泌尿生殖道结核.ppt

TuberculoisofTheGenitourinaryTract,HongshunMaDepartmentofUrologyTianjinFirstCentralHospital,TuberclebacillimayinvadeoneormoreoftheorgansofgenitourinarytractandcauseachronicgranulomatousinfectionthatshowsthesamecharacteristicasTBinotherorgans.,60%ofpatientsarebetweentheageof20-60.Alittlemorecommoninmalesthaninfemales,Etiology,MycobacteriumtuberculosisLungs-hematogenous-GenitourinaryOrgansKidneyandprostate-primarysitesofTBinfection,Pathogenesis&Pathology1,Kidney&UreterThetuberclebacillihitstherenalcortex.PathologicalTB.ClinicalTB.TBgranulomatousCasceation(cheesyMaterial),CalcificationPelvis,calyces,andureter-thickend,ulcerationHydronephrosisAutonephrectomy“golfhole”(gaping),Pathogenesis&Pathology2,BladderThemucosamaybeinflamed.TuberclesUlcerateFibrosedandContractedUreteralrefluxorStenosis,Pathogenesis&Pathology3,ProstateSeminalVesiclesEpidydimisandTestis,ClinicalFindings1,Chroniccystitisrefusestorespondtotherapy.Pyuriawithoutbacteria.HematuriaAnontender,enlargedepidydimisAchronicdrainingscrotalsinusIndurationornodulationofprostateandthickeningseminalvesicles,ClinicalFindings2,SymptomsVesicalirritabillity:burning,frequency,urgency,nocturia,hematuria.Flankpain:dullacheorcolicPainlessswellingoftheepididymisorchronicdrainingsinus.Nonspecificcomplaints:persistentfever,nightsweats.,ClinicalFindings3,SignsEnlargementortendernessofkidney.ExternalgenitallaProstate,LaboratoryFindings,PersistentpyuriaTuberclebacilliculturesBloodcountErythrocytesedimentationrateRenalfunctionTuberculintest,Imaging1,ChestfilmPlainfilmofabdomenExcretoryurograms:1)“moth-eaten”2)obliterationofcalyces3)dilatationofcalyces4)abscesscavities5)ureteralstrictures,shorteningandstraightening6)absenceoffunctionalkidneyRetrogradeurography,Imaging2,UltrasonographyCTMRI,Instrumentalexamination,Cystoscopy“golf-hole”Biopsy,Differentialdiagnosis,ChronicnonspecificcystitisandpyelonephritisNonspecificepididymitisRenalstonesUrologictumor,Complications,PerinephricabscessRenalstonesHydronephrosisUremia,Treatment1,Antituberculosisdrugs,Treatment2,Chemotherapy1,Treatment3,Chemotherapy2,Treatment4,SurgicalmanagementNephr