A rare case of urinary tuberculosis in a 14-year-old: Diagnosis and surgical management.

Introduction: Urogenital tuberculosis (UG-TB) accounts for 30-40% of extrapulmonary TB (EPTB) cases and is extremely rare in the pediatric age. It is usually diagnosed in advanced stages, and its treatment mostly requires antitubercular therapy combined with surgery.

Clinical case: 14-year-old patient with no previous history of lung disease, who presented recurrent UTIs (sterile pyuria) and chronic lower urinary tract symptoms. On ultrasound right hydronephrosis was seen, and a CT scan revealed vertebral lesions that led to the diagnosis of TB. Urinary symptoms improved after combined treatment with anticholinergics, suprapubic catheter placement and hyaluronic acid instillations. Additional studies showed right renal atrophy, parenchymatous calcifications and multiple ureteral stenoses. Due to global renal involvement and afunctionality, right nephroureterectomy was performed laparoscopically, without complications. Following completion of antituberculous therapy, the suprapubic catheter was removed and the patient was transitioned to clean intermittent catheterization (CIC). At present, the clinical course is favorable under intermittent catheterization, with no infectious episodes, and regular follow-up of the solitary remaining kidney is maintained.

Conclusions: UG-TB must be suspected in patients with recurrent UTIs who present with sterile pyuria. Laparoscopic approach is safe and feasible in spite of the intense scarring associated with this pathology.