Persistent posterior sinus in commonly due to:
Tuberculosis of the Epididymis and Testis
a. Hematospermia is a rare presenting symptom of genital TB.
b. TB should be considered in patients who are seen with repeated attacks of hematospermia as the only presenting symptom, even if there is no other evidence of genitourinary TB.
c. Tuberculous epididymitis may be the first and only presenting symptom of genitourinary TB.
d. The usual presentation is a painful, inflamed scrotal swelling that is difficult to differentiate from acute epididymo-orchitis.
e. The globus minor alone is affected in 40% of cases.
f. The disease usually develops in young, sexually active males, and in 70% of patients there is a previous history of TB.
g. TB of the testis is almost always secondary to infection of the epididymis via direct extension .
h. Tuberculous orchitis with no epididymal involvement is very rare.
i. Tuberculous epididymitis can also present as infertility due to scarring of the epididymis or multiple vasal obstructions .
a. TB of the prostate is uncommon, and in many cases the pathologist diagnoses it incidentally after a transurethral resection.
b. TB of the penis and of the urethra are also very unusual manifestations .
c. Primary TB of the penis appears as a superficial ulcer of the glAns.
d. Clinically, it is indistinguishable from malignant disease, although it can also progress to cause a tubercular cavernositis with involvement of the urethra .
e. Finally, TB of the urethra is caused by spread from another focus in the genital tract.
f. Its rarity is difficult to understand in view of the almost constant exposure of the urethra to infected urine.
g. Urethral strictures can also develop, leading to a slowing of the urinary stream or retention.