Tuberculosis, or TB, primarily affects the lungs but the causative bacteria, Mycobacterium tuberculosis, can spread to other parts of the body, including the kidneys, bladder and urinary tract. Urinary tuberculosis can arise because the tuberculosis virus directly invades the kidneys or lower urinary tract, or it can result from urinary system deposits of the protein amyloid, formed when tuberculosis destroys other body tissues.
Dysuria means painful or difficult urination. Urinary tuberculosis can cause a burning or gripping sensation during urination. Patients may feel an urge to urinate but be unable to. Many other conditions, including a run-of-the-mill urinary tract infection, can cause dysuria, so this symptom is not helpful in diagnosing urinary TB.
Hematuria means blood in the urine. The urine might carry a pinkish tinge that the patient can identify as blood, or the contamination might be visible only to a doctor checking urine under the microscope. Even a few drops of blood can discolor urine, so hematuria should not unduly worry the patient. As with dysuria, many conditions other than urinary TB can cause hematuria.
Patients with urinary TB typically complain of pain along the side between the last rib and the top of the hip, known as the flank. Flank pain is a common sign in many conditions that affect the kidneys. Patients often have back pain too, according to the Merck Manuals Online Medical Library.
Tuberculosis infection can spread from the kidney into the space surrounding it. The infection can spread to the psoas muscle, running from the lower back to the thigh. Sometimes infection of the psoas causes an abscess on the front of the thigh.
According to Drs. Golden and Vikram in their November 2005 paper in “American Family Physician,” urinary tuberculosis usually does not affect kidney function. The exception occurs with tuberculous interstitial nephritis, or inflammation in the spaces between the kidney tubules, which interferes with filtration and can shut down the kidneys.
In men, urinary TB can spread to the prostate gland, the tubes between the prostate and testes, and the testes themselves. Men with genital TB often have a lump in their scrotum, according to Drs. Golden and Vikram. The testicular infection can cause a low sperm count. In women, urinary TB can spread to the uterus, cervix, ovaries and vagina. Women might experience infertility, pelvic pain and unexplained vaginal bleeding.
Patients with urinary TB might or might not have general symptoms of tuberculosis. Such symptoms include unexplained weight loss, fatigue, fever and a general feeling of being unwell.