Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 2003  |  Volume : 13  |  Issue : 2  |  Page : 236--237

Primary tuberculosis of the prostate


N Bhargava, SK Bhargava 
 Department of Radiology and Imaging UCMS and GTB Hospital, E-3, GTB Hospital Campus, Dilshad Garden, Delhi-110095, India

Correspondence Address:
N Bhargava
Department of Radiology and Imaging UCMS and GTB Hospital, E-3, GTB Hospital Campus, Dilshad Garden, Delhi-110095
India




How to cite this article:
Bhargava N, Bhargava S K. Primary tuberculosis of the prostate.Indian J Radiol Imaging 2003;13:236-237


How to cite this URL:
Bhargava N, Bhargava S K. Primary tuberculosis of the prostate. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Oct 14 ];13:236-237
Available from: http://www.ijri.org/text.asp?2003/13/2/236/28670


Full Text

Sir,

We wish to report an unusual case in which primary tuberculosis of the prostate produced obstructive urinary symptoms. A 50 years old man presented with a history of acute retention of urine. Rectal examination revealed grade III benign prostatic hyperplasia, without any nodule. Focal tenderness was noted. Prostatic enzymes were within normal limits. Chest Radiograph was normal with no evidence of any recent or old tuberculous lesion.

Ultrasound of the pelvis revealed a grade III prostate with lobulated border. Heterogenous parenchymal echotexture along with multiple irregular cavitating lesions were noted within the prostate. Also noted were irregular projections of the prostatic tissue within the urinary bladder, & significant residual urine. These cavities were thought to represent necrosis or haemorrhagic areas due to carcinoma of prostate or prostatic infarction in a case of benign prostatic hypertrophy [Figure 1][Figure 2] .Cystoscopy revealed enlongated & stretched prostatic urethra. The bladder was of normal capacity.

Retropubic prostatectomy was performed & the material was sent for histopathological examination. The prostatic tissue measured 100 g and was firm in consistency. The cut surface showed small foci of necrosis. Caseating epitheloid granulomas with Langer hans type giant cells were seen. Acid fast bacilli were also seen. A diagnosis of tuberculosis of the prostate was made.

Following this, an extensive search for tuberculous foci elsewhere was made. None was found. The patient was placed on antitubercular therapy. He showed improvement & is on a regular follow up.

Sporer [1] reported 728 autopsies of tuberculosis cases of which 100 showed prostatic involvement. In Medlar's [2] series of cases of genital TB, the prostate was involved in all. Thus prostatic TB is an uncommon condition but its incidence should be higher than stated in the radiologic literature. The frequency of prostatic tuberculosis is not reflected in clinical practice as we have poor access to the organ as well as lack of awareness about this pathology [3]. Most of these lesions are post primary in nature.

Primary prostatic lesion in the truest sense are probably very rare [3]. Lesions considered to be primary are those in which there are no other demonstrable foci. The possible routes of TB involvement of the prostate are : descending infection from the urinary tract, lymphatic & haematogenous spread, direct extension from neighbouring organs & rarely ascending infection through the urethra. It has been known to occur following intravesical BCG therapy for bladder carcinoma [2].

Basically, the prostate gland is enlarged & contains intraprostatic lesions that represent caseous necosis & inflammation. Tuberculous abscesses & excavations produced within the gland may also communicate with the urethra [2]. Demonstration of Acid fast bacilli in prostatic passage & urinary deposits may be potent diagnostic tools, provided there is considerable awareness of this pathology [3].

US reveals enlargement of the gland with solitary (rare) or multiple hypoechoic zones of varying sizes within. Irregularity of the of outline these hypoechoic areas may also be noted. Irregularity of the external contour of the prostate has also been noted. The irregularity disappears with medical treatment [2]. The TRUS findings are variable, usually showing a heterogenous echotexture, and dystrophic calcification may be noted [4]. Color Doppler US may help in detection of increased vascularity in the inflammatory phase of granulomatous prostatitis [4]. FNAC / drainage may be performed under US guidance via a transperineal or transrectal route [2].

CT provides direct visualisation of the intraprostatic lesions & reveals them as low density areas with irregular borders. Contrast enhanced CT demonstrates these lesions more clearly [2]. Granulomatous prostatitis produces low signal intensity in the peripheral zone on long TR/TE images. A prostatic abscess is seen as an area of intermediate signal intensity on short TR/TE images & high signal intensity on long TR/TE images [2].

Our case is likely to be primary as there were no other demonstrable tuberculous lesions and the patient improved after initation of anti tubercular therapy

References

1Sporer A, Auerbach O. Tuberculosis of prostate. Urology,1978 ; 11:362-365.
2Suleman A Merchant. Tuberculosis of the genito urinary system. Part 2:Genital tract Tuberculosis. Ind J Radial Imaging 1993;3:275-286
3Basu A, Kapoor R, Sharma SK. Primary prostatic tuberculosis - A case report. Indian Journal of Urology 1988 ;4:85-86
4Bude R. Brec RC, Adler RS, Jafri SZ. Transrectal ultrasound appearance of granulomatous prostatits. J ultrasound Med 1990;9:677-680