Though the incidence of pulmonary tuberculosis has been on the decline, the incidence of genito-urinary tuberculosis has not decreased proportionately as the majority of patients have no associated pulmonary tuberculosis. Genito-urinary tuberculosis affects male and female equally and is commonest in the 4th decade of life. The most frequent presentation is that of persistent urinary tract infection in 2/3 of patients and gross haematuria in about 1/3 of our patients. A few may be relatively asymptomatic with loin ache. Though urine culture for acid-fast bacilli is important, diagnosis in most patients was established on histopathology and typical radiological features. The main stay of treatment is medical. The role of surgery is mainly reconstructive, to overcome strictures causing obstruction so as to preserve renal function. Close cooperation between physician and surgeon is important in the management of this disease.