Testicular tuberculosis (TB) is a rare form of genitourinary TB. It is usually presented as painful or painless testicular swelling with or without scrotal ulceration or discharging sinus. Infertility may occur. Epididymal involvement is usually seen in testicular TB. In most cases, genital TB is associated with TB involvement of kidneys or lower urinary tract. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, orchidectomy is required for both diagnosis and treatment. Here, we report a very rare case of left sided isolated testicular TB in a 20-year-old male who was completely cured with 6 months regimen of anti-TB chemotherapy.

A rare case of isolated testicular tuberculosis and review of literature.

Testicular tuberculosis (TB) is an uncommon presentation of extrapulmonary TB. Although rare in incidence, it is a great masquerader and should be kept in consideration while assessing focal abnormalities involving the testis. Ultrasound findings alone may be non-specific and mimic other diagnoses including infection, inflammation, tumor, infarct, and trauma. The main objective of this sonographic pictorial review is to discuss the imaging findings, specific differentiating features against each differential and use of ancillary imaging findings whenever available. Concurrent involvement of epididymis, septated hydrocele, scrotal wall edema, and calcification of tunica vaginalis provides strong evidence in an appropriate setting. Available extratesticular ancillary imaging findings must be correlated for correct diagnosis due to non-specific imaging and clinical presentation. Misdiagnosis of scrotal TB may lead to otherwise avoidable epididymo-orchiectomy.

"The Great Masquerader": Sonographic Pictorial Review of Testicular Tuberculosis and its Mimics

The pathogenicity of Mycobacterium tuberculosis (M. tuberculosis) causes it to most commonly manifest within the respiratory system (pulmonary tuberculosis); however, 15% of cases undergo extra-pulmonary spread to various organs. Genitourinary tuberculosis (GUTB) is a rare form of tuberculosis infection which has a propensity to affect the genitourinary tract, primarily affecting the kidneys, epididymis, seminal vesicles and prostate; however, 0.5% of cases result in infection of the testicles. This may present unilaterally or bilaterally with varying atypical presentations, thus misleading physicians in diagnosis. We present a case in a 48-year-old patient admitted to the surgical assessment unit in our hospital presenting with a unilateral painful testicular lesion and scrotal changes. He was admitted nine weeks prior for unexplainable constitutional symptoms however presented again whilst awaiting follow up in an outpatient clinic. Ultrasound guidance and fine-needle aspiration & culture (FNAC) of the lesion resulted in a positive diagnosis for M. tuberculosis. He underwent anti-tuberculous chemotherapy treatment for six months as per clinical guidance with adequate clinical response.

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Unilateral Testicular Tuberculosis: An Extra-Pulmonary Manifestation.

Tuberculosis of the genitourinary system has not lost its relevance. During the years of the pandemic of a new coronavirus infection, the number of newly diagnosed cases of tuberculosis of all localizations has decreased, but their structure has become more severe and mortality has increased. There is a wide variation in the statistics of urogenital tuberculosis (UGT) in the literature. The true incidence of scrotal tuberculosis is not known; at the end of the last century, it was believed that it was 7% of all cases of tuberculosis. It is believed that the share of isolated tuberculosis of the genital organs of men accounts for no more than 30% of all localizations of UGT, and most often tuberculosis develops in the epididymis. The spread of M.  tuberculosis to the organs of  the scrotum, as a rule, occurs by the hematogenous route from the primary focus in the lungs or kidney. However, the infection can also spread retrogradely from the prostate and seminal vesicles to the epididymis and  testicles. Tuberculosis of the testis and its epididymis is often complicated by infertility and the formation of fistulas. This disease has no pathognomonic symptoms. Differential diagnosis is carried out between tuberculous epididymo-orchitis, testicular tumor, testicular torsion, bacterial epididymo-orchitis. Ultrasound examination is of great diagnostic value in tuberculosis of the scrotal organs. The ultrasound picture in tuberculosis of the testis and its epididymis is divided into 4 types: diffuse enlargement, heterogeneous hypoechogenicity; diffuse increase, uniform hypoechogenicity; nodular enlargement, heterogeneous hypoechogenicity; miliary dissemination. The world literature does not describe an example of tuberculosis of  the scrotal organs, when the disease would be diagnosed during the  patient’s initial visit to the doctor. As a result of late diagnosis or low suspicion for TB, up to 70% of patients undergo unnecessary surgery, although TB orchiepididymitis can be treated medically. The lecture also analyzed a number of clinical observations. 

Tuberculosis of the testis and its appendages

Genital tuberculosis (TB) is a rare, comprising <0.5% cases of extrapulmonary TB. Among cases of genitourinary TB, glandular TB is even rarer. Its a diagnosis of exclusion. Most patients present later in the course of disease due to the associated stigma in view of site of involvement and the hesitancy on the patients's part. We saw two such cases of nonhealing genital ulcers in immunocompetent males.

Case series of genital tuberculosis

The genitourinary tract is the most common extrapulmonary site affected by tuberculosis. The male genital organs are involved in more than 50% of patients. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy. Key words: genitourinary tuberculosis, testis, USG, FNAC doi:10.3126/jnps.v29i1.1598 J. Nepal Paediatr. Soc. Vol.29(1) p.30-32

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SM Gurubacharya

Papers

A 14-year-old boy with Isolated Tuberculous Orchitis