Diseases masking and delaying the diagnosis of urogenital tuberculosis

To the editor:

We read with interest the article by Kulchavenya and Kholtobin on urogenital tuberculosis (UGTB) [Kulchavenya and Kholtobin, 2015], in which the authors provide information about unusual UGTB cases. While the authors claim that they have carried out a systematic review of the topic, we completely disagree with that statement. Systematic reviews represent the highest level of evidence available for making clinical decisions, particularly if they are based on high quality studies and a strict and accurate methodology has been followed [Akobeng, 2005].

A comprehensive and exhaustive search for primary studies that attempt to answer a clinical question is a key starting point to every systematic review; in the manuscript it is not clear what the authors want to answer. The title points towards diseases that mimic and delay diagnosis of UGTB, but the authors instead reviewed uncommon presentations of UGTB with no focus at all on diagnosis delay. Second, the search strategy included reviewing only the PubMed database, which has been considered an insufficient strategy for performing a literature search [Suarez-Almazor et al. 2000]. Other databases such as Embase should have been incorporated. In addition, most of the studies included were case reports, and guidelines for reviewing cases reports such as the CARE guidelines and the Institute of Health Economics tool for case series were not followed [Gagnier et al. 2013; Moga et al. 2012]. Third, no clear information on the selection criteria is provided; it is not clear what was considered a usual or a rare case of UGTB. Finally, the results were presented as a narrative review with no clear outcomes of their investigation.

Considering that UGTB is a difficult entity to diagnose, the review of unusual UGTB presentations can be a first step to fill the lack of evidence on the topic. We suggest the authors should use the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines [Moher et al. 2009]. These guidelines stand for high quality systematic reviews ensuring a transparent and thorough report of data. Authors’ endorsement of this kind of checklists warrants excellence in research and evidence-based medicine.