Tuberculosis of Urinary Bladder

Topic Name Introduction Pathophysiology Clinical Features Diagnosis Differential Diagnosis Management Complications Special Considerations Monitoring and Follow-up

Introduction

Urinary bladder tuberculosis is a significant form of genitourinary tuberculosis in children, representing about 8-10% of extrapulmonary TB cases. It typically occurs as a secondary infection from renal tuberculosis but can present as isolated bladder TB in rare cases.

Key Points

• Age distribution: More common in older children (>5 years)
• Gender ratio: Equal distribution
• Primary vs Secondary: Usually secondary to renal TB (90%)
• Association with pulmonary TB: Present in 30-40% cases

Epidemiology

• Global prevalence: 15-20% of extrapulmonary TB cases
• Risk factors:
  • Immunocompromised status
  • Malnutrition
  • Prior urinary tract infections
  • Urological anomalies

Pathophysiology

Mode of Spread

• Primary Routes:
  • Descending infection from kidneys
  • Hematogenous spread
  • Lymphatic spread
  • Direct extension from adjacent organs
• Tissue Response:
  • Initial mucosal inflammation
  • Granuloma formation
  • Tubercle development
  • Fibrosis and scarring

Disease Progression

• Early Stage:
  • Mucosal edema
  • Inflammatory response
  • Tubercle formation
• Intermediate Stage:
  • Granuloma coalescence
  • Ulcer formation
  • Mucosal irregularity
• Late Stage:
  • Fibrosis
  • Contracture
  • Reduced bladder capacity

Clinical Features

Early Symptoms

• Urinary Symptoms:
  • Frequency (90% cases)
  • Dysuria (85% cases)
  • Urgency
  • Nocturia
• Systemic Symptoms:
  • Low-grade fever
  • Weight loss
  • Fatigue
  • Night sweats

Advanced Features

• Local Signs:
  • Suprapubic pain
  • Hematuria
  • Reduced bladder capacity
  • Urinary retention
• Associated Features:
  • Renal colic
  • Flank pain
  • Recurrent UTIs
  • Growth retardation

Diagnosis

Laboratory Investigations

• Urine Analysis:
  • Early morning samples (3 consecutive days)
  • Sterile pyuria
  • Microscopic hematuria
  • Culture negative UTI
• Microbiological Studies:
  • AFB staining
  • NAAT (PCR)
  • Culture on Lowenstein-Jensen medium
  • Gene Xpert MTB/RIF
• Blood Tests:
  • Complete blood count
  • ESR/CRP
  • Renal function tests
  • Mantoux test

Imaging Studies

• Ultrasonography:
  • Bladder wall thickening
  • Reduced capacity
  • Upper tract changes
• CT Urography:
  • Calcifications
  • Wall irregularities
  • Perivesical extension
  • Associated renal lesions
• MRI:
  • Soft tissue involvement
  • Extravesical spread
  • Complicated cases

Endoscopic Assessment

• Cystoscopy Findings:
  • Tubercles
  • Ulcerations
  • Reduced capacity
  • Biopsy collection

Management

Medical Management

• Anti-tubercular Therapy:
  • Intensive Phase (2-3 months):
    • Isoniazid (10 mg/kg/day)
    • Rifampicin (15 mg/kg/day)
    • Pyrazinamide (35 mg/kg/day)
    • Ethambutol (20 mg/kg/day)
  • Continuation Phase (4-7 months):
    • Isoniazid
    • Rifampicin
• Supportive Care:
  • Pain management
  • Hydration
  • Nutritional support
  • Bladder training

Surgical Management

• Indications:
  • Failed medical treatment
  • Severe contracture
  • Obstruction
  • Fistula formation
• Procedures:
  • Augmentation cystoplasty
  • Fistula repair
  • Bladder reconstruction
  • Urinary diversion

Complications

Early Complications

• Urinary:
  • Reduced bladder capacity
  • Vesicoureteral reflux
  • Hydroureter
  • Hydronephrosis
• Local:
  • Persistent infection
  • Bladder ulceration
  • Perivesical abscess

Late Complications

• Structural:
  • Contracted bladder
  • Fistula formation
  • Bladder calcification
• Functional:
  • Overactive bladder
  • Urinary incontinence
  • Chronic retention

Special Considerations

High-Risk Groups

• Immunocompromised children
• Malnourished patients
• Children with urological anomalies
• Previous urological surgery

Prevention Strategies

• Early detection of renal TB
• Regular screening in high-risk groups
• Prompt treatment of UTIs
• Nutritional support

Monitoring and Follow-up

Treatment Monitoring

• Clinical Response:
  • Symptom improvement
  • Urinary symptoms
  • General condition
• Laboratory Monitoring:
  • Monthly urine analysis
  • Culture conversion
  • Renal function
• Imaging Follow-up:
  • Ultrasound at 3 months
  • CT/MRI as needed
  • Annual screening

Long-term Follow-up

• Duration: Minimum 2 years
• Frequency: Every 3-6 months
• Assessment points:
  • Bladder capacity
  • Renal function
  • Growth monitoring
  • Quality of life

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.