Understanding the Clinical Presentation of Patients with Urogenital Tuberculosis in a Sub- Saharan Tertiary Care Setting

Introduction: 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 at a tertiary hospital in a low- and middle-income country (LMIC), aiming to raise clinical suspicion among providers. 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. Conclusion UG-TB imposes a high surgical burden in otherwise young, healthy men. Expanding subspecialty training in complex urinary reconstruction is essential to equip urologists to manage these challenging cases.