Male genital tract tuberculosis: A comprehensive review of imaging findings and differential diagnosis.

Urogenital tuberculosis is the most common form of extrapulmonary tuberculosis. Genital organ involvement occurs as a continuum of urinary tract tuberculosis and often presents a diagnostic challenge due to the non-specific nature of the symptoms. Delay in diagnosis may lead to complications such as infertility and perineoscrotal sinuses. Imaging plays an important role in raising timely suspicion of tuberculosis. In this article, we describe the imaging findings of male genital tuberculosis and the differential diagnosis. High-resolution ultrasonography (HRUS) is the best modality for assessing the epididymis, testis, scrotum and vas deferens, whereas MRI is optimal for evaluating the prostate, seminal vesicles and ejaculatory ducts. Epididymis is the most common site of genital tuberculosis, and presents as a nodular lesion limited to the tail or as diffuse enlargement. The proximal vas deferens is also frequently involved due to anatomical contiguity and shows diffuse or nodular thickening. Advanced cases may show pyocele formation and scrotal wall sinuses. Testicular involvement is almost always secondary to epididymal tuberculosis and presents as single or multiple nodules, diffuse enlargement, or the 'miliary' pattern. Isolated testicular involvement should raise suspicion of malignancy. Tuberculosis of the prostate is often asymptomatic. The most common imaging manifestations are nodules and the diffuse forms, which may later evolve into abscesses. Fibrosis and calcification occur with healing. Seminal vesicle and ejaculatory duct involvement with fibrosis may cause infertility. Awareness of the imaging findings would enable the radiologist to raise timely suspicion, so that prompt treatment is initiated and complications are prevented.