Tuberculosis - I.T. Pyatnochka 2005

Extrapulmonary tuberculosis
Tuberculosis of the urinary system

Among newly diagnosed patients, urogenital tuberculosis accounts for 2.2%, and exceeds 35% among patients with extrapulmonary forms. The Kidneys are most commonly affected, followed in men by the Epididymis and Testis, and less frequently by the Prostate Gland and Seminal Vesicles; in women, the fallopian tubes and endometrium are most often involved, while the Ovaries, cervix, and Vagina are affected less frequently.

Urogenital tuberculosis is more commonly observed in young and middle-aged individuals, frequently in association with pulmonary, bone, or joint tuberculosis, although it may also develop as an isolated condition.

Pathomorphology of Renal tuberculosis. MBT enter the kidneys via hematogenous or lymphogenous routes. Within the Urogenital System, the infection typically spreads lymphogenously, and less commonly urogenitally. The initial specific changes appear as tuberculous tubercles in the renal cortex, which subsequently coalesce into discrete infiltrates leading to caseous necrosis and cavity formation. Over time, the specific process extends to the Ureter and eventually to the Urinary Bladder.

The clinical classifications include Tuberculosis of the renal parenchyma, renal papillae (papillitis), cavernous renal tuberculosis, and tuberculous Pyonephrosis. Foci, ulcerations, and scars may develop in the ureter, urinary bladder, and Urethra.

Under adverse conditions, urogenital tuberculosis can lead to the generalization of the infection and The Development of miliary Pulmonary Tuberculosis.

The Clinical presentation of renal and Urinary Tract tuberculosis directly depends on the localization and phase of the specific pathological process.

Diagnosis is based on patient history, clinical findings, Laboratory tests, X-ray imaging, ultrasound, and radioisotope studies.

The Treatment of patients with Kidney and urinary tract tuberculosis follows standard principles of antimycobacterial therapy, with an average duration of 6–12 months. Therapy is preferably initiated with intravenous drug administration. In cases of cavernous renal tuberculosis, Procedures such as renal segment resection, nephrectomy, or cavernectomy are frequently performed. Ureteral strictures are managed with reconstructive surgery, while bladder tuberculosis occasionally requires resection and colon cystoplasty.

Tuberculosis of the Male Genital Organs is frequently associated with Disseminated pulmonary tuberculosis, renal tuberculosis, or bone tuberculosis, from which MBT spread hematogenously or lymphogenously. The infection typically involves the epididymis, followed by the prostate gland, seminal vesicles, and testis; subsequently, it spreads via lymphogenous or contact routes to the contralateral epididymis and testis. The disease predominantly exhibits a chronic, paucisymptomatic course; an acute onset is less common and is accompanied by moderate intoxication symptoms, alongside local pain, enlargement of the epididymis or testis, and erythema and edema of the Scrotum. Hydrocele of the testicular tunics and scrotal Skin fistulas may also develop. Later, as the exudate organizes, a painful, dense mass can be palpated in the epididymal region. Tuberculosis of the prostate and seminal vesicles may remain asymptomatic for a prolonged period or present with subtle local and systemic signs. When an infiltrate or cavity forms within the prostate gland, patients experience pain in the perineal and rectal regions, occasionally accompanied by dysuric symptoms.

The diagnosis of Male Genital Tuberculosis is based on patient history, physical examination, Palpation, cystourethrography, as well as bacteriological, cytological, and histological examinations.

Patient management must be comprehensive, incorporating standard antimycobacterial treatment regimens combined with symptomatic therapy, desensitization, and vitamin therapy. When medical treatment fails, epididymectomy and other surgical interventions are occasionally warranted.

Female Genital Tuberculosis. MBT invade the FEMALE REPRODUCTIVE ORGANS via hematogenous, lymphogenous, and much less frequently contact routes, primarily during the period of primary tuberculous infection. The fallopian tubes are most frequently affected (up to 90%), followed by the endometrium, and occasionally the ovaries, cervix, and vagina. Adolescents and young women are most commonly affected.

Clinical symptoms depend on the specific form of genital tuberculosis. Chronic forms with productive tissue changes present with absent or mild clinical signs, frequently resulting in Infertility. Subacute and caseous forms of tuberculosis are accompanied by pronounced symptoms of intoxication and local signs of inflammation, such as lower abdominal and lower back pain, and menstrual irregularities.

Key diagnostic criteria for genital tuberculosis include a history of contact with tuberculosis patients, a prior history of tuberculosis in any organ system, positive or hyperergic tuberculin skin tests (including the Koch test), the detection of MBT in vaginal secretions, cytological and histological findings from needle biopsy or uterine curettage, as well as radiography and hysterosalpingography. The definitive stage of the diagnostic process is laparoscopy with biopsy of the affected organ.

The treatment of patients with genital tuberculosis involves prolonged (8–12 months) combination antimycobacterial therapy. Local administration of chemotherapeutic agents is also an option. Surgical intervention is indicated when conservative treatment fails, particularly in cases of pyosalpinx.