|Year : 2006 | Volume
| Issue : 3 | Page : 270-271
Renogluteal fistula: An unusual complication of genito-urinary tuberculosis
VS Hanchanale1, AR Rao2, HG Motiwala2
1 Department of Urology, Leighton Hospital, Crewe, United Kingdom
2 Department of Urology, Wexham Park Hospital, Slough, United Kingdom
V S Hanchanale
Research Fellow, Urology, Leighton Hospital, Crewe, Cheshire, CW1 4QJ
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Involvement of the genitourinary organs is the most common site of extra-pulmonary tuberculosis. Genitourinary tuberculosis (GUTB) almost always starts from the kidney. A wide spectrum of complications can arise from the kidney being affected by GUTB. A rare complication of GUTB in the form of renogluteal fistula is described. Excision of the fistula with nephroureterectomy combined with anti-tubercular treatment has resulted in cure.
Keywords: Nephroureterectomy, renal tuberculosis, renogluteal fistula
|How to cite this article:|
Hanchanale V S, Rao A R, Motiwala H G. Renogluteal fistula: An unusual complication of genito-urinary tuberculosis. Indian J Urol 2006;22:270-1
| Introduction|| |
Tuberculosis (TB) is the leading cause of death worldwide from a single infectious disease. There is a resurgence of TB worldwide and the appearance of multi-drug-resistant strains in HIV patients is also of concern. Involvement of genitourinary organs tops the site for extra-pulmonary tuberculosis. It can affect the kidney, ureter, bladder and genital organs. The incidence of extra-pulmonary TB is higher in HIV patients. Sinus elsewhere in the body is a common manifestation of cold abscess but a renal fistula is an uncommon presentation. We present an unusual case of renal tuberculosis presenting with a fistula in the gluteal region.
| Case Report|| |
A 20-year-old male patient presented with a left gluteal sinus discharging pus mixed with urine for one year with loss of weight, decreased appetite and left flank pain [Figure - 1]. In the past he had an abscess drained from his back, the nature of which was not known and he had not received any specific treatment for this. He had white cell count of 12,000 and ESR of 60 mm/1st hour. Urine microscopy showed sterile pyuria. Plain X-ray KUB revealed a left renal opacity consistent with calcification. Small scarred left kidney with loss of corticomedullary differentiation and normal right kidney was noted on ultrasound examination. Intravenous urogram revealed well draining right upper tract with no excretion of dye on the left side [Figure - 2]. Gluteal sinus communicating with the renal pelvicalyceal system was demonstrated on the fistulogram [Figure - 3]. Culture of the urine from the kidney grew mycobacterium tuberculosis. He underwent nephroureterectomy with excision of the fistulous tract extending from the left gluteal region up to the renal pelvis [Figure - 4]. Histopathological examination confirmed tuberculosis. The postoperative course was uneventful and the wound healed primarily. After nine months of anti-tuberculosis treatment, he gained 10 kg in weight and has remained symptom-free.
| Discussion|| |
The usual presentation of tubercular renal fistulae is mostly in the flank because of direct access. Currently, percutaneous and open abdominal surgical procedures are the leading causes of renal fistulae, this case was unusual to present as a renogluteal fistula. Other common causes of reno-cutaneous fistula are xanthogranulomatous pyelonephritis and calculus disease. It is possible that the tract had already been formed from incision and drainage of old cold abscess from the back. A new abscess resulting from kidney involvement must have tracked down the old tract. Presence of pus and urine is the hallmark of diagnosing such renal fistula. Investigations should include chest X-ray to rule out pulmonary tuberculosis. Radiological evidence is present in less than 50% of cases and active disease is present in approximately 5% of these patients. In future, high resolution sonographic examination and polymerase chain reaction may replace the traditional AFB staining and culture for diagnosis of GUTB., Complete excision combined with anti-tubercular treatment has resulted in cure in this case. The case was described for its rare presentation.
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
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