Editors
Ganesh Gopalakrishnan MS MCh Urology
Ex HOD, CMC Vellore Consultant Urologist Vedanayagam Hospital Coimbatore, Tamil Nadu, India
Sujata Patwardhan MS MCh Urology
Professor and Head Department of Urology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India
Foreword
P Venugopal
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2020, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Genitourinary Tuberculosis / Ganesh Gopalakrishnan, Sujata Patwardhan
First Edition: 2020
9789389776683
Printed at
_FM_5CONTRIBUTORS
Editors
- Ganesh Gopalakrishnan MS MCh Urology
- Ex HOD, CMC Vellore
- Consultant Urologist
- Vedanayagam Hospital
- Sujata Patwardhan MS MCh Urology
- Professor and Head
- Department of Urology
- Seth GS Medical College and KEM Hospital
- Mumbai, Maharashtra, India
Co-Editors
- Umesh Shelke MS MCh
- Urology
- Consultant Urologist
- Wockhardt Hospital
- Nagpur, Maharashtra, India
- Nikhar Jain MS
- Senior Resident Urology, 2017
- Admission for MCh Urology
- KEM Hospital
- Mumbai, Maharashtra, India
- Ajit Sawant MCh Urology
- Professor and HOD
- Department of Urology
- Lokmanya Tilak Medical College and Hospital, Sion
- Mumbai, Maharashtra, India
- Rupali Sable MD
- Assistant Professor
- Department of PSM KEM Hospital Mumbai, Maharashtra, India
- Rishikesh Velhal MS MCh
- Urology
- Assistant Professor
- Department of Urology
- KEM Hospital
- Mumbai, Maharashtra, India
- Yash Pamecha MS MCh
- Urology
- Senior Registrar
- Department of Urology
- KEM Hospital
- Mumbai, Maharashtra, India
Contributing Authors
- Anila Abraham Kurien MD Pathology
- Consultant Pathologist
- Renopath Centre for Renal and Urological Pathology
- Chennai, Tamil Nadu, India
- Anuj Deep Dangi MS Mch Urology
- Professor, Department of Urology
- CMC Vellore
- Tamil Nadu, India
- Camilla Rodrigues MD Microbiology
- Consultant Microbiologist and
- Chairperson Infection Control Committee
- PD Hinduja Hospital
- Mahim, Mumbai, Maharashtra, India
- Ganesh Gopalakrishnan MS MCh Urology
- Ex HOD, CMC Vellore
- Consultant Urologist, Vedanayagam Hospital
- Coimbatore, Tamil Nadu, India
- Narendra Sutar MBBS
- District TB Officer
- Department of Tuberculosis
- MCGM
- Mumbai, Maharashtra, India
- Nitin Kekre MS Mch Urology
- Professor
- Department of Urology
- CMC Vellore
- Tamil Nadu, India
- S Boopathy Vijayaraghavan MD Radiology
- Consultant Radiologist
- Sonoscan Centre Coimbatore
- Tamil Nadu, India
- Sujata Patwardhan MS MCh Urology
- Professor and Head
- Department of Urology
- Seth GS Medical College and KEM Hospital
- Mumbai, Maharashtra, India
- Suleman Merchant MD Radiology
- Ex Professor and Head of Department
- Radiology, LTMG Sion Hospital
- Ex Dean LTM Medical College and LTMG Sion Hospital
- Mumbai, Maharashtra, India
- Sunil D Khaparde MD PhD FIAP FIPHA
- Advisor, Public Health SPL, PHO
- Ministry of Health and Family Welfare
- Government of India
- Mumbai, Maharashtra, India
- Yash Pamecha MS MCh Urology
- Senior Registrar
- Department of Urology
- KEM Hospital Mumbai, Maharashtra, India
Tuberculosis continues to be a public health problem in most countries around the globe and it is more so in India.
Tuberculosis of urinary and genital organs is ancient but it continues to remain as an unsolved problem. Clinical features are flexible and genitourinary tuberculosis (GUTB) presentations are so varied that it can mimic many other conditions. Approximate 8,000 articles are available in the literature but there is probably no study encompassing all aspects of the disease. Most of them are quite superficial addressing some aspect of this disease. Hence to compile all aspects of the disease, even as a textbook, is well-nigh impossible.
The main issue attached to the problem is that delay in diagnosis and proper initiation of early treatment very often result in progress of disease leading to eventual renal functional deterioration. In many, the old statement that “Bladder is the Vocal cord of Kidney” is true as many present with varying bladder symptoms. This adds to the confusion as to the diagnosis of urinary tuberculosis.
The sequelae following proper treatment resulting in functional changes have to be borne in mind and need very frequent follow-ups and evaluation even after commencing treatment.
It has been noticed that though there are several diagnostic tests now available, the overall efficacy of detecting GUTB is being questioned by some. Hence, the question asked is whether one will have to wait for the results of diagnostic tests prior to initiation of treatment by drugs. Can the treatment be initiated on high index of suspicion? Professor HS Bhat (Doyen of Urology in India) often used to mention that “Urologists should be able to sniff GUTB”. According to him, even diagnosing by bacteriological tests and radiology is often too late. This view is now being questioned by many and mentions that the condition should be diagnosed beyond doubt to commence treatment.
Ganesh and Sujata have to be complemented for bringing out this book on time covering most aspects that we have to know and understand. The 26 cases illustrated provide more than adequate representation on all aspects of GUTB that we frequently encounter. Such a compiling adds considerable value for the book.
I am sure this book is a must read for all urologists across the globe and even for those countries where GUTB may not be under much consideration.
P Venugopal MBBS MS MCh (Urology)
Retired Professor Urology, KMC
_FM_9PREFACE
India accounts for 23% of the global burden of tuberculosis. In 2014 of a total of 9.6 million cases worldwide, 2.2 million cases of tuberculosis were estimated to have occurred in India. Renal tuberculosis is the most common site of extrapulmonary genitourinary tuberculosis (GUTB) comprising of 20% of all extrapulmonary tuberculosis (EPTB).
In 2014, the Central TB Division and Directorate General of Health Services of the Ministry of Health and Family Welfare, Government of India, recognized the need to develop evidence-informed guidelines for EPTB. This was aimed to run concurrently with those for pulmonary tuberculosis from the Revised National TB Control Programme (RNTCP). Unfortunately, evidence-based guidelines for treatment of GUTB are lacking. Should a 6-month regimen be sufficient or should it be 9 months.
While there are individual chapters in various textbooks relating to different aspects of GUTB, a single book devoted to renal tuberculosis is lacking. We, the editors felt that the vast experience in our country by individual physicians should be collated in a comprehensive book which would help urologists enhance their knowledge and also serve to manage our patients effectively.
This has been possible only because of the commitment of the authors who themselves have felt such a need and the untiring efforts of Drs Umesh Shelke and Yash Pamecha both ex-residents of the Urology Department, KEM Hospital, Mumbai.
Ganesh Gopalakrishnan
_FM_11ACKNOWLEDGMENTS
We would like to thank Drs Umesh Shelke, Yash Pamecha, Rishikesh Velhal, Nikhar Jain, ex and present staff of the Department of Urology, KEM Hospital, Mumbai for their untiring effort. We would like to especially appreciate Dr Rupali Sable, Department of Preventive and Social Medicine, KEM Hospital, for providing us the source material for this publication.
Last but not the least, we would like to thank Mr Padmanabhan and his team from Dr Reddy's Laboratories for supporting this venture.
We also want to acknowledge the sincere efforts and enthusiasm of Shri Jitendar P Vij, Mr Sabarish Menon, Dr Richa Saxena, Dr Nidhi Sood and their team from Jaypee Brothers Medical Publishers (P) Ltd for carrying out the process of publication swiftly and completing the book in short span of time._FM_12
_FM_13ABBREVIATIONS
AKT
Anti-Kock treatment
BDQ
Bedaquiline
C-DST
Culture and drug susceptibility testing
c/o
Complaint of
CAT 1
Category 1
CBNAAT
Cartridges based nucleic acid amplification test
CSIC
Clean self intermittent catheterization
CT
Computed tomography
DDR-TBC
District Drug Resistant Tuberculosis Centre
DMC
Designated Microscopy Centre
DM
Diabetes mellitus
DR-TB
Drug-resistant tuberculosis
DST
Drug Susceptibility Testing
DVDMS
Drug Vaccine Distribution Management System
e/o
Evidence of
EPDR-TB
Extrapulmonary drug-resistant tuberculosis
EP
Extrapulmonary
EPTB
Extrapulmonary tuberculosis
ESRD
End-stage renal disease
FL-LPA
First line probe assay
GUTB
Genitourinary tuberculosis
h/o
History of
HIV
Human immunodeficiency syndrome
IVP
Intravenous pyelography
k/c/o
Known complaint of
LPA
Line probe assay
LUTS
Lower urinary tract symptoms
MDR-TB
Multidrug resistant tuberculosis
MRI
Magnetic resonance imaging
MR-TB
Mono-resistant tuberculosis
PDR-TB
Poly-drug resistant tuberculosis
PMDT
Programmatic management of drug-resistant tuberculosis
PTB
Pulmonary tuberculosis
r/o
Resident of
RNTCP
Revised National Tuberculosis Control Program
RRTB
Rifampicin-resistant tuberculosis
s/o
suggestive of
TBC
Tuberculosis contact
TB
Tuberculosis
WHO
World Health Organization
XDR-TB
Extensively drug-resistant tuberculosis