泌尿生殖道结核

nullTuberculois of The Genitourinary TractTuberculois of The Genitourinary Tract Hongshun Ma Department of Urology Tianjin First Central Hospital Tubercle bacilli may invade one or more of the organs of genitourinary tract and cause a chronic granulomatous infection that shows the same characteristic as TB in other organs. Tubercle bacilli may invade one or more of the organs of genitourinary tract and cause a chronic granulomatous infection that shows the same characteristic as TB in other organs. 60% of patients are between the age of 20-60. A little more common in males than in females60% of patients are between the age of 20-60. A little more common in males than in females Etiology Etiology Mycobacterium tuberculosis Lungs--hematogenous--Genitourinary Organs Kidney and prostate--- primary sites of TB infection nullPathogenesis & Pathology 1Pathogenesis & Pathology 1Kidney & Ureter The tubercle bacilli hits the renal cortex. Pathological TB. Clinical TB. TB granulomatous Casceation (cheesy Material), Calcification Pelvis, calyces, and ureter--- thickend, ulceration Hydronephrosis Autonephrectomy “golf hole” (gaping) Pathogenesis & Pathology 2 Pathogenesis & Pathology 2Bladder The mucosa may be inflamed. Tubercles Ulcerate Fibrosed and Contracted Ureteral refluxor Stenosis Pathogenesis & Pathology 3Pathogenesis & Pathology 3 Prostate Seminal Vesicles Epidydimis and Testis Clinical Findings 1 Clinical Findings 1Chronic cystitis refuses to respond to therapy. Pyuria without bacteria. Hematuria A nontender, enlarged epidydimis A chronic draining scrotal sinus Induration or nodulation of prostate and thickening seminal vesicles Clinical Findings 2 Clinical Findings 2Symptoms Vesical irritabillity: burning, frequency, urgency, nocturia, hematuria. Flank pain: dull ache or colic Painless swelling of the epididymis or chronic draining sinus. Nonspecific complaints: persistent fever, night sweats. Clinical Findings 3 Clinical Findings 3Signs Enlargement or tenderness of kidney. External genitalla Prostate Laboratory Findings Laboratory FindingsPersistent pyuria Tubercle bacilli cultures Blood count Erythrocyte sedimentation rate Renal function Tuberculin test Imaging 1 Imaging 1 Chest film Plain film of abdomen Excretory urograms: 1) “moth-eaten” 2) obliteration of calyces 3) dilatation of calyces 4) abscess cavities 5) ureteral strictures, shortening and straightening 6) absence of functional kidney Retrograde urographynullnullnullnullnullnull Imaging 2 Imaging 2Ultrasonography CT MRI Instrumental examination Instrumental examinationCystoscopy “golf-hole” Biopsynullnullnullnull Differential diagnosis Differential diagnosis Chronic nonspecific cystitis and pyelonephritis Nonspecific epididymitis Renal stones Urologic tumor ComplicationsComplicationsPerinephric abscess Renal stones Hydronephrosis Uremia Treatment 1 Treatment 1Antituberculosis drugs Treatment 2 Treatment 2Chemotherapy 1 Treatment 3 Treatment 3Chemotherapy 2 Treatment 4 Treatment 4Surgical management Nephrectomy Partial nephrectomy Epididymectomy Reconstructive surgery Ureteral stricture Augmentation cystoplasty nullnull Prognosis Prognosis