Tuberculose prostática - revisão sistemática de relato de casos

Abstract

Introduction: Prostate tuberculosis is rare and presents with varied and often nonspecific symptoms, meaning that most urologists are unfamiliar with its diagnosis and treatment. Objective: To review reports and case series on prostate tuberculosis available in the literature to describe its clinical presentation and diagnostic methods. Methods: We used the keywords “Prostate Tuberculosis” in the Embase, Google Scholar, Pubmed, Scielo, Scorpus, and Web of Science search platforms to identify texts of interest with no start date limit until November 15, 2024. Articles in all languages were included whose abstract or full text presented epidemiological information, signs, symptoms, and diagnostic methods that could confirm and determine the clinical presentation of prostate involvement by tuberculosis. An independent peer review was performed to classify the cases, and in cases of disagreement, an additional review was performed by a third reviewer. Cases were grouped according to clinical manifestations into asymptomatic, chronic prostatitis, lower urinary tract obstruction and abscess. Epidemiological characteristics and diagnostic methods were established. Results: A total of 169 articles with 254 case reports were included. The most common presentation was asymptomatic with 99 cases (39.0%), followed by chronic prostatitis with 57 cases (22.4%), infravesical obstruction with 56 (22.1%) and abscess with 42 (16.5%). Previous suspicion of tuberculosis occurred in only 26.9% of cases. The most frequent diagnostic method was histological, with 82.1%, followed by bacteriological, with 11.5%, and clinicalradiological, with 6.4%. Sensitivity in urine tests was lower overall, ranging from 20% in bacterioscopy of acid-fast bacillus (AFB), 57.5% in culture, and 70.6% in PCR. The sensitivity of semen testing ranged from 85.7% in culture to 100% in PCR, and the analysis of fluid collected from abscesses had a sensitivity of 100% (AFB, culture e PCR). Conclusion: Prostatic tuberculosis has four clinical presentations: asymptomatic, chronic prostatitis, infravesical obstruction and abscess. Bacteriological examination and PCR should be performed in cases of abscess, as it has high sensitivity in drained material. Seminal analysis should be performed whenever possible. In suspected cases with negative PCR and bacteriological tests, prostate biopsy is indicated.