Mohd. Hamid Shafique AHMED, Swaroop SUBBARAYA, Vishnu PRATAP, Ajit SAWANT, Prakash PAWAR, Amandeep ARORA, Siddharth Nayak K, Vishwadip BHALERAO
Journal of Urological Surgery - 2026;13(3):155-159
Objective: Genitourinary tuberculosis (GUTB), a prevalent form of extrapulmonary tuberculosis, is challenging to diagnose because of non-specific symptoms, and the low sensitivity of conventional diagnostic tests. The GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay offers rapid detection, however, its performance in urine for GUTB diagnosis has not been well characterized. The objective is to evaluate the clinical spectrum, diagnostic approaches, and management of GUTB and assess the sensitivity of urine GeneXpert compared to acid-fast bacilli (AFB) culture. Materials and Methods: We conducted a retrospective analysis of 42 GUTB cases diagnosed using South Indian Consensus criteria at a tertiary care hospital in India (March 2013-March 2019). Diagnostics included urine AFB staining, GeneXpert MTB/RIF, and culture (Löwenstein-Jensen and mycobacterial growth indicator tube). The clinical features, radiological findings (computed tomography, intravenous pyelogram, retrograde pyelography, GUTB, magnetic resonance imaging), histopathology, and treatment outcomes were evaluated for each patient. The sensitivities of GeneXpert and culture were calculated with 95% confidence intervals (CIs) for all cases. Results: Among 42 patients (male: female ratio 1.1), 38% were in their fourth decade of life. Flank pain was predominant (52%; 22/42), and 27% had a history of tuberculosis. Urine AFB was positive in 12% (5/42) of samples, GeneXpert was positive in 57% (24/42; 95% CI: 41-72%), and culture was positive in 52% (22/42; 95% CI: 37-68%). In histopathologically confirmed cases (n=19), GeneXpert sensitivity was 52.6% (10/19; 95% CI: 29-76%) and culture sensitivity was 47.4% (9/19; 95% CI: 24-71%). Radiology suggested GUTB in 82.5% (35/42) of the cases, with renal involvement being the most common finding. Nephrectomy was performed in 59% (25/42) of the patients, and no rifampicin resistance was detected. Conclusion: The sensitivity of GeneXpert in urine samples (52-57%) is comparable to that of AFB culture, offering a rapid diagnosis of GUTB. The integration of clinical and radiological data enhances diagnostic accuracy. Multicenter studies are needed to optimize urine-based protocols.
