Arun(name changed) a 26 yr old male nurse approached me with a problem not very frequently associated with his age. He said he was passing urine frequently ( every 10 min,he said) for the past few months. He had been dismissed from his hospital job recently ( A 🧵)
because of this problem. He had been to numerous GPs & general physicians, who had given him a motley of antibiotics. Finally, he approached me, a urologist. As always, I took a thorough history and a physical examination. Apart from frequency, he cd not give me any symptoms.
I proceeded to do urine examination, routine urine culture and blood tests. Urine test (in this particular pt) and the urine culture was negative for the usual bacteria. Most normal adults urinate between 5 to 7 times in a 24 hour period. Anything more than 8 consistently shd be
investigated. Usual causes for⬆️ frequency of urination are:
1. Urinary Tract Infection
2. Benign Prostatic Hyperplasia
3.Diabetes Mellitus
4.Diabetes Insipidus
5.Overactive Bladder(OAB)
6.Prostatitis
7.Post-Radiation treatment
8.Bladder stones
9.Anterior Vaginal prolapse
10. Interstitial Cystitis
11.Pregnancy
12.Hypercalcaemia
13. Intake of diuretics drugs
14.Easy availability of toilets
15. Bladder cancer.
The cause needs to be identified and addressed.
Arun underwent a CT scan(with contrast), which revealed a very small urinary bladder (called Thimble Bladder). The normal urinary bladder hs a capacity of 500 ml. When 120 ml of urine accumulates, u get the first sensation of bladder filling. The first urge 2 void comes at 180 ml
A toilet being available, one usually voids at bladder urine volume between 225-300ml. Normal urine output in a day is btw 1-1.5 litres a day. Coming back to Arun, I did a Urine examination for Acid-Fast Bacilli(AFB) & a urine culture fr AFB. The latter is an excellent test.
The urine culture for AFB was positive in Arun. I proceeded to do a cystoscopy (putting a camera into the bladder to examine the insides). It revealed a very small capacity bladder(around 20 ml) , a distorted ureteric opening(called golf hole ureter).
The entire bladder wall had an unusual red glow. I took a small bit of tissue from the bladder, which showed infection with Mycobacterium Tuberculosis,one of the causative organisms of TB. A pulmonologist’s opinion was obtained and Antitubercular treatment (ATT) started.
For improving the capacity of the bladder, so that he cd hold more urine,I did a surgery called Augmentation Cystoplasty. A piece of bowel was recruited during surgery and stitched to the opened bladder. Today, Arun has found a new job, and leads a contended life.
In my series, I have found that Genito-urinary Tuberculosis (GUTB) affects 20% of patients with pulmonary (lung) tuberculous. This is 2nd only 2 lymph nodal TB as an extrapulmonary affliction.GUTB can cause:
Infertility
Strictures(narrowing of passages)anywhere in d urinary tract
Fistulas
Kidney Failure
Renal Hypertension
Prostatic abscess
Vaginal ulcers
The usual dose of ATT is same as that of Lung TB & the cure rates are excellent in GUTB. When diagnosed early,complications can be prevented by starting treatment early. In India, I find GUTB as a significant cause of infertility, by narrowing of the fallopian tubes in the female
and Vas Deferens in d male. With the emergence of HIV infection, Tuberculosis (that very often co-exists with HIV) hs found a resurgence. Multidrug resistant TB is also a serious concern in India. Research into newer Anti-TB drugs will yield great public health benefits in India.
deemagclinic
deemagclinic 