Ans. is c i.e. Retrograde spread Most common route of transmission of endometrial T.B. is - Retrograde spread. "Uterus is involved in 70% cases of genital tuberculosis and the infection descends from the fallopian tube." Genital tuberculosis is a very impoant topic for PGME exams so let us have a look at this topic in detail. Genital Tuberculosis Brief Review : Genital tuberculosis is almost always secondary to a focus elsewhere in body.deg Primary Focus : - Lungs (50%) -Lymph nodes (40%) - Urinary tract (5%) - Bones and Joints (5%) Most common route of spread - Hematogenous.deg Most common route of transmission to endometrium is retrograde spreaddeg. Maximum age incidence = 28 years (between 16 - 53). Very rarely it affects girls before pubey and women after menopause. Most common site involved = Fallopian tube. Tuberculosis of fallopian tube can be in the form of : Others : Postmenopausal bleedingdeg. Rarely dysmenorrheadeg Dyspareunia and repeated POdeg, a patient with recurrent sub acute P1D should be suspecteddeg of having Pain is uncommon and is a result of sub acute PIO. If a virgin stained girl suffer vaginal from a pelvic inflammatory mass, it is almost always of tuberculous origin. deg d inal discharge, post coital bleeding, leucorrhoea, and painful ulcer are characteristic of lower tuberculosis. genital T:B Increased incidence of estop ic pregnancy.deg Signs : TB of genital tract presents as : Doughy abdomendeg Tubercular encysted massdeg Pelvic adnexal mass may be presentdeg 1 I followingm - A rigid non - peristaltic pipe like tube called Lead Pi .e A - Beading of tube and variation in filling defectdeg - Calcificationof tubedeg - Cornual blockdeg - Tobacco pouch and dilated end of tubes due to hydrosalpinx and pyosalpine Note : In a proven case of TB HSG is contraindicated as it spreaaffiTtnterorrdeg Diagnosis : Dilatation and curettage is done in late pre-menstrual phase (week preceding menstruation as tubercles are present in superficial layer) and tissue sent for histopathological examinationdeg and tissue culturedeg. Optimal results are obtained from endometrial sample curetted from the_carnuof the uterusdeg, as cornu is the first pa of the uterine cavity to be affected. Endometrial repo may be falsely negative due to : - Endometrial involvement in only 60 - 70% only. - Wrong timing of sampling. Due to extensive endometrial destruction due to disease itself. Treatment : Chemotherapy with ATTdeg for 6 months provided pyrazinamide is included for the first 2 months of treatment. Types of surgery : TAH with BSOQ ii. Vulvectomy in case of hyperophied vulva.deg Indications for surgery : - Progression of diseasedeg - Persistent active lesiondeg - Persistence of large inflammatory massdeg - Persistence of symptomsdeg. - Persistence of fistuladeg Contraindications for surgery - active lesion elsewhere in body and plastic adhesion of bowel.deg Tuboplasty is contraindicateddeg as any surgery on the tube to improve feility will cause reactivation of the disease. Moreover, feility cannot be restored when tubal walls are damaged. Prognosis flearlye,d3 - Feility [athchenicithara lowever,is ronly 10% cases(); whereas live bih is seen in only 2% casesdeg.