Sujata Patnaik1, Radhika G


Genitourinary tuberculosis (GUTB) is the most common extra-pulmonary TB accounting for 14-41% of all tubercular affections. Caseation, parenchymal loss, intra-renal scars and strictures at calyceal neck, pelvi-ureteral junction and ureterovesical junction are hall-marks of GUTB. Radiological diagnosis of GUTB is often a challenge due to the variable imaging features it can cause. Varying degrees of calcifications in KUB region is seen 21-44% of cases. High dose IVU is the gold standard for its evaluation. Loss of calyceal sharpness, fuzzy margin, calyceal dilatation, papillary necrosis, cavitation and moth eaten calyces due to erosion are common findings on IVP. There may be stricture at calyceal neck, in pelvis resulting in hydrocalycosis and hydronephrosis or contracted pelvis. Ureteric involvement (typically a beaded, saw tooth or pipe stem appearance) mays seen in 50% of patients. One third of GUTB there is affection of the urinary bladder. ‘Thimble bladder’ may be a late manifestation. Our own observation of 25 proven cases, showed thimble bladder (n=16) followed by hydronephrosis (n=16), vesico-ureteric reflux (n=5), beaded ureter (n=7), scarred pelvis (n=8), infundibular stenosis (n=9) and non-functioning kidneys (n=4). Though uncommon, putty kidney (3), ghost calyx, granuloma/abscess and urethral diverticula were also observed. The most diagnostic radiological features of GUTB are lobar calcification, diffuse uneven caliectasis without pelvis dilatation, contracted pelvis with or without calcification, urothelial thickening and thimble bladder. Multiplicity of abnormal features in the same patient is very characteristic presentation. Knowledge of IVU features is important as CT Urography depicts the same features as IVU.