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+We present the case of a 66-year-old male patient with a history of hyperglycaemia on dietary treatment, epididymal tuberculosis (TBC), vocal cord decortication and a smoker of 40 cigarettes/day, who came to the outpatient clinic for an episode of haematuria.
+Physical examination: good general condition.
+Rectal examination: grade I-II/IV prostate, elastic consistency, preserved limits. No suspicious areas were observed.
+Blood tests were performed (haemogram: red blood cells 5.09 million/mm; haemoglobin 15.8 g/dl; haematocrit 47.35%; platelets 250.0 thousand/mm; leukocytes 10.67 thousand/mm (neutrophils 47.10%, lymphocytes 44.9%, eosinophils 1.20%, basophils 0.8%). Coagulation study: no alterations. Biochemistry: no alterations; PSA 2.9) and urine (urine systemic: density 1015; pH 6.5; leucocytes 500/microl; nitrites negative; erythrocytes 10/field. Sediment: abundant leukocytes), with negative urine cytology (intense acute inflammatory component), simple abdominal X-ray showing lithiasis in the lower pole of the left kidney and abdominal ultrasound with normal right kidney, lithiasis in the lower pole of the left kidney and irregular dilatation of the ureter on the same side. At the bladder level, a mass of approximately 1 cm in maximum diameter was observed on the left lateral side.
+IVUS was performed, showing a left kidney with calyceal dilatation and irregularities all around, dilatation of the ureter on the same side, with tortuous and irregular contours, up to the iliac ureter. In its last 8-10 cm up to the bladder, the ureter has a normal appearance. Cystogram with contour irregularities in its upper portion.
+Cystoscopy was carried out and a tumour was observed on the left lateral side of the bladder, with a solid appearance and whitish colouring, which prevented the left ureteral orifice from being seen. A Löwenstein urine culture was requested and TUR of the bladder mass was performed. The postoperative course was uneventful.
+PA report: granulomatous tuberculoid cystitis, compatible with TB.
+Lowenstein urine test: positive for Mycobacterium tuberculosis.
+Diagnosis of genitourinary tuberculosis with bladder tuberculoma and left renoureteral involvement and tuberculostatic treatment was started (Isoniazid 5 mg/kg/day + Pyrazinamide 30 mg/kg/day + Rifampicin 10 mg/kg/day for 2 months. Isoniazid + Rifampicin at the same doses for the following 4 months).
+During his follow-up (14 months after diagnosis and after treatment was completed), he developed a fistula with exudate in the left teste, the staining of which did not show any BAAR, with negative Lowenstein. It closed with local dressings. A control testicular ultrasound was performed, showing chronic changes in both epididymides with small bilateral hydrocele.
+Control IVUS was carried out and showed good evolution, improving the function and morphology of the urinary tract (left). In the last IVU performed (4 years after diagnosis), an alteration in the morphology of the lower pole of the left kidney was observed, with a decrease in the cortical area and associated variegated calcification in the parenchyma, all in relation to her diagnosis of TB. Ureters of normal calibre and morphology. Stress bladder and prostatic hypertrophy.
+Negative Löwenstein urine cultures were maintained at the end of medical treatment.
+