Beyond infection: the longitudinal impact of genitourinary tuberculosis on urologic and reproductive health.

PURPOSE: To address the limited understanding of the long-term morbidity of genitourinary tuberculosis (GUTB), by characterizing the clinical course and risk of urologic events (UE) both preceding and following GUTB diagnosis.

METHODS

This retrospective age-, sex- and comorbidity-matched cohort study evaluated all patients with GUTB in Merative Marketscan (2011-2021). Patients were followed throughout enrollment to capture comorbid diseases (pulmonary tuberculosis and HIV) and urologic events (diagnoses and procedures). Events- and diagnoses-of-interest that occurred both prior and after GUTB diagnosis were included. UEs were classified as low-grade events, high-grade events, or infertility. Multivariable cox proportional hazards models compared the risk of UEs over time.

RESULTS

1503 patients with GUTB were identified. Mean patient age was 43 years. Most patients were otherwise healthy (63% CCI ≤ 1). GUTB was associated with 2.5-fold the risk of high-grade UE prior to diagnosis (HR 2.5, p < 0.001) and 2.7-fold the risk after diagnosis (HR 2.7, p < 0.001). It was also associated with two-fold the risk of low-grade UE prior to diagnosis (HR 2.0, p < 0.001) and a 1.6-fold after diagnosis (HR 1.6, p < 0.001). Infertility risk was significant among GUTB patients in the pre-diagnosis setting (HR 2.6, p < 0.001).

CONCLUSION

GUTB is associated with a substantial increase in urologic morbidity, with elevated risks of low- and high-grade events before and after diagnosis, suggesting a prolonged and perhaps unrecognized subclinical disease course. The increased risk of infertility prior to diagnosis highlights importance of considering GUTB in unexplained infertility, particularly in TB-endemic regions.