GENITOURINARY TUBERCULOSIS....A NIGHTMARE FOR UROLOGISTS

            A 29 y gentleman presented with severe storage LUTS, dysuria, hematuria since 3 months.

Examination revealed bilateral epididymal nodules ( he also underwent I&D for scrotal abscess few years ago). His creatinine was raised (1.8), so as the ESR (45). USG revealed left pyonephros with contracted pelvis and dilated and thickened upper ureter and calyces. Bladder was only 40 ml (prevoid on USG). Modified AKT and other antibiotics were started after appropriate cultures and he was taken up for Cystoscopy + left RGP + Lt DJ stenting and bladder mucosal biopsy.

DILATED LOWER END OF URETER WITH LONG SEGMENT PROXIMAL STRICTURE

STRICTURED MID URETER

SEGMENTAL DILATION OF UPPER URETER

DESTROYED PCS ANATOMY WITH CONTRACTED RENAL PELVIS AND MOTH-EATEN CALYCES

After 4-6 weeks of AKT , split renal function will be assessed by renogram and further course of management planned.