|Year : 2020 | Volume
| Issue : 3 | Page : 248-253
A long journey to be diagnosed as a case of tuberculous cystitis: A Bangladeshi case report and review of literatures
Tajkera Sultana Chowdhury1, Md Fazal Naser1, Mainul Haque2
1 Department of Urology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
2 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
|Date of Submission||30-May-2020|
|Date of Decision||25-Jun-2020|
|Date of Acceptance||01-Jul-2020|
|Date of Web Publication||28-Aug-2020|
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000
Source of Support: None, Conflict of Interest: None
Urinary bladder tuberculosis (UB-TB) is one of the gravest public health issues of renal TB, and it is diagnosed with <50% of urogenital TB. Unsatisfactory and delayed diagnosis with imprudent medications for bladder TB frequently resulted in several urinary and complications, including contraction of the UB. The objectives of this research were to build awareness among medical professionals and subsequently minimize the sufferings of patients. This was a case report-based study regarding UB-TB. All routine tests for cystitis were conducted. In addition, 24-h urine sample for TB identification, including a polymerase chain reaction test, was performed. Twenty-four hours of urine sample revealed confirmatory findings of TB. The patient had responded well with the national TB guideline-designated medication. Recurrent cystitis had a higher possibility of tuberculous origin. Medical doctors must rethink when a patient visited multiple times for cystitis for the etiology of the disease.
Keywords: Diagnosis delay, failure, imprudent prescribing, irrational medication, prolonged suffering, tuberculosis, urinary bladder
|How to cite this article:|
Chowdhury TS, Naser MF, Haque M. A long journey to be diagnosed as a case of tuberculous cystitis: A Bangladeshi case report and review of literatures. Int J Mycobacteriol 2020;9:248-53
|How to cite this URL:|
Chowdhury TS, Naser MF, Haque M. A long journey to be diagnosed as a case of tuberculous cystitis: A Bangladeshi case report and review of literatures. Int J Mycobacteriol [serial online] 2020 [cited 2021 May 11];9:248-53. Available from: https://www.ijmyco.org/text.asp?2020/9/3/248/293533
| Introduction|| |
Globally, tuberculosis (TB) is one of the principal causes of death from a single infectious disease agent all over much of documented human history. In addition, TB causes around 40% mortality among patients with human immunodeficiency virus positive. It has been estimated that globally around 10.4 million individuals freshly developed TB, 1.3–1.8 million deaths, and 40% of these TB-infected patients remained undiagnosed and untreated in 2017.,,, TB is an international wide-ranging disease. Nevertheless, the TB incidence rate reported much higher anyplace; the population density is high with poor sanitation and negative social and economic markers. Around the globe, eight countries represent two-thirds of 10 million TB patients from low-middle-income countries (LMICs). The countries were India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%), and South Africa (3%). The Global TB Report 2016 assessed that 3.9% freshly identified and 21% of earlier spotted TB cases were multidrug-resistant TB (MDR-TB)., Thereafter, MDR-TB, extensively drug-resistant TB, polydrug-resistant TB, and rifampicin-resistant TB became an alarming global public health issue.,, The WHO reported that the incidence of worldwide TB cases and deaths had accounted for more than 90% of the total occurrence in the LMICs; of these TB patients, 75% are in the most frugally prolific age group.
TB has the potential to infect any part of the human body.,,, It has been reported that around 15%–40% of newly diagnosed 10 million TB patients of every year were extrapulmonary TB (EPTB). Common sites of EPTB include lymph nodes, pleura, bones, meninges, and the urogenital tract.,,, TB infection involving the kidneys, ureters, bladder, prostate, urethra, penis, scrotum, testicles, epididymis, vas deferens, ovaries, fallopian tubes, uterus, cervix, and vulva was primarily congregated and considered as genitourinary TB.,,,, At present, the term “urogenital TB (UGTB)” is believed to be more suitable as kidney, and urinary tract TB becomes obvious more frequently than genital TB., The first communication regarding UGTB was made by Porter in 1894 of Northwestern Ohio Medical Association, Van Wert, Ohio, USA. In addition, more than forty years later, in 1937, Hans Wildbolz Swiss urologists recommended the term “genitourinary TB”.,,
UGTB is an age-old public health issue but remains unresolved. UGTB remains the second top-most cause of EPTB, with a 90% incidence rate in LMICs.,, UGTB remain as clinical concerns because commonly maltreated, because of nonspecific symptoms, chronic, ambiguous, puzzling, fluctuating clinical features, thereby, goes unnoticed and undiagnosed.,,,,,,,,,,,,,,,, Moreover, general practitioners, nephrologists, urologists, and other responsible clinicians were unaware of the probability of the UGTB.,,, The research study revealed that failure to diagnose UGTB timely consequences in increasing the possibility of developing several complications of the mentioned disease. Those include ureteral strictures, contracted bladder, obstructive nephropathy, renal parenchymal destruction, irreversible organ damage, and end-stage renal failure.
UGTB can be classified into four groups: (i) urinary TB, (ii) male genital TB, (iii) female genital TB, and (iv) generalized UGTB.,, Urinary bladder TB (UB-TB) is alienated into four different stages: (1) tubercle infiltrative; (2) erosive ulcerous; (3) spastic cystitis (bladder contraction and false microcystitis); in fact, overactive bladder; and (4) real microcystitis up to full obliteration., Renal TB usually serves as the primary site of all UGTB; later, it involves as another urogenital anatomy, for example, UB to cause UB-TB, through the hematogenous spread of the TB bacilli and typically commences at the ureteral orifice and is found in nearly one-third of the patients.,,,, Besides, preliminary TB infection in the renal cortex, subsequently, TB bacilli persist as dormant for years together. Then these dormant TB bacilli wait till finds the way out to be active owing to the limitation of the weak immune system of the host, especially among those patients suffers from incapacitating diseases leading to weak cell-mediated immunity. Those diseases include shock, trauma, use of glucocorticoids or immunosuppressives, diabetes, or acquired immunodeficiency syndrome (AIDS).,,, Furthermore, it has been estimated that around 1.7–2 billion globally exits as latent TB cases, which epitomizes a vast pool of potential reactivation TB to spread among people of the community., UB-TB primarily reveals as tuberculous infective inflammation with bullous edema and granulation, later chronic inflammatory process eventually ended golf-hole forming,,, ureteral orifice, fibrosis and causes stricture formation with hydronephrosis or scarification with vesicoureteral reflux. If the patient remains untreated or irrationally treated UB-TB, consequently turn to severe cases involving the entire bladder wall, deep layers of muscle are sooner or later substituted by fibrous tissue, accordingly form a thick fibrous bladder. Tubercles are sporadic in the bladder if even found, typically seem at the ureteral orifice. Malignancy should be well thought out with any out-of-the-way tubercles away from the ureteral orifices.
The diagnosis of UGTB is problematic and tough because its warning sign is broad based.,, Multiple approaches are required for the diagnosis of UGTB. The patient had complaints of physical signs, histopathology, culture tests, polymerase chain reaction (PCR), and various imaging techniques (ultrasound and laparoscopic cystoscopy) that are needed to combine to reach a proper diagnosis.,,,, Even in this modern age, proper clerking of patients' history remains the most significant step in diagnosing UGTB.,, In the majority of cases, UGTB patients had the possibility of a history of a primary pulmonary TB (PTB) or an EPTB that offers a piece of vital evidence at large.,, Another side of the coin health professionals' awareness regarding latent TB remains an important issue as the reactivation of TB has been evident to even after 30 years.,,, The aim of the study was to create awareness among the health professionals when a case of repeated cystitis, to think may be TB cystitis, has been reported.
| Case Report|| |
A 37-year-old male patient was reported with history of TB, despite he rarely had any close contact with PTB patients in his life. The patient was a professional truck driver. He had a history of sex with professional sex workers 13 years back, followed by chronic urethral discharge, dysuria, and recurrent lower urinary tract symptoms. The patient received treatment earlier multiple times by a senior consultant urology surgeon. Nevertheless, patients' symptoms minimized occasionally, but recurrence came back soon. The patient repeatedly underwent various investigations to diagnose the cause for lower urinary tract infections. However, the patient was diagnosed as a case of the overactive UB. After that, antimuscarinics, β3-agonists, behavioral therapy, and lifestyle changes were frequently employed. Eventually, the patient was not at all improved. The patient's symptoms got worse around 3 (December 2019) months back. The patient needs to void 15–20 times a day, and additional had nocturia, fever, and painful micturition. This time, the patient was referred to Shaheed Suhrawardy Medical College Hospital (SSMCH), Dhaka 1207, Bangladesh. The patient (Hospital ID 36100/19) reported on December 10, 2019, in the outpatient department, urology section of SSMCH.
The patients complained about the abovementioned symptoms. On initial examination, the patient was found mildly anemic; there was no gross hematuria; the lower abdomen was tender, weight 85 kg, blood pressure 100/60 mmHg, no lymphadenopathy was found, and on auscultation of the chest, no abnormality was detected. The total lymphocyte count was 12,000 per cubic mm, differential lymphocyte count was 82% neutrophil, and erythrocyte sedimentation rate was 60 mm. Urine examination revealed microscopic hematuria with pyuria that was suggestive of cystitis. Tuberculin skin test was weakly positive (erythema: 50 mm × 30 mm, no induration). Ultrasonography revealed mild irregular thickening with a typical capacity (408 ml) of the UB [Figure 1]. Plain X-ray of the kidney, ureter, and bladder revealed no urinary calculus. Chest X-ray did not found any significant opacity or calcified shadow. PCR study of the 24-h urine sample detected TB. PCR study was conducted in the reference laboratory of Programmatic Management of Drug-Resistant Tuberculosis, National TB Control Program, Government of the People's Republic of Bangladesh, Mohakhali TB Gate, Mohakhali, Dhaka 1212, Bangladesh. The details of the study included patient Reference no. D24 17.12.19, Specimen ID: 19/22298/M. Urethrocystoscopic examination was not done initially. At this point, considering all facts that were found clinically and of laboratory findings, the patient was diagnosed as a case of tuberculous cystitis. Subsequently, anti-TB medication was given in correct dose, and combination as therapeutic intervention and trial (oral four-drug anti-TB therapy [INH, pyrazinamide, ethambutol, and rifampicin]) was started as per national guidelines. The patient was strictly observed and monitored for the next 2 weeks. Urethrocystoscopic examination done 1 month after receiving antitubercular therapy revealed mildly trabeculated UB wall, with multiple patchy healed ulcer anatomy with the capacity (about 500–600 ml) [Figure 2]. Patient symptoms such as frequency, nocturia, fever, and dysuria have relieved, and the appetite of the patient has subsequently improved. The patient was further advised to continue the same treatment for 6 months. On subsequent visits, the patient's overall health condition starts growing with weight gain after 4 months of medication.
|Figure 1: Ultrasonography photo showing irregular thickening wall of the urinary bladder|
Click here to view
|Figure 2: Urethrocystoscopic photo after 1-month antitubercular therapy revealed improved urinary bladder wall anatomy|
Click here to view
| Discussion|| |
TB remains as an existing public health delinquent, enduring one of the top ten global causes of death from the transmittable disease., Internationally, lower respiratory infections persisted the fatal infectious disease, triggering 3.0 million deaths 2016. The number of deaths due to TB had decreased; nonetheless, the death toll has been reported to be 1.3 million per year, from the year 2000 to 2016. In addition, in 2018, TB has claimed 1.5 million life. TB is an immense societal delinquent, not only a medical issue, because both PTB and EPTB often cause male and female infertility and sexually transmitted diseases.,,,,,,,,,,,,,,,, UGTB is one of the earliest-reported infectious diseases but remains to be an unresolved public health issue.,,, Clinical features of UGTB are supple, stretchy, and inconstant and often imitators of abundant other diseases, which consequences in deferring diagnosis. In PubMed 5215, articles available dated March 21, 2020, 1.22 PM (Malaysian Time) with the keywords “urogenital, genitourinary, TB.” Another study reported that although there is a lot of research studies being published, “there are no good multicenter studies with a high level of evidence on UGTB. UGTB is an embodiment of contradictions: from terms and classification to therapy and management.”
The current case TB cystitis symptoms, signs, standard laboratory reports where mimicking recurrent cystitis and overactive bladder. Thereafter, the diagnosis was delayed. In addition, they were treated irrationally or imprudently. Multiple studies reported that the diagnosis deferment TB cystitis was because of the furtive progression, rareness or nonspecific of symptoms of the disease, deficient cognizance of medical doctors, the neglected care-seeking attitude of patient, and poor access to proper health-care system. Consequently, diagnosis is seldom completed before severe urogenital complications developed.,,,,, The patient was typically frustrated and depressed only at that time was referred to tertiary care medical school hospital, and probably, the first time was clerked by a consultant urology surgeon. The patient was asked to wait sometime because the consultant had an idea to give enough time to this particular long time suffered. After finishing all outpatients for that day, the consultant listened to all the stories of sufferings and asked to repeat all routine laboratory tests with 24-h urine for TB identification with PCR in the reference laboratory of the government of Bangladesh. PCR findings were positive and treated according to the public guidelines. After receiving 1-month antitubercular therapy, endoscopic urethrocystoscopy examination was done and found improved bladder wall mucosa with increased urinary compliance. UB capacity returned to 500–600 ml after 1-month anti-TB medication, but the earlier study reported that it was about 408 ml capacity.
| Conclusion|| |
TB cystitis is rarely diagnosed early because of similar symptoms mimicking with other forms of chronic cystitis. This study revealed that while dealing with a case of recurrent cystitis patients, medical professionals must keep thinking regarding the possibility of having TB cystitis. As delayed diagnose may cause irreversible bladder wall damage leading to thimble or spastic bladder. This study recommends that if a patient with recurrent lower urinary tract symptoms presents as resistant to all conventional therapeutic interventions, physicians should adopt to do some minimal invasive investigations such as urethrocystoscopy evaluation taking tissue biopsy of the bladder mucosa and do the histopathological examination, collection of urine sample directly from the bladder to detect acid-fast bacilli under microscopic study, and culture with PCR.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In this way, the patient himself had given his consent for images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published, and outstanding efforts will be made to conceal the identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupta RK, Lucas SB, Fielding KL, Lawn SD. Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: A systematic review and meta-analysis. AIDS 2015;29:1987-2002.
Bloom BR, Atun R, Cohen T, Dye C, Fraser H, Gomez GB, et al
. Tuberculosis. In: Holmes KK, Bertozzi S, Bloom BR, Jha P. editors. Major Infectious Diseases. Ch. 11., 3rd
ed. Washington (DC): The International Bank for Reconstruction and Development The World Bank; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525174/doi: 10.1596/978-1-4648-0524-0/ch11
. [Last accessed on 2020 Mar 16].
Glaziou P, Sismanidis C, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Cold Spring Harb Perspect Med 2014;5:a017798.
MacNeil A, Glaziou P, Sismanidis C, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward achieving global targets 2017. MMWR Morb Mortal Wkly Rep 2019;68:263-6.
World Health Organization. Global Tuberculosis Report 2016. Geneva, Switzerland: World Health Organization; 2016. WHO/HTM/2016.13. WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Available from: https://apps.who.int/medicinedocs/documents/s23098en/s23098en.pdf
. [Last accessed on 2020 Mar 16].
Ragonnet R, Trauer JM, Denholm JT, Marais BJ, McBryde ES. High rates of multidrug-resistant and rifampicin-resistant tuberculosis among re-treatment cases: Where do they come from? BMC Infect Dis 2017;17:36.
Su WJ, Feng JY, Huang CC, Perng RP. Increasing drug resistance of Mycobacterium tuberculosis
isolates in a medical center in northern Taiwan. J Formos Med Assoc 2008;107:259-64.
Seung KJ, Keshavjee S, Rich ML. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Cold Spring Harb Perspect Med 2015;5:a017863.
Alene KA, Yi H, Viney K, McBryde ES, Yang K, Bai L, et al
. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis 2017;17:573.
Jilani TN, Avula A, Zafar Gondal A, Siddiqui AH. Active Tuberculosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
Lawn SD, Zumla AI. Tuberculosis. Lancet 2011;378:57-72.
Furin J, Cox H, Pai M. Tuberculosis. Lancet 2019;393:1642-56.
Kulchavenya E. Extrapulmonary tuberculosis: Are statistical reports accurate? Ther Adv Infect Dis 2014;2:61-70.
Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2015;78:47-55.
Porter MF. III. Uro-Genital Tuberculosis in the Male. Ann Surg 1894;20:396-405.
Wildbolz H. Ueber urogenital tuberkulose. Schweiz Med Wochenschr 1937;67:1125.
Kulchavenya E, Naber K, Bjerklund Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. Eur Urol Suppl 2016;15:112-21.
Adhikari S, Basnyat B. Extrapulmonary tuberculosis: a debilitating and often neglected public health problem. BMJ Case Rep 2018;11:e226098.
Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis-epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019;16:573-98.
Kulchavenya E. Urogenital tuberculosis: Definition and classification. Ther Adv Infect Dis 2014;2:117-22.
Zajaczkowski T. Genitourinary tuberculosis: Historical and basic science review: Past and present. Cent European J Urol 2012;65:182-7.
Kulchavenya E. Best practice in the diagnosis and management of urogenital tuberculosis. Ther Adv Urol 2013;5:143-51.
Quddus MA, Uddin MJ, Bhuiyan MM. Evaluation of extrapulmonary tuberculosis in Bangladeshi patients. Mymensingh Med J 2014;23:758-63.
Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004;120:316-53.
Kocjancic E, Sedlar A. Tuberculous cystitis. Curr Bladder Dysfunct Rep 2012;7:105-12.
Ahasan HA, Bala CS. Hurdles in management of extrapulmonary tuberculosis. J Bangladesh Coll Phys Surg 2016;34:182-3.
Abbara A, Davidson RN, Medscape. Etiology and management of genitourinary tuberculosis. Nat Rev Urol 2011;8:678-88.
Yadav S, Singh P, Hemal A, Kumar R. Genital tuberculosis: Current status of diagnosis and management. Transl Androl Urol 2017;6:222-33.
Prasad N, Patel MR. Infection-Induced Kidney Diseases. Front Med (Lausanne) 2018;5:327.
Figueiredo AA, Lucon AM. Urogenital tuberculosis: Update and review of 8961 cases from the world literature. Rev Urol 2008;10:207-17.
Figueiredo A, Lucon AM, Gomes CM, Srougi M. Urogenital tuberculosis: patient classification in seven different groups according to the clinical and radiological presentation. Int Braz J Urol 2008;34:422-32.
Figueiredo AA, Lucon AM, Junior RF, Srougi M. Epidemiology of urogenital tuberculosis worldwide. Int J Urol 2008;15:827-32.
Nakane K, Yasuda M, Deguchi T, Takahashi S, Tanaka K, Hayami H, et al
. Nationwide survey of urogenital tuberculosis in Japan. Int J Urol 2014;21:1171-7.
Kulchavenya E, Kholtobin D, Shevchenko S. Challenges in urogenital tuberculosis. World J Urol 2020;38:89-94.
Kulchavenya E, Zhukova I, Kholtobin D. Spectrum of urogenital tuberculosis. J Infect Chemother 2013;19:880-3.
Kulchavenya E, Kholtobin D. Diseases masking and delaying the diagnosis of urogenital tuberculosis. Ther Adv Urol 2015;7:331-8.
Kulchavenya E, Cherednichenko A. Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infections. Ther Adv Urol 2018;10:95-101.
Krishnamoorthy S, Palaniyandi V, Kumaresan N, Govindaraju S, Rajasekaran J, Murugappan I, et al
. Aspects of evolving genito urinary tuberculosis-A profile of genito urinary tuberculosis (GUTB) in 110 patients. J Clin Diagn Res 2017;11:PC01-5.
Hsieh HC, Lu PL, Chen YH, Chen TC, Tsai JJ, Chang K, Chen TP. Uro-genital tuberculosis in a medical center in southern Taiwan: An eleven-year experience. J Microbiol Immunol Infect 2006;39:408-13.
Ye Y, Hu X, Shi Y, Zhou J, Zhou Y, Song X, et al
. Clinical features and drug-resistance profile of urinary tuberculosis in South-Western China: A cross-sectional study. Medicine (Baltimore) 2016;95:e3537.
Decroo T, Henríquez-Trujillo AR, De Weggheleire A, Lynen L. Rational use of Xpert testing in patients with presumptive TB: Clinicians should be encouraged to use the test-treat threshold. BMC Infect Dis 2017;17:674.
Yoon C, Cattamanchi A, Davis JL, Worodria W, den Boon S, Kalema N, et al
. Impact of Xpert MTB/RIF testing on tuberculosis management and outcomes in hospitalized patients in Uganda. PLoS One 2012;7:e48599.
Walusimbi S, Semitala F, Bwanga F, Haile M, De Costa A, Davis L, et al
. Outcomes of a clinical diagnostic algorithm for management of ambulatory smear and Xpert MTB/Rif negative HIV infected patients with presumptive pulmonary TB in Uganda: A prospective study. Pan Afr Med J 2016;23:154.
Li S, Liu B, Peng M, Chen M, Yin W, Tang H, et al
. Diagnostic accuracy of Xpert MTB/RIF for tuberculosis detection in different regions with different endemic burden: A systematic review and meta-analysis. PLoS One 2017;12:e0180725.
Kulchavenya E. Urogenital Tuberculosis: Epidemiology, Diagnosis, Therapy. New York: Springer; 2014.
Kapoor R, Ansari MS, Mandhani A, Gulia A. Clinical presentation and diagnostic approach in cases of genitourinary tuberculosis. Indian J Urol 2008;24:401-5.
] [Full text]
Hemal AK, Aron M. Orthotopic neobladder in management of tubercular thimble bladders: Initial experience and long-term results. Urology 1999;53:298-301.
Mohan A, Sharma SK. Epidemiology. In: Sharma SK, Mohan A, editors. Tuberculosis. New Delhi: Jaypee Brothers Medical Publishers; 2001. p. 14-29.
Ahmad S. Pathogenesis, immunology, and diagnosis of latent Mycobacterium tuberculosis infection. Clin Dev Immunol 2011;2011:814943.
Lillebaek T, Dirksen A, Baess I, Strunge B, Thomsen VØ, Andersen AB. Molecular evidence of endogenous reactivation of Mycobacterium tuberculosis
after 33 years of latent infection. J Infect Dis 2002;185:401-4.
Lin PL, Flynn JL. Understanding latent tuberculosis: A moving target. J Immunol 2010;185:15-22.
Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: A re-estimation using mathematical modelling. PLoS Med 2016;13:e1002152.
Alizadeh F, Shahdoost AA, Zargham M, Tadayon F, Joozdani RH, Arezegar H. The influence of ureteral orifice configuration on the success rate of endoscopic treatment of vesicoureteral reflux. Adv Biomed Res 2013;2:1.
] [Full text]
Lyon RP, Marshall S, Tanagho EA. The ureteral orifice: Its configuration and competency. J Urol 1969;102:504-9.
Pal DK. Haemospermia: An Indian experience. Trop Doct 2006;36:61-2.
Thangappah RB, Paramasivan CN, Narayanan S. Evaluating PCR, culture histopathology in the diagnosis of female genital tuberculosis. Indian J Med Res 2011;134:40-6.
] [Full text]
Goel G, Khatuja R, Radhakrishnan G, Agarwal R, Agarwal S, Kaur I. Role of newer methods of diagnosing genital tuberculosis in infertile women. Indian J Pathol Microbiol 2013;56:155-7.
] [Full text]
Malik S, Sharma K, Vaiphei K, Dhaka N, Berry N, Gupta P, et al
. Multiplex polymerase chain reaction for diagnosis of gastrointestinal tuberculosis. JGH Open 2019;3:32-7.
Stamatiou K, Papadoliopoulos I, Dahanis S, Zafiropoulos G, Polizois K. The accuracy of ultrasonography in the diagnosis of superficial bladder tumors in patients presenting with hematuria. Ann Saudi Med 2009;29:134-7.
] [Full text]
Kulchavenya E, Naber KG, Johansen TE. Gastrointestinal and peritoneal tuberculosis. In: Senar A, Erdem H, editors. Extrapulmonary Tuberculosis. Switzerland: Springer; 2019. p. 141-53.
Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, et al
. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015;69:1257-67. doi:10.1111/ijcp.12686.
Walker HK. The Origins of the History and Physical Examination. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. Ch. 1., 3rd
ed. Boston: Butterworths; 1990. Available from: https://www.ncbi.nlm.nih.gov/books/NBK458/
. [Last accessed on 2020 Mar 19].
Loddenkemper R, Lipman M, Zumla A. Clinical aspects of adult tuberculosis. Cold Spring Harb Perspect Med 2015;6:a017848.
Daher Ede F, da Silva GB Jr, Barros EJ. Renal tuberculosis in the modern era. Am J Trop Med Hyg 2013;88:54-64.
McAleer SJ, Johnson CW, Johnson WD. Tuberculosis and parasitic and fungal infections of the genitourinary system. In: Campbell-Walsh Urology, 9th
Edition, Edited by Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell's Urology. 9th
ed. Philadelphia: WB Saunders; 2007. p. 436-70.
Lenk S, Schroeder J. Genitourinary tuberculosis. Curr Opin Urol 2001;11:93-8.
Al Jahdhami I. Latent tuberculosis in healthcare workers: Time to act. Oman Med J 2013;28:146-8.
Pathak V, Harrington Z, Dobler CC. Attitudes towards preventive tuberculosis treatment among hospital staff. PeerJ 2016;4:e1738.
National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh, in collaboration with Country of Bangladesh, World Health Organization. National Guidelines and Operational Manual for Programmatic Management of Drug-Resistant TB (PMDT), National Guidelines and Operational Manual for Programmatic Management of Drug-Resistant TB (PMDT). Second Edition, 2013. Real Printing and Advertising, K.R Plaza, 31 Purana Paltan, Dhaka-1000, Bangladesh. Available from: http://www.ntp.gov.bd/ntp_dashboard/magazines_image/1489644435.pdf
. [Last accessed on 2020 Mar 16].
World Health Organisation. Tuberculosis. Key Facts; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis. [Last accessed on 2020 Mar 21].
Zaman K. Tuberculosis: A global health problem. J Health Popul Nutr 2010;28:111-3.
Pai M, Memish ZA. Antimicrobial resistance and the growing threat of drug-resistant tuberculosis. J Epidemiol Glob Health 2016;6:45-7.
Pai M, Memish ZA. Global tuberculosis control requires greater ambition and resources. J Epidemiol Glob Health 2015;5:1-2.
Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: A global multifaceted phenomenon. Pathog Glob Health 2015;109:309-18.
Liu Y, Jiang S, Liu Y, Wang R, Li X, Yuan Z, et al
. Spatial epidemiology and spatial ecology study of worldwide drug-resistant tuberculosis. Int J Health Geogr 2011;10:50.
Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J 2011;52:864-7.
Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. Int J Gynaecol Obstet 2011;113:229-34.
Wise GJ, Marella VK. Genitourinary manifestations of tuberculosis. Urol Clin North Am 2003;30:111-21.
Tzvetkov D, Tzvetkova P. Tuberculosis of male genital system-myth or reality in 21st
century. Arch Androl 2006;52:375-81.
Shcherban' MN, Kul'chavenia EV, Brizhatiuk EV, Kaveshnikova EIu, Sveshnikova NN. Male and female genital tuberculosis. Reproductive function in a patient with tuberculosis. Probl Tuberk Bolezn Legk 2008;9:3-6.
Wise GJ, Shteynshlyuger A. An update on lower urinary tract tuberculosis. Curr Urol Rep 2008;9:305-13.
Scherban M, Kulchavenya E. Prostate tuberculosis – New sexually transmitted disease. Eur J Sexol Sexual Health 2008;17 Suppl 1:S163.
Devasia RA, Blackman A, Gebretsadik T, Griffin M, Shintani A, May C, et al
. Fluoroquinolone resistance in Mycobacterium tuberculosis
: The effect of duration and timing of fluoroquinolone exposure. Am J Respir Crit Care Med 2009;180:365-70.
Shahzad S. Investigation of the prevalence of female genital tract tuberculosis and its relation to female infertility: An observational analytical study. Iran J Reprod Med 2012;10:581-8.
Nagelkerke NJ, de Vlas SJ, MacDonald KS, Rieder HL. Tuberculosis and sexually transmitted infections. Emerg Infect Dis 2004;10:2055-6.
Macdiarmid SA, Sand PK. Diagnosis of interstitial cystitis/painful bladder syndrome in patients with overactive bladder symptoms. Rev Urol 2007;9:9-16.
Kul'chavenja EV, Holtobin DP. Reasons of Delayed Diagnosis of Bladder Tuberculosis. Urologiia 2015;3:29-32.
Taber JM, Leyva B, Persoskie A. Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med 2015;30:290-7.
Legido-Quigley H, Camacho Lopez PA, Balabanova D, Perel P, Lopez-Jaramillo P, Nieuwlaat R, et al
. Patients' knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: a qualitative study. PLoS One. 2015;10:e0122112.
Ramanathan R, Kumar A, Kapoor R, Bhandari M. Relief of urinary tract obstruction in tuberculosis to improve renal function. Analysis of predictive factors. Br J Urol 1998;81:199-205.
Hemal AK, Gupta NP, Rajeev TP, Kumar R, Dar L, Seth P. Polymerase chain reaction in clinically suspected genitourinary tuberculosis: Comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology 2000;56:570-4.
Lübbe J, Ruef C, Spirig W, Dubs M, Sigg C. Infertility as the first symptom of male genitourinary tuberculosis. Urol Int 1996;56:204-6.
Marahatta SB, Yadav RK, Giri D, Lama S, Rijal KR, Mishra SR, et al
. Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers. PLoS One 2020;15:e0227293.
Kaneko T, Kudoh S, Matsushita N, Kashiwabara Y, Tamura T, Yoshida I, et al
. Case of bladder tuberculosis with onset at the age of nineteen-treatment of urinary tract tuberculosis in accordance with the new Japanese Tuberculosis Treatment Guidelines. Nihon Hinyokika Gakkai Zasshi 2008;99:29-34.
[Figure 1], [Figure 2]