A Rare Case of Urinary Retention Due to Prostate Tuberculosis in Vietnam

Prostate tuberculosis is a rare clinical form of extrapulmonary tuberculosis, which causes acute urinary retention infrequently. Cases of prostate tuberculosis reported in the literature often show slow progression with insidious pre-existing urinary disturbances. It can pose a diagnostic dilemma, and the treatment protocols can be challenging. Most clinical cases are managed by antitubercular medications, and surgery is usually reserved for cases where medical treatment fails. Here, we present the case of a 62-year-old male patient who presented to the hospital with acute urinary retention, with a history of dysuria for three months. Ultrasound and magnetic resonance imaging showed enlarged prostate pushing into the bladder lumen with an increasing signal of the parenchyma on T2-weighted imaging. In addition, some lymph nodes were noted near the bilateral iliac vessels pointing toward a chronic inflammation condition with elevated prostatic-specific antigen (4.5 ng/mL). Therefore, transurethral resection of the prostate was carried out for voiding purposes, and the biopsy was sent to the pathology laboratory to rule out malignancy. Intraoperative images revealed a prostatic urethral mass (12 mm x 15 mm x 32 mm) pushing into the bladder lumen, and the histopathological results confirmed the diagnosis of prostate tuberculosis. The patient received a six-month course of antitubercular medications immediately after surgery with a regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol daily for two months, maintaining daily for four months with rifampicin, isoniazid, and ethambutol. Follow-up treatment was conducted two years later, and the results showed a good response with no recurrence. Prostate tuberculosis is best managed with antitubercular chemotherapy, but surgery is unavoidable for acute complications such as urinary obstruction, as seen in this case.