On World Tuberculosis Day, celebrated today (24), the Brazilian Society of Urology (SBU) warns the population that the disease, when not diagnosed and treated or when treatment is suspended, can cause complications in other organs of the body, including genitourinary tuberculosis, one of the most serious consequences of pulmonary tuberculosis.
The president of the SBU, Alfredo Canalini, explained to the Brazil Agency that, in the country, the entrance door of Koch’s bacillus, which causes tuberculosis, is the lung. Most of the time, the disease starts with a lung infection that can cause some symptoms that the patient ends up neglecting, such as fever, persistent cough and weight loss.
“This Koch bacillus, as it colonizes the lung, the lymph nodes, it can reach the bloodstream. When that happens, it can lodge in different parts of the body,” he said. The consequences can be bone tuberculosis and urinary tuberculosis. Tuberculosis can be prevented with the BCG vaccine in newborns.
In the case of urinary tuberculosis, Canalini informed that, as the kidney is an extremely vascularized organ, the chance of being affected by this disease is very high, depending on the blood load it receives. Tuberculosis affects, in the first place, the kidney tissue, without causing, at first, any problem for the patient to urinate.
“But as the kidney disease grows, that bacterium reproduces and can begin to be expelled through the urine. It gets to the collecting system, which is where the urine produced by the kidney is being conducted to the bladder and, there, urinary problems can start to happen”, he indicated.
When symptoms are present, pain when urinating, pain in the lower back, blood in the urine, frequent urination, recurrent urinary tract infection and fever may occur. These symptoms, however, usually take time to appear.
Campaign
According to Canalini, the problems are very reminiscent of the complaints of a common cystitis. Often, the patient thinks that it is a common bladder inflammation and even primary care professionals will medicate it as if it were cystitis and do not pay attention to the possibility of urinary tuberculosis.
If the patient is not seen by a urologist who asks for tests to detect tuberculosis, what can happen is the disease progressing and destroying the ureter, the bladder and, in the case of men, it can cause an abscess in the testicles.
“It is a disease that, if not treated properly, can even cause the death of the patient.” The president of the SBU recalled that when tuberculosis was untreated, many people died. Today, there is treatment.
Therefore, the campaign that the SBU is doing aims to make people think about the possibility of diagnosis in patients who have urinary complaints and do not improve with treatments that would be used in more common situations, such as simple cystitis.
Secondly, the purpose is to warn the population that, when the diagnosis of tuberculosis is made, the treatment has to be carried out with a very strict discipline.
“The patient has to follow the doctor’s recommendations. He cannot abandon treatment in the middle. This is a situation that we sometimes find ourselves in. The patient begins treatment and, at the end of the third month, decides to abandon treatment. In a few years he will have urinary tuberculosis,” he said.
The treatment lasts for six months and has to be done until the end, even if the symptoms have disappeared. It is that the end of symptoms does not necessarily mean that the disease is completely overcome. Medication is available from public health services and is given free of charge. “The patient has to adhere to the treatment and strictly follow the doctor’s recommendations”, stressed the specialist.
specific infection
In women, in addition to the urinary tract, genitourinary tuberculosis can affect the tubes, endometrium and ovaries, cause infertility, pelvic inflammatory disease, amenorrhea or increased menstrual flow.
The disease has an incidence between 7.1% and 15% of cases of pulmonary tuberculosis. Canalini explained that, in medicine, tuberculosis is called a specific infection. This means that the reactions that Koch’s bacillus causes, no other bacillus causes.
Another aspect is that, in urinary tuberculosis, there are complications resulting from the infection and, throughout the treatment, the patient has to be followed up by a urologist because the healing process of the lesions can cause problems.
“We have to be attentive and follow this patient throughout the treatment process because, as those lesions heal, they can cause an obstruction of the ureter, which is a thin tube that carries urine from the kidney to the bladder” , he said. This obstruction is removed through surgery.
He added that the patient can only undergo definitive treatment when the disease is cured and overcome. The sequels will be dealt with later.
Risk factors
According to the Ministry of Health, in 2019, Brazil registered 73,864 new cases of the disease (35 per 100,000 inhabitants). In 2020, this number dropped to 66,819 new cases of tuberculosis, which corresponds to an incidence of 31.6 cases per 100,000 inhabitants. the fall can to have as a result of the Covid-19 pandemic.
Diabetes, smoking, and diseases that lower immunity (such as AIDS) can make it easier for you to become infected with Koch’s bacillus. The president of the SBU also stated that smoking is the leading cause of preventable death on the planet, responsible for a series of problems such as pulmonary emphysema, lung cancer and bladder cancer.
For the patient who is a smoker, has emphysema and acquires tuberculosis, “this is a potentiator of the severity of the problem and the respiratory failure that he can to have”. Tuberculosis is more common among males, as well as people in vulnerable situations, such as health professionals, homeless people and individuals deprived of their liberty.
