An interesting case of vesical fistula complicating urogenital tuberculosis

The genitourinary tract is one of the commonest regions that can be affected by extrapulmonary tuberculosis where the diagnosis can be quite difficult. A high index of suspicion and an awareness of the atypical clinical manifestations of urogenital tuberculosis (UGTB) are important, especially in patients from regions where tuberculosis continues to be a major public health problem. Herein, we report a 33-year-old male who presented with a non-healing fistula at the site of suprapubic catheter following an emergency repair of traumatic bladder rupture. Further evaluation revealed a scarred, small capacity bladder with urinary fistulae along with a poorly functioning kidney which was suspicious of a tuberculous etiology. Urinary isolation of Mycobacterium tuberculosis and a positive bladder biopsy confirmed our suspicions that the findings were indeed part of the spectrum of UGTB. The patient was started on anti-tubercular chemotherapy and underwent a nephrectomy along with an ileal conduit and is doing well at 1-year follow-up. To conclude, urogenital tuberculosis always has to be kept in mind especially when dealing with patients with non-healing urinary fistula, especially in endemic countries. A high index of suspicion along with careful and methodical workup of patients with atypical complications following common surgeries can lead to identification of this morbid condition and thereby avoid mismanagement and progression to chronic kidney disease.