Tuberculosis of the penis
Introduction
Introduction to penile tuberculosis The incidence of penile tuberculosis accounts for 4% of the incidence of genitourinary tract tuberculosis. The onset can be on the surface of the penis skin, in the corpus cavernosum, or in the penis urethra. Mycobacterium tuberculosis can be transmitted from urinary tract tuberculosis, and can also be transmitted through sexual intercourse or contact with contaminated clothing. Whether it is due to blood source transmission is still controversial. After the onset, there is a reddish tuberculosis nodule at the penis head, penis ligament or urethral opening. After the central nodule depression, the depression becomes an ulcer, the surrounding tissue is hard, and the cheese-like necrotic tissue appears at the bottom of the ulcer. Increasing, the inguinal lymph nodes are enlarged. basic knowledge The proportion of illness: 0.003%-0.004% Susceptible people: male Mode of infection: non-infectious Complications: bladder tuberculosis ureter tuberculosis kidney tuberculosis hematuria
Cause
Penile tuberculosis
(1) Causes of the disease
Tuberculosis of penis, mainly through the penis and M. tuberculosis direct contact infection, a small number of blood infections, severe urethra tuberculosis can also affect the penis.
(two) pathogenesis
Infection is mainly caused by direct contact between the penis and Mycobacterium tuberculosis. 65% of the primary penile tuberculosis counted by Lewis (1946) is caused by the circumcision of the circumcision during the religious circumcision. This method has been abandoned, the penis has been abandoned. Head contact with the diseased cervix can also cause penile tuberculosis, blood infection can directly invade the corpus cavernosum, causing tuberculous cavernositis, another form of infection is severe urethral tuberculosis develops into urethral inflammation, and finally invade And the corpus cavernosum and the penis head.
Direct contact with infectious lesions occurs mostly in the penis head, penile ligament or external urethral orifice, initially tuberculous nodules, and later become ulcers. The ulcer has a clear boundary, the periphery is hard, and there is caseous necrosis or granulation tissue at the base, and the ulcer gradually enlarges and invades. And the entire penis head, inguinal lymph nodes also often have secondary tuberculosis infection, cavernous tuberculosis mostly manifested as nodular hyperplasia, fibrous tissue can make the penis deformed and bent, and sometimes can form a fistula.
Prevention
Penile tuberculosis prevention
The fundamental measure to prevent genitourinary tuberculosis is to prevent tuberculosis. Due to advances in molecular biology in recent years, humans may use new prevention, diagnosis and treatment methods to eliminate tuberculosis.
Complication
Penile tuberculosis complications Complications bladder tuberculosis ureter tuberculosis kidney tuberculosis hematuria
When the corpus cavernosum is involved, the penile erection is bent and painful, sometimes forming a fistula. Mycobacterium tuberculosis can affect the bladder, ureter, and kidney through the urethral ascending infection, leading to bladder tuberculosis, ureteral tuberculosis, renal tuberculosis, hematuria, purulent urine, and Frequent changes in urinary frequency, and concurrent ureteral obstruction (called kidney self-cutting), bladder contracture, so that the bladder volume is reduced, and severe urinary frequency.
Symptom
Penile tuberculosis symptoms common symptoms penile induration penis pain nodules penis and scrotal edema penile superficial ulcer
Patients often have a history of tuberculosis, mainly characterized by mild pain in the head of the penis, and see long-term unhealed ulcers. Physical examination showed nodules and ulcers on the head of the penis. The edges of the ulcer were clear and the surrounding area was hard. The base was granulation tissue or caseous necrosis.
Examine
Penile tuberculosis examination
Mycobacterium tuberculosis can be found by direct smear of ulcer secretion or culture of tuberculosis.
Local biopsy, pathological examination can confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of penile tuberculosis
diagnosis
The disease is mainly based on clinical manifestations. If there is a "granuloma"-like change in the yin, you need to be alert to the possibility of the disease. You can take the smear of the ulcer secretion or the tuberculosis culture to find the tuberculosis, once the tuberculosis is clear If the bacillus grows, the disease can be diagnosed. Local biopsy can also be performed. Pathological examination can be confirmed by characteristic pathological changes of caseous necrosis.
Differential diagnosis
Because penile tuberculosis is rare, it is easy to be misdiagnosed. It should be differentiated from other diseases that cause penile ulcer such as soft squat, hard squat and penile amebiasis. For patients with severe tuberculosis, it should be more vigilant, nodules of penile tuberculosis The ulcer may be confused with penile cancer, and the method of determining the diagnosis relies on biopsy or direct smear to find M. tuberculosis and tuberculosis culture.
1. Soft chancre is also a superficial ulcer of the head of the penis. The patient often has a history of unclean sexual intercourse, and the edge of the ulcer is not neat, the surrounding is soft, and the smear of the secretion shows Gram-negative coryneform bacteria, but no acid-fast bacilli.
2. Penis syphilis (hard chancre) also appears as superficial ulcer in the head and foreskin of the penis, but the basal granulation tissue of the ulcer is purple-red, with inguinal lymphadenopathy, and the dark-field examination of the secretion can be found to be treponema At the same time, there is a change in syphilis throughout the body.
3. Penile cancer can also be manifested as penile head ulcers, usually with a lump, local necrosis, a cauliflower-like change, the ulcer is located on the mass, the edges are not neat, and biopsy can be seen in cancer cells.
4. Penile amebic disease can also be manifested as penile head ulcers, but the edges of the ulcers are not neat, and the amoebic trophozoites can be found in the secretion examination.
