Clinical presentation of urogenital tuberculosis in a Sub-Saharan tertiary care center: a retrospective cross-sectional study

Background Tuberculosis remains the second leading infectious killer worldwide. Extrapulmonary tuberculosis represents 15%-40% of all cases, with urogenital tuberculosis (UG-TB) as the second most common form. UG-TB can cause severe urologic complications - including obstructive uropathy, renal failure, and infertility - due to inflammation and scarring. This study describes the presentation of UG-TB in a low- and middle-income country (LMIC). Methods We conducted a retrospective, cross-sectional study of patients diagnosed with UG-TB at a semi-private, tertiary referral hospital with a 160-bed capacity in Kigali, Rwanda between 2015 and 2023. We collated patient logs from the hospital’s inpatient and laboratory’s tuberculosis registry to identify all cases of UG-TB. Results 32 patients were diagnosed and treated for UG-TB. Nearly all were male (96.9%), Rwandan nationals (90.6%), and younger than 55 years old (90.6%). Most had no known medical comorbidities (87.5%), and none were HIV positive. The majority (75%) presented with a scrotal mass, typically a unilateral epididymal nodule (83%); and the remaining presented with upper urinary tract and/or bladder TB. Nearly half (41%) of the patients required surgical intervention for their disease. Three patients required nephrectomy, one underwent bladder augmentation with bilateral ureteroneocystostomy, and one required unilateral nephroureterectomy with contralateral ileal ureter. Conclusions UG-TB imposes a high surgical burden in otherwise young, healthy men. Raising the clinical suspicion of this disease in LMICs may improve earlier detection and subsequent treatment. Further, expanding subspecialty training in complex urinary reconstruction is essential to equip urologists to manage these challenging cases.