Question

A 30 year old male presents with severe bladder irritation, persistent pyuria, microscopic hematuria and absence of bacteria in usual smears and culture. What is the probable diagnosis?

• A. Monilial infection
• B. Lower urinary tract obstruction
• C. Vesical calculus
• D. Genito urinary tuberculosis

Hint:

Think of the classic cause of sterile pyuria.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
A young man has bladder irritation, pus cells in the urine, and blood cells in the urine, but routine urine culture and smear do not grow any bacteria. We need the diagnosis that best fits this pattern.

Step 2: Key Formula or Approach:
Pyuria (pus cells in urine) together with a negative routine culture is called sterile pyuria. This combination is a classic clue in medicine, and one diagnosis is famous for producing exactly this picture.

Step 3: Detailed Explanation:
Genitourinary tuberculosis happens when Mycobacterium tuberculosis reaches the kidney through the blood and later spreads down to the ureter, bladder and genital tract. It causes chronic bladder irritation, pus cells and red cells in the urine, but the tuberculous bacilli do not grow on the ordinary culture media used for common urinary pathogens like E. coli. This is why genitourinary tuberculosis is the textbook cause of sterile pyuria with hematuria. A monilial (fungal, Candida) infection usually shows organisms on a wet mount and tends to occur in diabetics or immunosuppressed patients, not this exact picture. Lower urinary tract obstruction would usually show a clear cause on imaging and often gets secondarily infected with ordinary bacteria that do grow on culture. A vesical calculus (bladder stone) causes irritation and hematuria too, but again does not typically give sterile pyuria unless a stone is directly linked to tuberculosis.

Step 4: Final Answer:
The most probable diagnosis is genitourinary tuberculosis, option (D).