rifampin and Tuberculosis--Urogenital

Effective methods for diagnosing urogenital tuberculosis (UGTB) are important for its clinical management. Therefore, we undertook a systematic review to assess the performance of the urine-based Xpert MTB/RIF assay for UGTB.. PubMed, Embase, Web of Science, the Cochrane library, and Scopus were systematically searched up to July 30, 2019. A hierarchical summary receiver operating characteristic (HSROC) was applied to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) for the diagnostic accuracy of the Xpert test.. Our search identified 858 unique articles from which 69 studies were selected for full-text revision, with 12 studies meeting the inclusion criteria. Eleven studies comprising 1202 samples compared Xpert with mycobacterial culture, while 924 samples from eight studies compared it with a composite reference standard (CRS). The values for pooled sensitivity, specificity, PLR, NLR, and OR were 0.89, 0.95, 20.1, 0.18, and 159.53, respectively, when compared with the mycobacterial culture. Likewise, when compared with a CRS, the respective pooled sensitivity, specificity, PLR, NLR, and OR values were 0.55, 0.99, 40.67, 0.43, and 166.17, thereby suggesting a high level of accuracy for diagnosing UGTB. A meta-regression and sub-group analysis of TB-burden countries, study design, decontamination, concentration, and reference standard could not explain the heterogeneity (p > 0.05) in the diagnostic efficiency.. Our results suggested that Xpert is a promising diagnostic tool for the diagnosis of UGTB via urine specimen.

Topics: Drug Resistance, Bacterial; Humans; Likelihood Functions; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Odds Ratio; Rifampin; ROC Curve; Sensitivity and Specificity; Tuberculosis, Urogenital; Urine

On the basis of a series of 86 cases of urogenital tuberculosis and a review of literature, a detailed study of the different therapeutic methods of this affection is done. Today, with the tuberculostatic agents, the medical treatment alone is frequently sufficient and ablative surgery is less often mandatory than reconstructive. Different types of short course chemotherapy and the role of associated steroids are reviewed. Finally, the authors stress the indications of ablative surgery and review the different procedures of reconstructive surgery in order to clearly define a logical therapeutic approach.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Constriction, Pathologic; Endoscopy; Female; Humans; Isoniazid; Male; Middle Aged; Nephrectomy; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital; Ureter; Ureteral Diseases; Ureteroscopy

In the United States, an increasing proportion of all forms of reactivation tuberculosis occurs in patients over the age of 60 years. Atypical presentations and presence of chronic illness obscure the diagnosis of tuberculosis in the elderly. Prompt diagnosis requires a high index of suspicion and aggressive procedures for diagnostic microbiology. Short-course (9 months) chemotherapy with isoniazid and rifampin is the treatment of choice for elderly patients with uncomplicated pulmonary tuberculosis. Isoniazid chemoprophylaxis is recommended for selected elderly patients.

Topics: Aged; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Pyridoxine; Rifampin; Streptomycin; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital; United States

Topics: Aminosalicylic Acids; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Streptomycin; Thioacetazone; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital

Topics: Aminosalicylic Acids; Antitubercular Agents; Child; Child, Preschool; Cycloserine; Drug Resistance, Microbial; Drug Therapy, Combination; Ethionamide; Female; Follow-Up Studies; Humans; Hypertension, Renal; Isoniazid; Kanamycin; Male; Nephrectomy; Pyridoxine; Radiography; Rifampin; Tuberculosis, Renal; Tuberculosis, Urogenital; United States

Topics: Antitubercular Agents; Capreomycin; Drug Evaluation; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Kidney Function Tests; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Nephrectomy; Rifampin; Tuberculosis, Urogenital

Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.

Topics: Antibiotics, Antitubercular; Blood Transfusion; Child; Cystitis; Female; Hematuria; Humans; Kidney; Mycobacterium tuberculosis; Necrosis; Recurrence; Rifampin; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Urogenital; Urogenital System

A 71-year-old patient with a superficial carcinoma of the urinary bladder and high risk of recurrence was treated with intravesical instillation of Bacillus Calmette-Guérin (BCG) after transurethral resection. As a complication of the catheterization during BCG-instillation therapy the patient suffered from tuberculosis. The patient received a tuberculosis triple-therapy including rifampicin 600 mg once daily, isoniazid 300 mg once daily and ethambutol 400 mg thrice daily. The existing arterial hypertension had successfully been controlled by 3.75 mg bisoprolol medication once daily for the last 15 years. An increase of blood pressure and cardiac arrhythmia were seen after combining the β1-receptor blocker treatment with the triple-therapy.. The blood pressure was 160/90 mm Hg. The heart rate reflected a value of 98 beats per minute. In the resting ECG monotopic ventricular extrasystoles could be diagnosed.. The dosage of bisoprolol was changed to 3.75 mg in the morning and additional 1.875 mg in the evening. Due to this increase of dosage the blood pressure could be controlled sufficiently.. Rifampicin is one of the best known potent enzyme inducing drugs. It strongly induces the expression of cytochrome P450 3A4 in the liver. The enzyme induction enhance the hepatic bisoprolol metabolism, hence the metabolic clearance of the drug increased. The maximal plasma level of bisoprolol decrease and in our use the arterial hypertension could not be treated sufficiently. It is well known that half the dose of bisoprolol undergoes oxidative metabolism in the liver and the rest eliminated unchanged in the kidney. A dosage adjustment of bisoprolol is necessary if the clinical status of the patient requires treatment with the antituberculosis drug rifampicin.

Topics: Adjuvants, Immunologic; Administration, Intravesical; Aged; Antihypertensive Agents; Antitubercular Agents; BCG Vaccine; Bisoprolol; Blood Pressure; Carcinoma, Transitional Cell; Cardiac Complexes, Premature; Combined Modality Therapy; Cytochrome P-450 CYP3A; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Electrocardiography; Enzyme Induction; Ethambutol; Humans; Isoniazid; Male; Metabolic Clearance Rate; Neoplasm Recurrence, Local; Rifampin; Tuberculosis, Urogenital; Urinary Bladder Diseases; Urinary Bladder Neoplasms

A 71-year-old patient with a superficial carcinoma of the urinary bladder and high risk of recurrence was treated with intravesical instillation of Bacillus Calmette-Guérin (BCG) after transurethral resection. As a complication of the catheterization during BCG-instillation therapy the patient suffered from tuberculosis. The patient received a tuberculosis triple-therapy including rifampicin 600 mg once daily, isoniazid 300 mg once daily and ethambutol 400 mg thrice daily. The existing arterial hypertension had successfully been controlled by 3.75 mg bisoprolol medication once daily for the last 15  years. An increase of blood pressure and cardiac arrhythmia were seen after combining the β (1)-receptor blocker treatment with the triple-therapy.. The blood pressure was 160 / 90 mmHg. The heart rate reflected a value of 98  beats per minute. In the resting ECG monotopic ventricular extrasystoles could be diagnosed.. The dosage of bisoprolol was changed to 3.75 mg in the morning and additional 1.875 mg in the evening. Due to this increase of dosage the blood pressure could be controlled sufficiently.. Rifampicin is one of the best known potent enzyme inducing drugs. It strongly induces the expression of cytochrome P450 3A4 in the liver. The enzyme induction enhance the hepatic bisoprolol metabolism, hence the metabolic clearance of the drug increased. The maximal plasma level of bisoprolol decrease and in our use the arterial hypertension could not be treated sufficiently. It is well known that half the dose of bisoprolol undergoes oxidative metabolism in the liver and the rest eliminated unchanged in the kidney. A dosage adjustment of bisoprolol is necessary if the clinical status of the patient requires treatment with the antituberculosis drug rifampicin.

Topics: Aged; Antihypertensive Agents; Antitubercular Agents; BCG Vaccine; Bisoprolol; Carcinoma, Transitional Cell; Chemotherapy, Adjuvant; Combined Modality Therapy; Cytochrome P-450 CYP3A; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Enzyme Induction; Humans; Hypertension; Male; Rifampin; Tuberculosis, Urogenital; Urinary Bladder Diseases; Urinary Bladder Neoplasms

Genitourinary tuberculosis is a form of secondary tuberculosis with vague symptoms and presentation, and is rare in children. Antitubercular therapy is the cornerstone of treatment, although surgical intervention is required in a minority of the cases. We retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery.. Case records of 17 children diagnosed and admitted with genitourinary tuberculosis at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied.. There were 11 male and six female children with a mean age of 11.6 years, admitted during the period July 1990 to June 2005. The most common presentation was storage lower urinary tract symptoms. The most commonly involved organ was the ureter in seven (41%) cases. Mycobacterium tuberculosis was identified on urinary examination in only five (29%) cases. A total of 28 procedures, including 15 endoscopic, four ablative and five reconstructive, were performed with some children requiring more than one procedure. Renal functional parameters stabilized or improved in four of five children (80%) in whom they were deranged at presentation.. Genitourinary tuberculosis presents with a wide variety of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of surgery achieve satisfactory results in the majority of cases. With improved drug therapy and experience with the use of bowel segments in the urinary tract, more reconstructive procedures are being performed with satisfactory outcomes. Children undergoing surgical procedures and reconstruction in particular need to be followed up rigorously.

Topics: Antibiotics, Antitubercular; Child; Drug Therapy, Combination; Education, Medical, Continuing; Female; Follow-Up Studies; Humans; Isoniazid; Male; Pediatrics; Pyrazinamide; Retrospective Studies; Rifampin; Tuberculosis, Urogenital; Urology

A 24-year-old man experienced gross haematuria and dysuria several times a year from the age of 19, presenting to this Department for the first time at age 21, when he was given standard antibiotic treatment for acute cystitis. Although urinary symptoms persisted, he failed to attend for follow-up. He attended another clinic at the age of 24 with increased urinary frequency. Transrectal ultrasonography revealed thickening of the bladder wall, concavity of the right bladder neck, and nodular changes extending from the left bladder neck to the left bladder wall, so he was referred to this department for further investigation. Mycobacterium tuberculosis was detected in the urine by the referring doctor, so the diagnosis was made of bladder tuberculosis (TB). We treated him with rifampicin (RFP), isoniazid (INH) and pyrazinamide (PZA) triple therapy for 2 months, followed by RFP and INH dual therapy for 4 months. His urinary frequency improved markedly after one month, and his bladder capacity was 420 ml after 4 months of treatment. After 2 and half year follow-up he remains well without any signs of relapse. To our knowledge, this is only the ninth case of teenage onset of urinary tract TB in Japan since 1995. As specified in Clause 22 of the Enforcement Regulations of the Tuberculosis Control Law, chemotherapy and surgical treatment of TB, the mainstays of treatment, should be administered in accordance with the 'Standards for the Treatment of Tuberculosis', issued by the Japanese Minister of Health and revised in 2004. The level of recognition of the 'Standards for the Treatment of Tuberculosis' is low, however. Although the incidence of TB of the urinary tract has dropped dramatically, as urologists we must be aware that treatment of this condition must be given in accordance with the Standards.

Topics: Adult; Antitubercular Agents; Diagnostic Imaging; Drug Therapy, Combination; Follow-Up Studies; Humans; Isoniazid; Japan; Male; Practice Guidelines as Topic; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Urogenital; Urinary Bladder Diseases

Topics: Anti-Bacterial Agents; Antitubercular Agents; Biopsy, Fine-Needle; Child; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Laparotomy; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Urogenital; Ultrasonography, Interventional; Urination Disorders

A 66-year old female suffering from rheumatoid arthritis was treated with methotrexate and intra-articular steroid injections. She had gone through pulmonary tuberculosis at the age of 2 years, also, surgery had been performed 2 years ago because of perforated sigmoid diverticulitis. The patient now presented with episodes of abdominal pain and diarrhea as well as occasional night sweats. Laboratory investigation (normal BSR, CRP and white blood cell counts) did not indicate the presence of an inflammatory process, such as reoccurrence of diverticulitis. However, leukocyturia was repetitively found in this patient with the conventional urine culture yielding no significant bacterial growth. Further urine investigation did not indicate infection with Chlamydia trachomatis or Neisseria gonorrhoeae. Ziehl Neelson stains of morning urinary samples did not show acid-fast rods, however, Mycobacterium tuberculosis was finally isolated by culture. Thus, urogenital tuberculosis was finally diagnosed in this patient. Infection, hematogenic dissemination, and spontaneous remission of pulmonary tuberculosis had occurred more than 60 years ago. After a long latent period, reactivation of tuberculosis happened during drug-induced immunosuppression. The patient was successfully treated with an anti-tuberculosis triple-drug therapy during 2 months followed by a double-drug therapy during 4 months.

Topics: Aged; Antibiotics, Antitubercular; Antitubercular Agents; Arthritis, Rheumatoid; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Isoniazid; Mycobacterium tuberculosis; Pyrazinamide; Pyridoxine; Radiography, Abdominal; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Urogenital; Urine

A case of prostatic tuberculosis is reported. A 61-year-old male visited our clinic complaining of urinary retention. On digital rectal examination, the prostate was found to be enlarged, hard, and uneven. Transrectal ultrasound revealed a large hypoechoic lesion in the posterior aspect of the prostate. Transrectal ultrasound guided systematic biopsies of the prostate were performed. The specimens obtained from the hypoechoic lesion, were diagnosed histopathologically as prostatitis with epithelioid granuloma, Langhans' type giant cells, and caseous necrosis. Mycobacterium tuberculosis was detected in the physiological saline solution injected into the urethra after prostatic massage. The patient was diagnosed as having prostatic tuberculosis and underwent antituberculotic therapy with INH and RFP. Transrectal ultrasound seemed to be useful in detecting histopathological changes associated with tuberculosis in the prostate.

Topics: Anemia, Refractory, with Excess of Blasts; Antibiotics, Antitubercular; Antitubercular Agents; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Prostatic Diseases; Rifampin; Tuberculosis, Urogenital; Ultrasonography

Urinary tuberculosis is a rare disease in children. It poses major diagnostic problems because of clinical symptoms, which are often atypical and misleading. It causes serious lesions which are often multifocal and extensive, requiring complex surgical excision and urinary tract reconstruction. Prevention of this disease is based on generalized vaccination with BCG and adequate treatment of pulmonary tuberculosis. The authors report a case of urinary tuberculosis in a fourteen-year-old child who presented episodes of cystitis and hematuria refractory to treatment. The diagnosis, confirmed by the positive test for AFB in the urine was established late, at the stage of silent kidney and scleroatrophic bladder. The patient was treated with antituberculous chemotherapy (Isoniazid; Rifampicin, PZA) and nephro-ureterectomy with augmentation enterocystoplasty.

Topics: Adolescent; Antitubercular Agents; Atrophy; Bacteriuria; BCG Vaccine; Child; Cystitis; Hematuria; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Nephrectomy; Pyrazinamide; Rifampin; Sclerosis; Tuberculosis, Pulmonary; Tuberculosis, Renal; Tuberculosis, Urogenital; Ureter; Urinary Bladder; Urinary Bladder Diseases

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.

Topics: Adolescent; Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Biopsy; Combined Modality Therapy; Constriction, Pathologic; Cystitis; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Nephrectomy; Prostatic Diseases; Pyrazinamide; Rifampin; Stents; Tuberculosis, Male Genital; Tuberculosis, Renal; Tuberculosis, Spinal; Tuberculosis, Urogenital; Ureteral Diseases; Urinary Bladder Diseases; Urography

The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0.74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scortal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Urogenital; Ureteral Obstruction

A 52-year-old female with the chief complaint of miction pain was referred for the examination of a urethral nodule. Physical inspection revealed the meatus to be reddish and swollen. The painless nodule (1 x 1 x 2 cm) was situated between the urethra and vagina on transvaginal examination. Chest X-ray, drip infusion pyelography (DIP) and urethrocystography (UCG) showed no evidence of tuberculosis. Bladder mucosa was normal on cystoscopy. Mycobacterium tuberculosis was not detected from urine or sputum. The nodule was resected along with a portion of the urethra. Histopathological examination revealed tuberculous granuloma of the urethra.

Topics: Drug Therapy, Combination; Female; Humans; Isoniazid; Middle Aged; Rifampin; Tuberculosis, Urogenital; Urethral Diseases

Study of the bacteriostatic activity (BA) of the blood, urine and tissue of the tuberculosis-affected urinary bladder after the administration of two tuberculostatic combinations (isoniazid + cycloserine and isoniazid + rifampicin) has demonstrated the difference in the BA curves that were formed in the above media. Use of isoniazid + cycloserine gives rise to a high BA level by 6-9 h with further gradual decrease of the parameters. The combination of isoniazid + cycloserine produces a typical double-humped curve with titre prolongation. The data obtained give evidence on the experience of the use of the first combination of the preparations in patients with fresh circumscribed urinary bladder lesions. The second combination (isoniazid + rifampicin) is indicated in the presence of ulcerous-cicatricial changes in association with a more prolonged circulation of the preparations in the organism (specific features of rifampicin metabolism).

Topics: Blood Bactericidal Activity; Cycloserine; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Time Factors; Tissue Distribution; Tuberculosis, Urogenital; Urinary Bladder; Urinary Bladder Diseases

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tuberculosis, Urogenital

Rifampicin (RMP, 600 mg), isoniazid (INH, 300 mg) and pyrazinamide (PZA, 1,000 mg) administered daily in the hospital for a duration of 2 months was followed at home by daily administration of 600 mg RMP and 300 mg INH for a duration of 4 months. 113 patients with previously untreated and bacteriologically proven urogenital tuberculosis were admitted to the study. Therapy was completed and evaluated in 106 (94%) patients. No failure of chemotherapy was observed during the treatment; one bacteriologically proven relapse occurred after completion of treatment within the 45- to 63-month follow-up. This 6-month chemotherapy seems as efficient as the standard treatment which lasted for 18-24 months.

Topics: Adult; Aged; Drug Therapy, Combination; Female; Humans; Isoniazid; Middle Aged; Pyrazinamide; Radiography; Rifampin; Tuberculosis, Urogenital

The problem of genito-urinary tuberculosis particularly for developing countries is stressed. The clinical presentation is outlined and investigations discussed, special mention being made of the importance of the high dose intravenous pyelogram and the limited use of retrograde pyelogram, cystography and arteriography. The most important part of the article is the chemotherapeutic treatment; and the significance of the short course regimen which should now be the standard practice. The reasoning of this method of treatment is discussed and toxicity is briefly mentioned. Surgical treatment is presented within the context of modern short course chemotherapy and is discussed under two headings "Excision of diseased tissue" and "Reconstructive surgery".

Topics: Angiography; Antitubercular Agents; Developing Countries; Drug Therapy, Combination; Endoscopy; Epididymis; Female; Humans; Isoniazid; Male; Nephrectomy; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital; Urinary Diversion; Urography

The chemotherapy of urinary tuberculosis is controversial as far as choice of drug regimen and duration of treatment are concerned. We propose a course of treatment that is tailored to the pathological state of infection and the type of surgical procedure performed. One hundred and ten patients with tuberculous infection were divided into three groups. Group I comprised 27 patients in whom surgery was not necessary; Group II contained 48 patients where ablative surgery was carried out; Group III consisted of 35 patients who underwent reconstructive surgery. Anti-tuberculous drugs (rifampicin, pyrazinamide, isoniazid and ethambutol) were given according to this tailored regimen. Patient compliance and results of treatment were excellent.

Topics: Adult; Aged; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Urogenital

One thousand one hundred and seventeen patients with genitourinary tuberculosis who were treated over a period of 34 years have been reviewed. During this time various regimens of treatment were used and have been evaluated. Emphasis is placed on the results of the group on short-course chemotherapy which has been in use since 1970 and is now standard practice. This group has been carefully studied, as the chemotherapeutic combinations are important to developing countries. The clinical response, sterilisation of urine, urinary reversion, drug toxicity and the place of surgery in relation to modern chemotherapy have been discussed and assessed. They show that the results of short-course chemotherapy are satisfactory and confirm that there is no need to extend chemotherapy beyond 4 months, except in unusual circumstances.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital; Urine

Topics: Aged; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Rifampin; Streptomycin; Tuberculin Test; Tuberculosis; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital

During the last 7 years we treated 92 patients with tuberculosis of the urinary tract. Patients with tuberculous infection were divided into 3 groups according to treatment: group 1--no surgical treatment (18 patients), group 2--ablative surgery (45 patients) and group 3--reconstructive surgery (29 patients). Antituberculous drugs, consisting of rifampin, pyrazinamide, isoniazid and ethambutol, were given according to the severity and extent of the infection process. The results of medical and surgical treatment were most gratifying. Surgical morbidity was low and there was no immediate mortality.

Topics: Adult; Aged; Ethambutol; Female; Follow-Up Studies; Humans; Isoniazid; Kidney; Male; Methods; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Urogenital; Ureter; Urinary Bladder; Urinary Tract; Urography

From our data urinary tuberculosis, clearly reduced as regards past decennia, now results constant in annual number of cases. The reduced frequency sometimes requires some problems of differential diagnosis. After a few considerations about anatomo-pathologic aspects, we examine the diagnostic procedures starting from that urinary tuberculosis has not pathognomic clinical signs, except identification of M. tuberculosis in urine. The medical treatment consists in administering three drugs (rifampin, isoniazid, ethambutol) for 3 months and then two drugs for 6-9 months, on the ground of clinical course. Surgical treatment can be divided in destroying and preserving surgery. At last, endoscopic treatment takes aim at dilating ureteral stenoses.

Topics: Calcinosis; Diagnosis, Differential; Endoscopy; Ethambutol; Female; Humans; Isoniazid; Italy; Male; Pyelonephritis; Rifampin; Tuberculosis, Urogenital; Ureteral Calculi; Ureteral Obstruction; Urinary Tract Infections; Urine

Topics: Adult; Aged; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Tuberculosis, Urogenital

Genitourinary tuberculosis should be managed on an outpatient basis, patients being seen once a week. The treatment of choice is a short-course regimen comprising 2 months of either three or fours drugs - streptomycin, rifampicin, isoniazid, and pyrazinamide - followed by isoniazid and rifampicin three times a week for either 2 or 4 months, depending on the severity of the lesion. Patients should be followed-up, normally for one year, and be told to report to their doctors if they have any recurrence of urinary symptoms. However, if they have renal calcification they should be followed-up as for any other case of calcification and seen annually for at least 10 years. Surgery still has an important part to play in the present management. Radical surgery, nearly always nephrectomy or epididymectomy, should be carried out when there are destructive lesions. Reconstructive surgery, mainly the the repair of strictures at the lower end of the ureter and bladder augmentation for a small fibrotic bladder, is frequently required. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy. There is no reason now why all patients should not be able to return to a normal efficient life - free from all association with the disease - not later than 4 months after the start of treatment.

Topics: Cystoscopy; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Isoniazid; Methods; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital; Urine

Since 1970 short course regimes of chemotherapy have been adopted for the treatment of 87 patients suffering from genitourinary tuberculosis. The response to chemotherapy, the effect of surgery, the importance of hypertension and the relapse rate have been studied. It is concluded that all cases of genitourinary tuberculosis will respond to a short intensive course of chemotherapy, which need not be given for longer than 6 months.

Topics: Adolescent; Adult; Aged; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Forecasting; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Time Factors; Tuberculosis, Urogenital

The present therapy of the urogenital tuberculosis is based on the effective medicaments (rifampizin, isonicotinic acid hydrazid, streptomycin, and ethambutol). It rests on an optimum dosage in connection with a best suited combination, taking into consideration the relations of sensitiveness and side effects as well as consequent long-term treatment. It is referred to the possibility of additional administrations of corticosteroid preparations and it is taken notice to the necessity also to treat unspecific mixed infections. Under the modern chemotherapy with bactericidal effect a stable negativation practically always develops within 3 months. Actual recidivations were not seen during the last 12 years. Apart from a compilation of the indications to nephrectomy references to possibilities of plastic surgical corrections of the urinary system are given. Two tables give information about the patients who were operatively treated during the last 15 years. A close collaboration of the various therapeutic institutions with a consulting urologist -- particularly in problematic and advanced cases of the disease -- nearly always saves the patient with urogenital tuberculosis from invalidism.

Topics: Adrenal Cortex Hormones; Drug Therapy, Combination; Ethambutol; Female; Genitalia, Male; Hospitalization; Humans; Isonicotinic Acids; Male; Nephrectomy; Rifampin; Streptomycin; Tuberculosis, Urogenital; Urogenital System

Topics: Ambulatory Care; Ethambutol; Female; Humans; Isoniazid; Kidney Failure, Chronic; Pregnancy; Pregnancy Complications; Prothionamide; Rifampin; Streptomycin; Time Factors; Tuberculosis, Urogenital

The chemotherapy of all forms of tuberculosis is basically performed according to homogeneous principles. Different opinions exist within the extrapulmonary forms particularly with regard to the duration of the treatment. Here, the so-called long-term therapy is frequently still postulated with 18--24 months. But newly developed, highly effective antituberculotic medicaments do not only allow but actually demand a shortening of the time of treatment in interest of the patient. Apparantly rifampicin and also pyrazin amide are able to effect on the germs in rest -- the persisters. Up to now the last mentioned gave the actual rise for the long-term application. Under the notion short-term therapy on the one hand by the application of the preparations mentioned and on the other hand basing on the experiences in the medicamentous treatment of the pulmonary tuberculosis now in the same measure the possiblity of a total duration of the therapy of on an average twelve months develops for the extrapulmonary manifestations of tuberculosis. Here, the two-phase regime is preferred with a continuous application of medicaments lasting for three months and following controlled phase with intermitting application of antituberculotics twice a week. The duration of application for rifampicin in these cases should neither trandgress nor be below three months.

Topics: Female; Humans; Male; Pyrazinamide; Rifampin; Time; Tuberculosis; Tuberculosis, Urogenital

Topics: Aminosalicylic Acid; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital

The problem in the treatment of genitourinary tuberculosis was to find a new regimen of chemotherapy that was shorter in time but equally effective as the traditional 2-year method, using streptomycin, isoniazid and para-aminoslicylate. A short course of treatment using rifampin, isoniazid and ethambutol was then devised, the method depending on the severity of the disease using the Semb classification. This short course of chemotherapy was combined with an early operation in advanced or extensive disease in the urinary tract. The regimen is as satisfactory as the traditional method and a followup of 2 years is all that is necessary.

Topics: Adult; Aged; Antitubercular Agents; Calcinosis; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Kidney Diseases; Male; Middle Aged; Rifampin; Tuberculosis, Urogenital

In the past year 20 new cases of genitourinary tuberculosis were referred for treatment at Wrightington Hospital. Many of these patients had waited a long time between diagnosis and referral and the start of effective treatment. We suggest that a new short course of chemotherapy should be used, and surgery undertaken during the first three months of treatment, but after the patient has had at least four weeks' drug treatment. After chemotherapy follow-up may be reduced to two years. Genitourinary tuberculosis remains a serious disease and should be managed by a urologist.

Topics: Adult; Aged; Calcinosis; Ethambutol; Female; Humans; Isoniazid; Kidney Diseases; Male; Middle Aged; Nephrectomy; Rifampin; Tuberculosis, Urogenital

Urogenital tuberculosis has not decreased in incidence like other forms of tuberculosis and this is not to be expected in the coming years. Following combined modern chemotherapy the chances of conversion and also clinical cure are increased. The patient's cooperation during a systematic triple drug therapy in adequate dosage is important. The possibility of ambulatory treatment will depend on the clinical findings and the patient's social situation. Physical and occupational therapy and early resocialization of the patient are important. Prolonged unemployment should be avoided. Urological care of the patient is particularly important in the early phases of the treatment.

Topics: Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Germany, West; Humans; Isoniazid; Long-Term Care; Male; Pregnancy; Rifampin; Streptomycin; Tuberculosis, Urogenital

Topics: Adult; Diagnosis, Differential; Female; Humans; Isoniazid; Mycobacterium; Mycobacterium Infections; Rifampin; Tuberculosis, Urogenital; Urinary Tract Infections

Topics: Aminosalicylic Acids; Antitubercular Agents; Capreomycin; Cycloserine; Drug Synergism; Endoscopy; Ethambutol; Female; Humans; Isoniazid; Male; Radiography; Rifampin; Streptomycin; Tuberculosis, Urogenital

Topics: Acne Vulgaris; Adult; Drug Eruptions; Female; Humans; Isoniazid; Male; Rifampin; Thioacetazone; Tuberculosis, Urogenital; Zambia

Topics: Adult; Antitubercular Agents; Cortisone; Ethambutol; Female; Humans; Isoniazid; Methods; Middle Aged; Rifampin; Tuberculosis, Urogenital; Ureteral Diseases; Ureteral Obstruction

Topics: Capreomycin; Drug Resistance, Microbial; Ethambutol; Female; Germany, West; Humans; Microbial Sensitivity Tests; Mycobacterium bovis; Mycobacterium tuberculosis; Rifampin; Time Factors; Tuberculosis, Urogenital

Topics: Chromium Isotopes; Diuresis; Edetic Acid; Ethambutol; Female; Humans; Iodohippuric Acid; Isoniazid; Radioisotope Renography; Rifampin; Time Factors; Tuberculosis, Urogenital

Topics: Female; Humans; Male; Nephrectomy; Prognosis; Rifampin; Transaminases; Tuberculosis, Renal; Tuberculosis, Urogenital; Ureteral Diseases; Urinary Bladder Diseases

Topics: Female; Humans; Rifampin; Tuberculosis, Urogenital

Topics: Aminosalicylic Acids; Calcinosis; Drug Synergism; Epididymitis; Ethambutol; Female; Humans; Hypertension, Renal; Isoniazid; Kidney Calculi; Male; Mycobacterium tuberculosis; Nephrectomy; Prednisolone; Rifampin; Streptomycin; Tuberculosis, Urogenital; Ureteral Obstruction; Urinary Bladder; Urinary Diversion; Urine

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Renal; Tuberculosis, Urogenital

Topics: Aminosalicylic Acids; Cycloserine; Drug Synergism; Ethambutol; Ethionamide; Female; Humans; Isoniazid; Phenylthiourea; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Urogenital

Topics: Adolescent; Adult; Age Factors; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Streptomycin; Tuberculosis, Renal; Tuberculosis, Urogenital; Urinary Bladder

Topics: Aminosalicylic Acids; Drug Resistance, Microbial; Female; Humans; Hypertension, Renal; Isoniazid; Male; Nephrectomy; Rifampin; Streptomycin; Tuberculosis, Renal; Tuberculosis, Urogenital; Ureter; Ureteral Diseases; Urinary Bladder

Topics: Administration, Oral; Blood Chemical Analysis; Female; Hematocrit; Humans; Kidney Function Tests; Liver Function Tests; Male; Middle Aged; Radiography; Rifampin; Time Factors; Tuberculosis, Urogenital

Topics: Anti-Bacterial Agents; Antitubercular Agents; Chronic Disease; Drug Resistance, Microbial; Ethambutol; Female; Humans; Microbial Sensitivity Tests; Peptides; Rifampin; Tuberculosis, Urogenital