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
Dilip Kumar Pal
A-30, Govt. Housing Estate, Govindanagar, Side - B, Bankura (W.B.) - 722 102
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.
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Pal DK. Tuberculosis of prostate.Indian J Urol 2002;18:120-122
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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
Tuberculosis of prostate is very rare. , 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.
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]
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. , Tubercular involvement of prostate almost always results from haematogenous dissemination.  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.  On rectal examination the gland is nodular, hard, tender and rarely enlarged.  Sometimes in fulminating cases due to poor host defenses spontaneous sloughing of prostatic tissue may lead to autoprostatectomy. 
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.
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