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Abstract: The patient had urinary frequency, urinary urgency, and low fever for six months, and had been treated according to prostatitis and cystitis, with poor results of common antibiotics. A chest CT examination was considered old tuberculosis, and urography showed delayed visualization of the right kidney and right ureter, stenosis of the lower ureter, worm-eating-like changes in the renal pelvis, a positive T-cell test for tuberculosis infection, a positive tuberculin test, and a positive urinary antacid bacillus, and the final diagnosis was tuberculous cystitis. After 9 months of drug treatment, he was cured by clinical examination.
[Basic information] Male, 32 years old
Type of disease】Tuberculous cystitis
Hospital】Zhengzhou First People’s Hospital
Date of consultation】March 2021
Treatment plan】Oral medication (pyrazinamide tablets, isoniazid tablets, rifampin capsules, vitamin C tablets)
Treatment period】9 months of oral medication and 5 years of outpatient review
Treatment effect】Symptoms disappeared, urinary antacid bacilli continued to be negative for half a year, and right hydronephrosis was relieved
I. Initial consultation
The patient complained of frequent and urgent urination six months ago, and has been treated for prostatitis and cystitis at the local hospital. In the past month, the patient had recurrent afternoon hypothermia with a maximum temperature of 37.7°C. For further treatment, he came to our hospital. On examination, there was mild percussion pain in the right kidney area, no pressure pain and percussion pain in the left kidney, no pressure pain in the suprapubic bladder area, normal genital development, and no abnormal urethral opening. Outpatient ultrasound showed hydronephrosis of the right kidney, dilatation of the right ureter, calcified foci visible in the bladder, and routine urine examination showed 2098 leukocytes/UL.
II. Treatment history
The patient continued to improve the examination, and urography showed delayed visualization of the right kidney and right ureter, stenosis of the lower ureter, worm-like changes in the renal pelvis, normal visualization of the left urinary tract, positive T-cell test for tuberculosis infection, positive tuberculin test, positive antacid bacilli in the urine, and multiple ulcerated surfaces in the bladder with caseous necrosis in the deeper ulcers were seen on cystoscopy, and the diagnosis of tuberculous cystitis was clear.
After consultation by the infection department, the patient was advised to take oral pyrazinamide tablets, isoniazid tablets, rifampin capsules and vitamin C tablets for treatment. The patient was instructed to adhere to the medication, and the liver and kidney function and urinary routine and urography were reviewed regularly during the period.
III. Treatment effect
After 1 month of treatment, the patient’s liver and kidney functions were normal on recheck, the urinary routine leukocytes were 197/UL, the urinary antacid bacilli were positive, and the patient’s symptoms of urinary frequency, urinary urgency and afternoon hypothermia were relieved. After 3 months of medication, the liver and kidney function and urinary routine were normal, the symptoms of urinary frequency, urinary urgency and afternoon hypothermia disappeared, the urography showed that the right hydronephrosis was reduced, the renal pelvis became worm-like changes, the left urinary tract was normal, and the urinary antacid bacillus was negative. Six months and nine months after taking the drug, the patient continued to review, and the results showed that the indicators basically returned to normal, and the negative urinary antacid bacilli had lasted for six months, so the drug was discontinued.
IV. Notes
We are glad that after the treatment, the patient’s symptoms disappeared, the urinary antacid bacillus continued to be negative for six months, the right hydronephrosis was relieved, and the drug was successfully discontinued. However, during the treatment period, patients need to pay attention to regular medication in daily life, not to stop or reduce the dose of medication at will, and must take enough courses of treatment. Secondly, patients must pay attention to regular review because anti-tuberculosis drugs can cause liver damage and elevated transaminases, so it is important to pay attention to liver function indexes during the medication period, and review can also be a good way to understand the efficacy of drugs. In addition, since tuberculosis is a wasting disease, it is important for patients to enhance nutrition and improve physical fitness during the medication period, and they can drink milk in moderation before taking the medication to help them tolerate it.
V. Personal insight
The symptoms of tuberculous cystitis are mostly urinary frequency and urgency, and the disease is rare. Most patients are treated according to common urinary tract inflammation in the early stage, and only after repeated treatment with poor results do they choose to go to a large and experienced hospital for treatment, and the same is true for the treatment process of the patients in this article.
Tuberculous cystitis is only a part of urological tuberculosis, mostly originating from renal tuberculosis, except that the early symptoms of tuberculous cystitis are more obvious and are often the first lesions found in urological tuberculosis. Once tuberculous cystitis is detected, a thorough examination of the urinary system is required, as well as knowledge of extra-renal tuberculous infections, such as pulmonary tuberculosis. In this case, the patient had a good outcome with the disappearance of symptoms with drug treatment, continued negative urinary antacid bacilli for six months, and relief of right hydronephrosis.