0022-5347 /79/1223-0417$02.00/0 Vol. 122, September Printed in U.S. A.
THE ,JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Wilkins Co.
TUBERCULOSIS OF THE MALE URETHRA N. V. RAGHAVAIAH* From the Department of Urology, Andhra Medical College, Visakhapatnam, India
ABSTRACT
Tuberculosis of the male urethra is a rare lesion, with 21 cases reported in the literature. Two patients with tuberculosis of the who presented with multiple perimeth.ral fistulas and a tuberculosis. periureth.ral abscess, are described. In both patients there was associated tuberculosis could be isolated from the urine and the exudate of the ulcers. tuberculous ulcers demonstrated tuberculous ~,,~,,~,"V'" tissue n. ,·~'l•nu and a course of antituberculous acid and iso:niazid. The urethral fistulas healed urethral dilations. 0
Tuberculosis of the male urethra is an uncommon with 21 cases in the literature a period of 26 years. The diagnosis of this condition is difficult and may cause delay in treatmento Two cases of this rare lesion are reported hereino ~m~mcTA~
CASE REPORTS
Case 1. A ·'"'·"'''""·" man was admitted to the service because a poor urinary stream and multiple urinary fistulas. A perineal swelling had burst 6 months previously, resulting in the fistulas. Physical examination revealed ulcers with puckered and undermined edges (see the right epididymis revealed a non-tender nodule 2 cm. in diameter in the globus major with a beaded right vas deferenso On rectal examination the prostate was found to be slightly large, irregular, boggy and tender. The remainder of the physical examination was unremarkable. Because of the multiple fistulas with undermined edges, epididymal nodule and tender irregular prostate, clinical diagnosis was .,,,,,v,,,u, to be tuberculosis of the urethra. Urinalysis revealed pyuria and Mycobacterium tuberculosis could be identified in the urinary sediment and in the exudate from the perineal ulcers. Urine culture yielded Escherichia coli and Mo tuberculosis. A chest x-ray revealed a tuberculous cavernous ulcer lesion of the r:ight upper lobe. An excretory urogram (IVP) was normaL Tuberculous bacilli could be isolated from the sputumo A retrograde urethrogram showed narrowing of the bulbous urethra with multiple urethral fistulas. Biopsy of the perineal ulcer revealed tuberculous granulation tissue with caseation. Acid-fast bacillus could be demonstrated in the tissues with difficulty. Cystourethroscopy revealed a stricture of the bulbous urethrao The was treated with suprapubic cystostomy and a complete 2-year course of streptomycin, isoniazid and paraaminosalicylic acid. The fistulas healed in 6 months. The urethral stricture was treated later with repeated urethral dilations. Case 2. A 25-year-old man, who suffered from pulmonary tuberculosis in the past, was referred to the urology service because of painful perineal swelling and voiding difficulty. Examination revealed a abscess and a stricture in t:he bulbous urethra. The was treated with cystostomy and of the periureth_ral abscess. woill!.d m the periinto a fistula and did not heal even urinary diversion &"i.d an.ti-
biotics, Because of the tuberculosis u:rituberculosis was exdudedo tuberculosis was identified in the sediment and was later cultured from the urine. A chest x-ray revealed evidence of healed bilateral apical tuberculosis. An IVP revealed irregularity of the upper minor calix of the left kidneyo A retrograde urethrogram was unremarkable except for narrowing of the bulbous urethra and urethral fistula. Mo tuberculosis was isolated from the purulent drainage of the periurethral ulcer. Biopsy of the perineal ulcer revealed tuberculous granulation tissue with giant cell formation. Tuberculous bacilli could be seen in the tissueo The patient was given a full course of antituberculous treatment with streptomycin, para-aminosalicyhc acid and isoniazid for 2 years. The perineal ulcer and fistula healed in 3 months. The urethral stricture was later treated with dilations. COMMENT
Tuberculosis of the male urethra has occurred i.n all age groups, ranging from 10 to 67 but most of the cases were in patients
THE ,JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Wilkins Co.
TUBERCULOSIS OF THE MALE URETHRA N. V. RAGHAVAIAH* From the Department of Urology, Andhra Medical College, Visakhapatnam, India
ABSTRACT
Tuberculosis of the male urethra is a rare lesion, with 21 cases reported in the literature. Two patients with tuberculosis of the who presented with multiple perimeth.ral fistulas and a tuberculosis. periureth.ral abscess, are described. In both patients there was associated tuberculosis could be isolated from the urine and the exudate of the ulcers. tuberculous ulcers demonstrated tuberculous ~,,~,,~,"V'" tissue n. ,·~'l•nu and a course of antituberculous acid and iso:niazid. The urethral fistulas healed urethral dilations. 0
Tuberculosis of the male urethra is an uncommon with 21 cases in the literature a period of 26 years. The diagnosis of this condition is difficult and may cause delay in treatmento Two cases of this rare lesion are reported hereino ~m~mcTA~
CASE REPORTS
Case 1. A ·'"'·"'''""·" man was admitted to the service because a poor urinary stream and multiple urinary fistulas. A perineal swelling had burst 6 months previously, resulting in the fistulas. Physical examination revealed ulcers with puckered and undermined edges (see the right epididymis revealed a non-tender nodule 2 cm. in diameter in the globus major with a beaded right vas deferenso On rectal examination the prostate was found to be slightly large, irregular, boggy and tender. The remainder of the physical examination was unremarkable. Because of the multiple fistulas with undermined edges, epididymal nodule and tender irregular prostate, clinical diagnosis was .,,,,,v,,,u, to be tuberculosis of the urethra. Urinalysis revealed pyuria and Mycobacterium tuberculosis could be identified in the urinary sediment and in the exudate from the perineal ulcers. Urine culture yielded Escherichia coli and Mo tuberculosis. A chest x-ray revealed a tuberculous cavernous ulcer lesion of the r:ight upper lobe. An excretory urogram (IVP) was normaL Tuberculous bacilli could be isolated from the sputumo A retrograde urethrogram showed narrowing of the bulbous urethra with multiple urethral fistulas. Biopsy of the perineal ulcer revealed tuberculous granulation tissue with caseation. Acid-fast bacillus could be demonstrated in the tissues with difficulty. Cystourethroscopy revealed a stricture of the bulbous urethrao The was treated with suprapubic cystostomy and a complete 2-year course of streptomycin, isoniazid and paraaminosalicylic acid. The fistulas healed in 6 months. The urethral stricture was treated later with repeated urethral dilations. Case 2. A 25-year-old man, who suffered from pulmonary tuberculosis in the past, was referred to the urology service because of painful perineal swelling and voiding difficulty. Examination revealed a abscess and a stricture in t:he bulbous urethra. The was treated with cystostomy and of the periureth_ral abscess. woill!.d m the periinto a fistula and did not heal even urinary diversion &"i.d an.ti-
biotics, Because of the tuberculosis u:rituberculosis was exdudedo tuberculosis was identified in the sediment and was later cultured from the urine. A chest x-ray revealed evidence of healed bilateral apical tuberculosis. An IVP revealed irregularity of the upper minor calix of the left kidneyo A retrograde urethrogram was unremarkable except for narrowing of the bulbous urethra and urethral fistula. Mo tuberculosis was isolated from the purulent drainage of the periurethral ulcer. Biopsy of the perineal ulcer revealed tuberculous granulation tissue with giant cell formation. Tuberculous bacilli could be seen in the tissueo The patient was given a full course of antituberculous treatment with streptomycin, para-aminosalicyhc acid and isoniazid for 2 years. The perineal ulcer and fistula healed in 3 months. The urethral stricture was later treated with dilations. COMMENT
Tuberculosis of the male urethra has occurred i.n all age groups, ranging from 10 to 67 but most of the cases were in patients
