Tuberculose Urogenital: estudo qualitativo das causas de atraso diagnóstico em pacientes com bexiga contraída

Abstract

Introduction: Urogenital tuberculosis (TUG) is the second most frequent extrapulmonary form of the disease. After a pulmonary focus, 2-20% of patients develop TUG. Once a kidney is involved urinary dissemination reach the bladder which progressively contracts, losing its function leading to contralateral reflux. Objective: To identify the causes of delayed diagnostic in patients with TUG and contracted bladder. Materials and methods: Eight patients diagnosed with TUG and contracted bladder were evaluated. Data were obtained through semi-structured interviews and confronted with analysis of medical records and personal medical files. Codification was performed using the ATLAS.ti software. Codes were divided into 3 categories (CAT): 1- Health system; 2 – Disease factors; 3 – Medical factors. All 8 invited patients signed informed consent. The study was authorized by the CEP HU/UFJF. Results: The 8 interviews produced 220 min. audio and 1.3 GB of scanned documents. The most frequent categories were “CAT 3-Medical Factor”; “CAT 2- Disease´s factors” and finally “CAT 1-Health System”. The codes “No clinicallaboratory-radiological suspicion” and “No clinical suspicion” were the most frequent, both belonging to the CAT 3-Medical Factors. Conclusion: The causes of causes of delayed diagnostic, in our sample, are related to “CAT 3 – Medical factors”, followed by “CAT 2 – Disease factors”. These findings suggest that the diagnosis of TUG remains challenging. Clinically, tuberculosis mimics other pathologies and as the gold standard specific tests has drawbacks regarding low sensitivity and specificity. The short representation of the “CAT 1 – Health System” codes indicate that access to public and private health services does not seem to have an influence on delayed diagnosis.