The effect of treatment timing and urinary drainage on the outcome of urinary tuberculosis

Abstract

Background: Urinary tuberculosis (TB) has a variety of clinical manifestations and is a diagnostic challenge for urologists. Delayed treatment can lead to loss of renal function and structural destruction. In this study, we analyzed the relationship between the timing of treatment and outcomes in patients with urinary TB. Methods: We performed a retrospective chart review of all patients with urinary TB from 1978 to 2016 at our hospital and analyzed the patients' symptoms, diagnostic methods, imaging studies, time to diagnosis, treatment methods, and follow-up. Results: Twenty-one patients (median age: 49 years) had urinary TB, of whom 18 had hydronephrosis and hydroureter. No bilateral renal involvement was noted. The median duration from symptom onset to anti-TB treatment was 78.5 days. There was no significant relationship between symptom-to-treatment time and posttreatment changes in renal function (Pearson's r = 0.103, P > 0.05); however, the symptom-to-treatment time was linearly associated with pre- and posttreatment hydronephrosis grade (Pearson's r = 0.667, P= 0.03, and r = 0.710, P= 0.007, respectively). In multivariate analysis, the symptom-to-treatment time was found to be an independent predictor of improvements in hydronephrosis but was not associated with renal function change. Of nine patients with upper urinary tract drainage, hydronephrosis improved in three and was stable in five patients. Of 12 patients without drainage, four experienced renal loss. Conclusion: Urinary TB has vague clinical manifestations and is prone to a delayed diagnosis. Early diagnosis and prompt internal ureteral stenting may prevent renal loss in certain patients.

Keywords

• Early urinary drainage
• hydronephrosis
• ureteral stenting
• urinary stricture
• urinary tuberculosis