《泌尿生殖道结核.ppt》由会员分享，可在线阅读，更多相关《泌尿生殖道结核.ppt（34页珍藏版）》请在三一办公上搜索。
1、Tuberculois of The Genitourinary Tract,Hongshun MaDepartment of UrologyTianjin 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.,60%of patients are
2、between the age of 20-60.A little more common in males than in females,Etiology,Mycobacterium tuberculosisLungs-hematogenous-Genitourinary OrgansKidney and prostate-primary sites of TB infection,Pathogenesis&Pathology 1,Kidney&UreterThe tubercle bacilli hits the renal cortex.Pathological TB.Clinical
3、 TB.TB granulomatous Casceation(cheesy Material),CalcificationPelvis,calyces,and ureter-thickend,ulcerationHydronephrosisAutonephrectomy“golf hole”(gaping),Pathogenesis&Pathology 2,BladderThe mucosa may be inflamed.Tubercles UlcerateFibrosed and ContractedUreteral refluxor Stenosis,Pathogenesis&Path
4、ology 3,ProstateSeminal VesiclesEpidydimis and Testis,Clinical Findings 1,Chronic cystitis refuses to respond to therapy.Pyuria without bacteria.HematuriaA nontender,enlarged epidydimisA chronic draining scrotal sinusInduration or nodulation of prostate and thickening seminal vesicles,Clinical Findi
5、ngs 2,SymptomsVesical irritabillity:burning,frequency,urgency,nocturia,hematuria.Flank pain:dull ache or colicPainless swelling of the epididymis or chronic draining sinus.Nonspecific complaints:persistent fever,night sweats.,Clinical Findings 3,SignsEnlargement or tenderness of kidney.External geni
6、tallaProstate,Laboratory Findings,Persistent pyuriaTubercle bacilli culturesBlood countErythrocyte sedimentation rateRenal functionTuberculin test,Imaging 1,Chest filmPlain film of abdomenExcretory urograms:1)“moth-eaten”2)obliteration of calyces 3)dilatation of calyces 4)abscess cavities 5)ureteral
7、 strictures,shortening and straightening 6)absence of functional kidney Retrograde urography,Imaging 2,UltrasonographyCTMRI,Instrumental examination,Cystoscopy“golf-hole”Biopsy,Differential diagnosis,Chronic nonspecific cystitis and pyelonephritisNonspecific epididymitisRenal stonesUrologic tumor,Co
8、mplications,Perinephric abscessRenal stones HydronephrosisUremia,Treatment 1,Antituberculosis drugs,Treatment 2,Chemotherapy 1,Treatment 3,Chemotherapy 2,Treatment 4,Surgical management Nephrectomy Partial nephrectomy EpididymectomyReconstructive surgery Ureteral stricture Augmentation cystoplasty,Prognosis,
