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