Tuberculosis Study Guide - M. M. Savula 2002

Extrapulmonary tuberculosis
Urogenital tuberculosis
Male genital tuberculosis

Pathogenesis. Male Genital Tuberculosis develops when the infection is spread via lymphatic and hematogenous routes. It is frequently diagnosed in men with Disseminated Pulmonary Tuberculosis or Tuberculosis of the Kidneys and bones. Typically, the Epididymis is affected first, from where the infection spreads through the vas deferens and Lymphatic vessels to the Prostate Gland, Seminal Vesicles, and Testis. Later, via the Lymph flow, mycobacteria penetrate the contralateral epididymis and testis.

Clinical Features and Diagnosis. Most commonly, tuberculosis of the epididymis (epididymitis) presents with a chronic, oligosymptomatic course. It manifests only as a painless induration and enlargement of the epididymis. An acute onset is much less common, accompanied by fever, pain, Swelling, and redness of the corresponding side of the Scrotum. In such cases, Palpation of the affected epididymis is painful, and the vas deferens is thickened. In both clinical courses, the process eventually spreads to the testis, resulting in a hydrocele and sometimes a scrotal fistula. The exudate rapidly organizes, and the testis and epididymis merge into a dense, nodular mass.

Diagnosis is based on physical examination and palpation. A history of past tuberculosis and the presence of tuberculous lesions in other Organs are of key importance. Bacteriological Analysis of the ejaculate and Cytological examination of the epididymal aspirate are performed. The disease must be differentiated from Syphilis, tumors, actinomycosis, and, in cases of acute onset, from non-specific inflammatory processes.

Treatment. Standard Chemotherapy is administered in combination with glucocorticoids. If conservative treatment fails, surgery—epididymectomy—is indicated.