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Male genital tuberculosis

Male genital tuberculosis is mostly associated with coexistent renal tuberculosis, arising from retrograde spread of infected urine along the vas deferens.
In order of decreasing frequency, the prostate, epididymis, seminal vesicles and testis may be involved. 
The usual presentation is a scrotal mass (initially unilateral but eventually bilateral in about a third of cases) which may be accompanied by draining skin sinuses.
Female genital tuberculosis is not usually linked to kidney disease but begins with a haematogenous focus in the endosalpinx (the inner lining of the fallopian tube).
From there it may spread to the endometrium, peritoneum, ovaries, cervix or vagina.
The usual presentations include infertility, pelvic pain, poor general health and menstrual disturbance.

Male genital tuberculosis (Case 2491)

The specimen shows a massive caseous involvement of the head of the epididymis and lesser involvement of the tail and of the body of the testis.
There was a secondary reactive hydrocoele (accumulation of fluid between the two layers of the tunica vaginalis).

Diagram and specimen photograph: male genital tuberculosis