Tuberculosis has been a serious threat to human health since the dawn of mankind, and therefore people have never stopped fighting against it. With the introduction of various anti-tuberculosis drugs and the use of BCG vaccine, the morbidity and mortality rate of tuberculosis has been decreasing year by year. However, since the mid-1980s, the global tuberculosis epidemic has been on the rise again. According to the World Health Organization (WHO), currently one-third of the global population is infected with tuberculosis bacteria, and 9 million new cases of tuberculosis occur each year, 60% of which are in the Asia-Pacific region, while 1 million cases are in China; about 3 million people die of tuberculosis each year, and tuberculosis has ranked as the first cause of death from a single pathogenic disease. In view of this, WHO declared a “global state of emergency for tuberculosis” in 1993. The main reasons for the resurgence of TB incidence are: the over-optimistic control of the TB epidemic over the past 30 years and the neglect of TB in health care planning; the global spread of HIV infection, with WHO reporting in 1995 that 1/3 of HIV-infected people worldwide were co-infected with TB bacteria; the irregularity of TB treatment, resulting in the emergence of drug-resistant strains of TB and multidrug-resistant strains of TB; and the indiscriminate disposal of urine from patients with bladder cancer treated with BCG vaccine should also be given high priority. The urinary tract is one of the most common sites of extrapulmonary tuberculosis, and from 1996 to 1999, urinary tract tuberculosis was second only to peripheral lymphatic tuberculosis (38.3%) and bone and joint tuberculosis (19.9%), accounting for 12.9% of all cases of extrapulmonary tuberculosis in Shanghai. With the rebound of the global tuberculosis epidemic, the incidence of urologic tuberculosis has rebounded in recent years, but a considerable number of urologists do not seem to pay high attention to this, and do not understand the changes in the epidemic of urologic tuberculosis, and do not know enough about the characteristics of urologic tuberculosis, which often leads to misdiagnosis and underdiagnosis; the number of cases of atypical renal tuberculosis and ureteral tuberculosis has increased significantly in recent years, which is also the objective reason for the first diagnosis of patients. This is also an objective reason for the difficulty of first diagnosis. To pay attention to urologic tuberculosis and improve the understanding of urologic tuberculosis, first of all, we should pay more attention to the symptoms of long-term chronic bladder irritation and deepen the understanding of “chronic cystitis”. This is very important and is the key to timely detection and diagnosis of urological tuberculosis. For patients with long-term recurrent urinary frequency, urinary urgency, and painful urination, many doctors rashly diagnose non-specific urinary tract infection without careful consideration and examination, which is the most common mistake in the diagnosis of urologic tuberculosis. This is the most common mistake in the diagnosis of urinary tract tuberculosis. The reason is that, firstly, the typical symptoms of renal tuberculosis are not in the kidney but in the bladder; secondly, the clinical thinking is limited and the possibility of tuberculosis is not considered. It is especially noteworthy in middle-aged and elderly male patients with long-term symptoms of urinary tract irritation, because primary cystitis in men is almost nonexistent. Second, attention must be paid to the phenomenon that the number of cases of atypical renal tuberculosis has increased significantly in recent years. The so-called atypical renal tuberculosis refers to the absence of the typical symptoms of severe urinary frequency and urgency, which are manifested only as mild urinary frequency or with hematuria and lumbar pain as the main manifestations, or even without any clinical symptoms, with only some changes in imaging. In a group of 96 cases of atypical renal tuberculosis reported by Yanfeng Li et al. (1999), 55.2% of patients had symptoms of lumbago, 47.9% had hematuria, and only 27.1% had symptoms of urinary frequency. Among the 14 cases of atypical renal tuberculosis reported by Fu Guang et al. (2002), their most common symptoms were, in order, lumbago, hematuria, cloudy urine, urinary frequency, fever, and night sweats. The rate of misdiagnosis of atypical cases at the first diagnosis is quite high, and long-term misdiagnosis and mistreatment of some patients can lead to serious consequences, which should be taken seriously. Third, one of the characteristics of the changing global TB epidemic is that the peak of the TB epidemic has moved to the elderly population. A survey of 100,000 people in the United States showed the highest incidence of tuberculosis at age 65, and data from our national epidemiological survey also showed that the prevalence of tuberculosis and the rate of smear-positive cases were significantly higher in 60 years and older than in other age groups. The diagnosis of urologic tuberculosis in the elderly is basically the same as that of young and middle-aged patients, but the key is to raise awareness and vigilance, especially for elderly female patients with long-term symptoms of urinary tract irritation, and not to easily make the diagnosis of “intractable urinary tract infection” or “urethral syndrome. The diagnosis of “intractable urinary tract infection” or “urethral syndrome” should not be easily made. Fourth, the majority of ureteral tuberculosis is secondary to renal tuberculosis (83.1%), while primary ureteral tuberculosis is rare, and sometimes hydronephrosis is the only abnormality in patients. Because ureteral obstruction causes the tuberculosis bacilli to no longer continue down the drainage, urine may be negative for finding tuberculosis bacilli, and because of the atypical presentation of imaging, such patients are difficult to diagnose, and the diagnosis is often confirmed only after surgery. Zheng Fuping (2000) reported 4 cases of simple ureteral tuberculosis that were misdiagnosed as ureteral tumors, polyps, stones and inflammatory strictures before surgery, and the diagnosis was confirmed only after postoperative pathological examination. The author has encountered 2 patients with lower ureteral obstruction of unknown nature with negative urine routine, urine for antacid bacilli and urine exfoliative cytology, which were pathologically confirmed as tuberculosis after ureteroscopy and biopsy. Since 75% of ureteral tuberculosis occurs in the lower ureteral segment, ureteroscopy is an effective screening tool, but it also poses a great risk of causing ureteral injury, which can lead to serious retroperitoneal infection and should be performed with caution. Fifth, the systemic symptoms of urologic tuberculosis are often not obvious, but it is not uncommon to have other parts of the body complicated by tuberculosis. The most common of these is genital tuberculosis. Li Yanfeng et al. (1994) reported that 47% of a group of renal tuberculosis cases were complicated by tuberculosis of other sites. Therefore, after the diagnosis of urologic tuberculosis is confirmed, further investigations must be performed to exclude other sites of tuberculosis; conversely, if tuberculosis occurs in other parts of the body, the presence of urologic tuberculosis should also be further investigated. At present, the diagnosis of urologic tuberculosis is somewhat overly dependent on imaging, but in fact imaging is not valuable for early urologic tuberculosis, and those with significant imaging changes are often already in the middle to late stages. The decisive factor in the diagnosis of urologic tuberculosis is still urinalysis. Routine urinalysis is often not taken seriously by physicians in the diagnosis of tuberculosis, but it is in fact valuable in the initial diagnosis. For those who have symptoms of chronic cystitis and have protein, red and white blood cells in the urine and acidic urine, the possibility of tuberculosis should be considered. In recent years, with the application of DNA probe technology and PCR technology, the sensitivity and specificity of tuberculosis diagnosis has reached a new height. Domestic Liao Limin et al. (1995) reported that the sensitivity of PCR method can reach 1 pg level, which is equivalent to the level of DNA contained in 100-200 Mycobacterium tuberculosis, while the sensitivity of antacid staining method is only 104-105 level. However, in clinical application, the false positive and false negative rates of PCR are still high, and the positive rate reported in China is only between 50% and 70%. However, in a group of 35 patients with renal tuberculosis reported by Hemal et al. (2000) abroad, the positive rate of urine PCR reached 4.29%, which was much higher than the positive rate of tuberculosis culture (37.14%) and bladder biopsy (45.83%). Although urine detection of Mycobacterium tuberculosis can clarify the diagnosis of urological tuberculosis, it does not determine the extent of the lesion and the degree of destruction. Imaging is essential in the diagnosis of urologic tuberculosis because not all patients with positive urinary tubercle bacilli develop clinical renal tuberculosis. ultrasound lacks specificity for the diagnosis of urologic tuberculosis, but has a high positive rate of detecting renal abnormalities, especially for the understanding of nonfunctioning renal lesions, and can be complemented by x-ray. At present, intravenous urography is still the main tool for the diagnosis of urologic tuberculosis. It is not difficult to diagnose the typical X-ray manifestations of renal tuberculosis, such as destruction of the renal calyces, irregular margins like worm-like, and loss of calyces deformation. It is worth noting that some early or atypical changes, such as narrowing of the cervical calyces and ureteric lumen leading to dilated hydronephrosis, shallow and blurred cervical calyces, and deformed and stiff ureter, can be easily missed if not taken care of. For those whose kidneys do not show up, further examination should be performed promptly. Retrograde pyelogram and percutaneous nephrostomy have recently been replaced by magnetic resonance urography (MRU) because they are invasive and have relatively more complications. The latter is noninvasive, does not require contrast, and is not renal function dependent, but the cost of the test is higher. While intravenous urography is of limited value in kidneys with advanced functional loss, CT provides a full picture of the extent and degree of renal destruction, clearly demonstrating cavities, calcifications, thickened pelvic and ureteral walls, and the formation of perinephric cold abscesses, especially in atypical cases with only thickened ureteral walls, and offers unparalleled advantages. The introduction of drugs such as isoniazid, rifampin, and ethambutol has led to a significant reduction in the number of cases of urologic tuberculosis requiring surgery. “Short-course chemotherapy” has become the accepted standard of care in the treatment of tuberculosis, and anti-tuberculosis drugs have played an extremely important role, both as treatment alone and as preoperative drugs. However, while we are still talking about the achievements of anti-tuberculosis drugs, there is an outstanding and serious problem in front of us: the drug resistance of Mycobacterium tuberculosis! It has been reported that there are about 50 million patients with drug-resistant tuberculosis (DRTB) worldwide, and 2/3 of TB patients are at risk of developing multidrug resistance (MDR). China is one of the countries with the most severe drug resistance in TB, with an initial resistance rate of 18.6% and a secondary resistance rate of 46.0%. Although studies have identified mutations in genes such as katG and rpoB as the main molecular mechanisms of resistance to several major antituberculosis drugs such as INH, the mechanism of drug resistance in M. tuberculosis is complex and has not been fully elucidated. treatment of patients with DRTB and MDRTB is quite tricky and the cost of treatment is several times or even tens of times that of a primary patient. The possibility of drug resistance should be considered when the clinical treatment of urological TB with anti-tuberculosis drugs is ineffective, and drug sensitivity testing is necessary at this time.