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Genitourinary tract tuberculosis:

الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة محمد رضا جودي عبود جلو       05/01/2017 04:09:07

Genitourinary tract tuberculosis:

Renal tuberculosis:
T.B bacilli may invade one or all organs of genitourinary tract and cause chronic granulomatous infection that give the same character as tuberculosis of other organ.
The infecting organism is Mycobacterium tuberculosis , through hematogenous route from the lungs.
The kidney and the prostate is the primary site of TB in the GUT .

Pathogenesis:
If enough bacteria of sufficient virulence become lodged in the kidney and are not overcome, a clinical infection is established.
TB of the kidney is slow progress it may take 15-20 years to damage a kidney in a patient with good resistance, so no pain or any clinical disturbance till the lesion invade the calyces or the pelvis the pus and the organisms discharge to urine so symptoms of cystitis.
Then may reach the pelvic mucosa and ureter where causing hydronephrosis.
Then a caseouss breakdown of tissue until the entire kidney replace by cheesy material.
Calcium may laid down.
Because ureteral fibrosis my complete that may lead to autonephrectomy( fibrosed and non functioning kidney).
Tubercles may undergo a central degeneration and caseat, creating a tuberclous abscess cavity that can reach the collecting system and break through. So paranchymal damage. And depending on the patient resistance healing by fibrosis occur.

Symptoms and sings :
TB of GUT should be considered in the presence of the following: 1. chronic cystitis not responding to treatment.
2. sterile pyuria(negative urine culture with pyuria).
3.hematuria.
4.non tender enlarge epididymis with beaded or thickened vas.
5.chronic draining scrotal sinus.
6. induraton or nodulation of prostate or seminal vesicle.

History of TB elsewhere in the body bring suspicion .


Symptoms:
Most symptom of the disease even in advanced stage are vesical in origin(cystitis).
Generalize fatigability, low grade fever but persistent with night sweats.
Some time Asymptomatic.
Dull aching pain.
Passage of blood clot secondary calculi or a mass of debris may cause renal or ureteral colic.
Or painless mass in the abdomen.


Signs:
There may be evidence of extra genital TB , may found in(lungs ,bone, lymph nodes tonsils, intestines)
There is usually enlargement or tenderness of involved kidney.

Diagnosis:
1.presistant pyuria without organisms on cutler means tuberculosis until prove otherwise.
24 urine for AFB( acid fast bacilli).
2. 3-5 first morning voided specimens , for culture for TB .bacilli is highly positive.
3. X-ray: enlargement of the kidney, obliteration of psoas shadow. Punctuate calcification, renal stones calcification of the ureter.
Excretory urogram(EU) can be diagnostic: absence of the function of the kidney( in addition to :moth-eaten appearance of involved ulcerated calyces, obliteration or dilatation of calyces ,abscess cavity ureteral stricture ).
4. U/S
5. CT scan with contrast is highly sensitive for calcification and characteristic anatomic changes.
5. cystoscopy is indicated to see the extent of the disease in the bladder.

Complication:
Perinephric abscess, renal stones ,uremia if both kidneys involved.





Treatment:
A strict medical regimen should be instituted. The following drug in combination: isoniazide (INH),rifampin(RMR), ethanbutol (EMB). Streptomycine , pyrazinamide , usually intensive coarse for 2-3 months (by using INH, RMP, EMB), followed by 3 months of treatment with INH and RMP two or three times per a week according to European
treatment :surgery
Is indicated when there is perinephric abscess, should be drained and nephrectomy should be done either then or later to prevent development of chronic draining sinus
Note : surgical intervention should be preceded by 3 weeks coarse of anti TB drugs. To prevent complication association of urology. If resistance to any drug we can replace by other listed drugs.
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المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .