Indian Journal of Urology
ORIGINAL ARTICLE
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 120--122

Tuberculosis of prostate


Dilip Kumar Pal 
 Urology Unit, Department of Surgery, Bankura Sammilani Medical College, Bankura, India

Correspondence Address:
Dilip Kumar Pal
A-30, Govt. Housing Estate, Govindanagar, Side - B, Bankura (W.B.) - 722 102
India

Abstract

Tubercular involvement of prostate is rare. Though the symptoms are nonspecific, haemospermia is an im­portant clinical symptom. Asymmetry of prostatic lobes or nodular fibrotic prostate on digital rectal examina­tion is an importantphvsical6nding. Altered echotexture of the prostate or hypoechoic nodules on USG leads to suspicion. AFB staining or AFB culture of seminal fluid or trucut needle biopsy of the prostate gives the definite diagnosis.



How to cite this article:
Pal DK. Tuberculosis of prostate.Indian J Urol 2002;18:120-122


How to cite this URL:
Pal DK. Tuberculosis of prostate. Indian J Urol [serial online] 2002 [cited 2020 Nov 24 ];18:120-122
Available from: https://www.indianjurol.com/text.asp?2002/18/2/120/37400


Full Text

 Introduction



Tuberculosis of prostate is very rare. [1],[2] Very little literature is available on this subject. Though it is a blood-borne disease tubercular infection of the prostate is occasionally found in advanced cases of genitourinary tuberculosis. Most of the patients usually present with features of prostatism. Strong clinical suspicion leads to the diagnosis of tuberculosis of prostate as the symp­toms are nonspecific.

 Materials and Methods



This study was conducted in Bankura Sammilani Medical College from 1995 to 2000. During this six years period only five prospective and three retrospec­tive prostatic tuberculosis cases were found from the hospital records. Detailed clinical data of the cases are presented in the [Table 1]. Strong clinical suspicion led to the diagnosis of tuberculosis. All the cases were screened by total and , differential count of WBC, ESR, renal bio­chemical parameters, serum IgG and 1gM for tubercu­losis and X-ray chest. Seminal fluids were stained for acid-fast bacillus and subjected to culture to detect M. tuberculosis. Intravenous urography and trucut needle biopsy from the prostate were done where indicated. After diagnosis all the cases were treated with rifampicin, pyrazinamide, ethambutol and INH for first two months and rifampicin with INH for another seven months.

 Observations



Prostatic tuberculosis usually occurs in fourth or fifth dec­ades of life. Usually the symptoms are nonspecific as the patients present with dysuria, frequency, urgency like pros­tatism. Haemospermia is an important sign of prostatic or seminal vesical tuberculosis and in this study five cases pre­sented with haemospermia. Four cases presented with other features of genitourinary tuberculosis and on digital rectal examination they had a suspected prostate. X-ray chest was noncontributory in all the cases. Mantoux test was positive for tuberculosis only in three cases. Serum immunoglobulin study was positive for tuberculosis in four cases. Seminal fluid was subjected to AFB staining and AFB culture in all patients presented with haemospermia, where four cases M. tuberculosis was detected. In one case prostatic involvement was detected incidentally on histopathological examination after TURP, where the patient presented with features of prostatism. Transrectal ultrasonography [Figure 1] suggested hypoechoic nodule with altered echotexture in four cases and calcifications within prostate was noted in three cases. Intravenous urography was nominal in all cases except three, where the patients had advanced genito-urinary tuberculo­sis. Transrectal biopsy from the suspected nodule gave defi­nite diagnosis in six cases. [Figure 2]

 Discussion



Tuberculosis of prostate is a very rare disease and litera­ture on this subject is scanty. Frequently the cases are not properly diagnosed or under-reported. Mainly it is diagnosed by the pathologist or it is found incidentally after transure­thral resection. [1],[2] Tubercular involvement of prostate almost always results from haematogenous dissemination. [3] Symp­toms are usually nonspecific. Patients usually present with irritative voiding symptoms, terminal dysuria of haemo­spermia. Sometimes advanced cases of genitourinary tuberculosis may present with prostatic involvement. Haemospermia gives a strong suspicion for prostatic or seminal vesical involvement with tuberculosis. Advanced lesion may cause a reduction in the volume of semen due to destruction of the gland which may help in the diagno­sis. [4] On rectal examination the gland is nodular, hard, ten­der and rarely enlarged. [1] Sometimes in fulminating cases due to poor host defenses spontaneous sloughing of prostatic tissue may lead to autoprostatectomy. [2]

Transrectal ultrasonography should be suggested in every case where an altered echotexture or hypoechoic nodules within prostate is doubtful [Figure 1]. Mycobacteria may be demonstrated in the seminal fluid by Z.N. stain­ing or by culture. Serum IgG or IgM for tuberculosis indirectly may help in diagnosis. Mantoux test becomes nega­tive in most of the ccases. Prostatic biopsy is the mainstay of diagnosis [Figure 2]. Once the disease is diagnosed the patient should receive full course of anti-tubercular chemo­therapy for nine months.

References

1Gow GJ. Genitourinary tuberculosis. In: Walsh PC, Retik AB, Starry TA, Vaughan ED (eds). Campbell's Urology, 6" edn. Philadelphia, Saunders 1992; 919-51.
2Hemal AK, Aron M, Nair M, Wadia SN. 'Autoprostatectomy' : An unusual manifestation in genito-urinary tuberculosis. Br J Urol 1998: 82: 140-141.
3Sporer A, Auerbach 0. Tuberculosis of prostate. Urology 1978: 11: 362-366.
4LattimerJK, WeechslerM. Genito-urinary tuberculosis. In: Harrison JH et al (eds). Campbell's Urology, 4"' edn. Philadelphia, Saunders 1978; 1.