A Review of Genitourinary Tuberculosis in the Indian Subcontinent: From Pathogenesis to Modern Management and Future Perspectives

Abstract

Genitourinary tuberculosis (GUTB) represents a significant and often underestimated manifestation of extrapulmonary tuberculosis (TB), posing a unique challenge to healthcare systems in high-burden regions like the Indian subcontinent. While India accounts for the world’s largest TB burden, with an estimated 2 million new cases annually, GUTB is frequently overlooked due to its insidious onset and nonspecific symptoms. This review synthesizes current knowledge on GUTB, focusing on its epidemiology, clinical presentation, and diagnostic dilemmas within the Indian context. It examines the pathological progression from a latent, hematogenously seeded infection to irreversible organ damage, such as a “putty kidney” or contracted bladder. This study highlights recent advancements that have revolutionized diagnosis and management, including the GeneXpert Mycobacterium tuberculosis /rifampicin assay for rapid detection and drug resistance profiling, and the emergence of new all-oral drug regimens for multidrug-resistant TB. The critical role of surgical intervention as a necessary adjunct to medical therapy is discussed, with an emphasis on modern minimally invasive and robot-assisted techniques for managing complex sequelae. The review concludes by outlining key areas for future research and connecting clinical best practices to the strategic goals of India’s National TB Elimination Program, underscoring the necessity of a multi-pronged approach to meet national health targets.