ABSTRACT

Urinary system tuberculosis may involve the kidneys, pelvicalyceal system, ureters, urinary bladder, and rarely the urethra. Imaging plays a pivotal role in early detection, assessment of disease extent, identification of complications, and differential diagnosis. Ultrasonography is usually the first-line modality and may demonstrate hydronephrosis, parenchymal heterogeneity, and mass-like lesions. Computed tomography urography provides comprehensive evaluation of parenchymal granulomas, papillary necrosis, calyceal deformities, strictures, calcifications, and autonephrectomy with high diagnostic accuracy. Magnetic resonance imaging, with its superior soft-tissue contrast and diffusion-weighted imaging, is particularly useful for characterizing granulomatous inflammation, abscesses, and fibrotic changes. A systematic and integrated interpretation of imaging findings significantly improves diagnostic confidence and facilitates differentiation of urinary system tuberculosis from renal cell carcinoma, acute pyelonephritis, and other inflammatory or neoplastic conditions.