,3, Shing-Hwa Lu1,2,3, Tzu-Ping Lin1,2,3, Chi-Cheh Lin1,2,3, Y.H. Fan1,2,3, Tzu-Hao Huang1,2,3 Zi-jun Wei1,2,3, I-shen Huang1, 2 Alex T.L. Lin1,2,3,
Department of Urology, Taipei Veterans General Hospital1
National Yang-Ming University, Taipei, Taiwan2
Shu-Tien Urological Science Research Center3
Taipei, Taiwan
Purpose:
Genitourinary tuberculosis(GUTB) is the secondary most common form of extrapulmonary tuberculosis, comprising 4 - 17% of extrapulmonary forms. Its diagnosis is often difficult. In recent years diagnosis has been improved by polymerase chain reaction (PCR) targeted against mycobacterium tuberculosis DNA. We retrospectively reviewed patients with GUTB in our hospital after 2000, and investigated all the factors and treatment outcome.
Materials and Methods:
Of all patients with GUTB, diagnosed or confirmed microbiologically(Urine acid-fast stain/ Mycobacterial culture/ Urine PCR) or histopathologically at Taipei Veterans General Hospital from 2000 to 2016, were retrospectively reviewed. We analyzed the age, clinical presentation, organ distribution(confirmed by lower abdominal ultrasonography/ Computed tomography/ Intravenous pyelography or pathologic report ) and medical treatment of GUTB.
Results:
From January 2000 to December 2016, there were 46 patient with GUTB, diagnosed and treated at Taipei Veterans General Hospital. Mean patient age at diagnosis was 76.0 years (range 19 to 94) old, 26 men (56.5%), 20 women (43.5%); 43 urinary tuberculosis(93.5%) and 3 genital tuberculosis(6.5%). Lesion located at right kidney in 8 patients ( 17.4%), left side in 9 (19.6%), and bilateral kidney in 8 (17.4 %), uterus in 1 patient(2.2%), left testis/left epididymis in 1 patient(2.2%), 1 in left fallopian tube(2.2%), 18 patient(63.4%) with positive microbiological findings but lack of radiology or pathology proof. Sensitivity of Urine acid-fast stain/ Mycobacterial culture/ Urine PCR was 41.5%/92.7%/70.6%. LUTS symptoms was presented(62%) and storage symptoms(75%) as major symptom. Pyuria(WBC>6-10) with sterile culture was 54%(p =0.011, odds ratio= 6.79). Computed tomography/Intravenous pyelography revealed abnormalities in 83.3% of patients and renal ultrasonography in 69%. Mean treatment period was 9 (range 6 to 12) months.
Conclusions:
Anti-TB medication for 9 months is mainstream of treatment in TVGH especially for patient with radiology proof urinary tuberculosis . Patient with recurrent pyuria(WBC> 6-10) should underwent urine microbiological test(p =0.011, odds ratio= 6.79) for urinary TB surveillance.