Tuberculosis of the Testis, Epididymis, Scrotum and Scrotal Contents and Tuberculosis of the Penis and Urethra: A Review and Update

Cases of tuberculosis of the testis, epididymis, scrotum and or the penis including the urethra are very rare even though pulmonary tuberculosis is common globally. In view of the fact that tuberculosis of the scrotum and scrotal contents and penis is rare, it would be envisaged that majority of clinicians would not have encountered a case of this infection during their training and professional practices. Tuberculosis which has afflicted either the scrotum, testis, epididymis and penis does manifest with non-specific symptoms that simulate symptoms of more common conditions of the scrotum, scrotal contents and penis and hence a high index of suspicion is required in order to establish a prompt correct diagnosis in order to initiate the correct treatment. Tuberculosis of the testis and tuberculosis of the scrotal contents as well as the penis usually manifests as is as painful or painless testicular swelling with or without scrotal ulceration or discharging sinus. Infertility may occur. Epididymal involvement is usually seen in testicular TB. In most cases, genital TB is associated with TB involvement of kidneys or lower urinary tract. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, orchidectomy is required for both diagnosis and treatment. Tuberculosis of the scrotum would tend to present as a nodule, ulceration, mass or bleeding or rash on the scrotum. Tuberculosis of the penis would tend to manifest as a nodule, ulceration, a mass or masses on the penis, a urethral fistula or voiding problems. Tuberculosis of the scrotal contents, scrotum or penis may occur alone or there may be a history of contemporaneous pulmonary tuberculosis or tuberculosis elsewhere in the body or there may be a history of an antecedent tuberculosis elsewhere in the body which had been treated before. Isolation and culture of M. tuberculosis, fine needle aspiration cytology (FNAC) and polymerase chain reaction (PCR) may provide an accurate diagnosis of tuberculosis of the scrotum and scrotal contents as well as the penis even though in some cases histology may be the only confirmatory diagnostic modality. Anti-TB chemotherapy is the mainstay of treatment, however, in few cases, orchidectomy is required for both diagnosis and treatment of tuberculosis of the testis and epididymis. Also, on rare occasions when tuberculosis of the penis is misdiagnosed initially as possibly malignancy of the penis, partial amputation of the penis may be undertaken before the diagnosis of tuberculosis of penis is finally confirmed. Nevertheless, if a high index of suspicion for the possible diagnosis of tuberculosis of the scrotum and scrotal contents is maintained then early biopsy of the scrotal and intra-scrotal lesion or penile lesion for pathology examination would help establish the diagnosis of tuberculosis so that mutilating surgery would be avoided. The association between infertility and testicular and epididymis mass should alert the clinician to have a high index of suspicion for tuberculosis. Diagnosis of tuberculosis of the scrotum, testis, epididymis, and or penis can be confirmed by the histopathology examination finding of caseating Granuloma with multi-nucleated Langhan’s giant cell upon pathology examination of biopsy specimen of the lesion. Conclusions: Tuberculosis of the testis, epididymis, scrotum, penis, and urethra are rare clinical entities which all clinicians should have a high index of suspicion for in order to ensure they establish a prompt diagnosis for in order to avoid misdiagnosis as well as delay in the provision of appropriate early treatment of their patients who have the condition. Cases of tuberculosis of the testis, epididymis, scrotum, penis, and urethra do simulate many common clinical conditions of the testis, epididymis, scrotum, penis as well as urethra. Biopsy of lesions of the testis, epididymis, scrotum, penis, and urethra for pathology examination is very useful for the diagnosis of tuberculosis of the testis, epididymis, scrotum, penis, and urethra in order to treat patients who have the disease appropriately and to avoid the undertaking of mutilating surgery and patients who have been treated for this disease should be followed-up carefully over a long time period to ensure the patients do not develop recurrence and to identify quickly patients who develop recurrence early in order to quickly effective and appropriate treatment for the early recurrent disease so ss to achieve satiety of all patients who are treated for the disease. Tuberculosis of the testis, epididymis, scrotum, penis, and urethra, could manifest as de novo disease or they may manifest contemporaneously (synchronously) with pulmonary tuberculosis or tuberculosis elsewhere of at times pursuant to previous treatment of patients who had undergone treatment for pulmonary tuberculosis or tuberculosis elsewhere in the body. Tuberculosis of the testis and epididymis may on rare occasions manifest as infertility as well as pursuant to treatment of tuberculosis of the testis and epididymis, some patients may manifest with infertility subsequent to complete and appropriate treatment of the disease related to scarring and obliteration of the lumen of the epididymis and perhaps obliteration of the ejaculatory duct as well as scarring within the testes of the disease is bilateral.