Genitourinary tuberculosis (GUTB) remains a significant public health concern, particularly in endemic regions, presenting a wide clinical spectrum that poses diagnostic and therapeutic challenges. This study aims to evaluate the clinical manifestations, surgical management strategies, and outcomes of GUTB based on a retrospective analysis of patients treated at a tertiary care center.

A retrospective analysis of genitourinary tuberculosis (GUTB) cases was conducted in a urology department at a teritiary teaching centre from January 2021 to July 2024. The analysis focused on demographic profiles, clinical presentations, diagnostic modalities. . Surgical interventions, such as nephrectomy, ureteric reimplantation, and augmentation cystoplasty, were employed as needed, alongside standard antitubercular therapy. The extent of disease progression guided treatment decisions. Data were analyzed using SPSS and presented as frequencies and percentages.

The mean age of the participants was 39 years ranging from 10 to 76 years with slightly higher proportion of females (57.6%) than males (42.4%). The most common clinical presentation was Storage Lower Urinary Tract Symptoms (LUTS) seen in 66.6% of patients, of which frequency was most commonly observed. Hematuria occurred next in frequency (27.2%), followed by Flank Pain (21.2%). Other symptoms such as fever, discharging sinus, and abdominal pain were less frequent (6% or less). Eleven (33.3%) patients reported multiple symptoms. The kidney was the most involved organ (54.5%), followed by the ureter (45.4%), and bladder (42.4%). More than one organ being involved in 57.6%. Most of the cultures were negative (94%) for mycobacteria. Diagnosis by Radiological findings was the most common approach for diagnosing genitourinary tuberculosis, accounting for 42.4% of the cases. CBNAAT (30.3%) was the second most common diagnostic method, Urine ZN stain for AFB was positive in (21.2%), and in 6% culture was positive for MTB. Augmentation cystoplasty (15.1%) was the most performed major surgery, followed by ureteric reconstruction (9.09%). For minor procedures, DJ stenting (24.24%) was the most common due to ureteral obstruction, while PCN (15.15%) was used for severe renal cases. DJ stent replacement (15.15%) was sometimes required due to complications.

Early detection, multidisciplinary team decision making, and long-term monitoring are essential for the management of GUTB. Surgery in combination with Anti Tubercular therapy plays a crucial role in restoring normal function to the genitourinary system on individualised basis. The reconstructive procedures involved can be complex, intricate and time-consuming, but when carried out with precision, they have the potential to yield outstanding results, effectively offering a new lease of life to individuals who are contending with the challenges of genitourinary tuberculosis.