bladder tuberculosis
Introduction
Introduction to bladder tuberculosis Bladder tuberculosis is secondary to kidney tuberculosis, and a small number of prostate tuberculosis spreads. Bladder tuberculosis is more common with genitourinary tuberculosis. Early lesions are hyperemia and ulceration of inflammatory edema, and bladder contracture occurs in the late stage. The lesion involves stenosis or insufficiency of the ureteral orifice, resulting in renal and ureteral hydrops and renal dysfunction. basic knowledge The proportion of illness: 0.06% Susceptible people: no special people Mode of infection: non-infectious Complications: tuberculous bladder contracture, renal tuberculosis, contralateral hydronephrosis, tuberculous bladder spontaneous rupture, urethral stricture
Cause
Bladder tuberculosis
Disease factors (35%):
Bladder tuberculosis is part of the urinary system tuberculosis, mostly from kidney tuberculosis, due to tuberculosis and urine contamination from the submucosal ureter.
Infection factor (25%):
The pollution of renal tuberculosis and the spread of ureteral tuberculosis along the submucosa make the bladder triangle area quickly become congested, edematous, and gradually develop tuberculous nodules. The triangle area is first affected and spreads to the entire wall of the bladder. Tuberculosis nodule fusion , the bean dregs, forming an ulcer.
Pathogenesis
If the ulcer invades the bladder muscle layer extensively, even if the kidney is removed, severe fibrosis will still occur in the bladder muscle layer, which will cause the bladder muscle to lose its stretching capacity and reduce the volume, forming a tuberculous small bladder - bladder contracture, bladder tuberculosis When the ulcer is severe, a small number of cases can penetrate the whole layer of the bladder, invade and penetrate other organs and tissues, forming tuberculous bladder spasm, such as vesicovaginal fistula, bladder rectal fistula, etc., also perforation at the top of the bladder, urine flowing into the abdominal cavity, forming Acute abdomen, after bladder contracture, due to the shrinking capacity of the bladder, the ability to adjust the intravesical pressure is lost, the internal pressure is often in a relatively high state, the volume is reduced, the internal pressure is repeatedly strengthened, causing water in the upper urinary tract, in addition, Scar tissue formed by bladder tuberculosis can cause ureteral stenosis; also, bladder tissue fibrosis, loss of sphincter effect and ureteral orifice insufficiency, is also a factor in the change of upper urinary tract water, these conditions can be in bladder lesions During the active period, after the application of anti-tuberculosis drugs, tuberculosis lesions tend to heal and tissue fibrosis occurs.
Bladder tuberculosis involves the urethra, causing urethral mucosal ulcers, erosion, urinary tract violent burning in patients at the end of urination, severe cases can form tuberculous urethral stricture or urethral fistula.
Prevention
Bladder tuberculosis prevention
The fundamental measure to prevent genitourinary tuberculosis is to prevent tuberculosis. Due to recent advances in molecular biology, the Center for Disease Control (1989) proposed a strategic plan to eliminate tuberculosis within 20 years. Humans may use new prevention, diagnosis and treatment methods to eliminate it. The main measures for tuberculosis are as follows:
1 to prevent the development of infection status into clinical disease, in the past, isoniazid 300mg daily for close contact with tuberculosis patients and other people who may develop tuberculosis to prevent and treat, the incidence of tuberculosis decreased after use, reducing the spread of disease, Through the application of short-course chemotherapy, it was found that intermittent medication can also achieve similar effects on daily use. The experimental study used rifampicin and pyrazinamide twice a week. After 2 months of treatment, it can effectively prevent infection from developing into tuberculosis. If the method is used for preventive treatment, the spread of tuberculosis can be greatly reduced by using only 10 times of medicine.
2 Study the species of tuberculosis, genus-species specific, surface antigen, manufacture monoclonal antibodies and produce tuberculosis-specific DNA probes for early diagnosis of tuberculosis.
In 1998, Cole et al. determined the sequence of Mycobacterium tuberculosis DNA. The vaccine made of Mycobacterium tuberculosis DNA not only has the effect of preventing tuberculosis, but also can be used as a treatment to eliminate the Mycobacterium tuberculosis remaining after drug treatment. Breakthrough progress will accelerate control and eliminate human tuberculosis infection.
Complication
Bladder tuberculosis complications Complications tuberculous bladder contracture renal tuberculosis contralateral hydronephrosis tuberculous bladder spontaneous rupture urethral stricture
Complications of severe bladder tuberculosis include bladder contracture, contralateral hydronephrosis, spontaneous rupture of tuberculous bladder, tuberculous bladder spasm (bladder rectal fistula, vesicovaginal fistula), and urethral stricture or urethral fistula.
Symptom
Bladder tuberculosis symptoms Common symptoms Bladder volume reduction Urinary frequency urinary pain Urinary incontinence Puriria Hematuria Anuria
In addition to frequent urination, more often accompanied by dysuria, pyuria, hematuria, etc., after anti-tuberculosis treatment can be improved, and bladder contracture symptoms in addition to frequent urination and urinary incontinence, often no dysuria, pyuria, hematuria, etc., after anti-tuberculosis treatment Symptoms do not improve, sometimes due to further fibrosis of the bladder lesions, the symptoms are aggravated.
Analysis of medical history and clinical manifestations:
1. There are chronic cystitis irritation symptoms, no significant effect after antibiotic treatment.
2. The urine is acidic and has pus cells, while ordinary cultures have no bacterial growth.
3. There are tuberculosis lesions other than tuberculosis or other urinary tracts, a small amount of protein in the urine, and red blood cells in the urine.
4. Epididymis, seminal vesicle, spermatic cord or prostate found induration, scrotum with chronic sinus.
Examine
Examination of bladder tuberculosis
Urine examination: more pus cells can be seen in urine, red blood cells, inflammatory sputum, the degree of pyuria and hematuria is basically the same as urinary frequency, while the urinary frequency is significant in bladder contracture, but there are not many inflammatory cells in the urine, urine examination Looking for acid-fast bacilli is often positive, and polymerase chain reaction (PCR) technology can improve the positive rate of detection and is rapid.
1. Cystoscopy: see bladder mucosal congestion, edema; tuberculous nodules or ulcer formation; and visible bladder capacity becomes smaller, biopsy can be confirmed as tuberculosis.
2. Cyst angiography: inflammatory sputum is painful when injecting contrast agent, bladder shape can be normal, or folded and bladder neck sputum; while bladder contracture patients do not hurt when injecting contrast agent, only bulging, bladder is very Small round, not smooth, not folded, heavy bladder neck open, posterior urethra dilatation, if necessary, can be identified with saddle anesthesia: inflammatory sputum can expand bladder volume after saddle anesthesia, and bladder contracture Still can't expand.
3. Tuberculous bladder spontaneous rupture has sudden abdominal pain, abdominal perforation visible yellow urine, cystography is helpful for diagnosis.
4. Late stage has anemia, edema, renal insufficiency and other manifestations, IVU examination showed renal ureteral tuberculosis and bladder capacity decreased.
5. CT examination: In recent years, CT examination has been widely used in the diagnosis of genitourinary tuberculosis. Its advantages are sensitive to calcification, renal functional abnormalities and perirenal expansion, and can also show substantial scars and low density. Case-like necrosis, advanced renal disease can show hydronephrosis, renal atrophy and renal calcification.
Diagnosis
Diagnosis and diagnosis of bladder tuberculosis
diagnosis
Firstly, patients with urinary tuberculosis often have the performance, and combined with clinical manifestations can determine bladder tuberculosis, but more clinically atypical, need to be differentiated from other diseases, although the tuberculin test is not reliable, but the diagnosis of genitourinary system Tuberculosis still has a certain value, especially in patients with negative tuberculin test, which suddenly turned positive, should be paid attention to, and the erythrocyte sedimentation rate should also be used as a routine examination for screening patients.
Differential diagnosis
1. Chronic cystitis: also often manifested as frequent urination, urgency, dysuria, hematuria and pyuria, but the frequency of urinary frequency is lighter than bladder tuberculosis, IVU performance is also basically normal, no hydronephrosis and renal destructive lesions, middle urine Bacterial culture is positive, and there is no growth of acid-fast bacilli, and the symptoms can be alleviated after antibacterial treatment.
2. Urethral syndrome: mainly seen in women, often manifested as frequent urination, urgency, dysuria, more accompanied by lower abdomen and pubic pain, no white blood cells in the urine, no growth of acid-fast bacilli, IVU showed no hydronephrosis and Renal destructive lesions.
3. urethritis: also often manifested as frequent urination, urgency, dysuria, severe urethral orifice with purulent secretions and initial hematuria, there may be white blood cells in the urine, but no acid-fast bacilli growth, antibiotic treatment effect is obvious, IVU Show no hydronephrosis and kidney destructive lesions.
4. Interstitial cystitis: mainly manifested as urinary frequency, urgency, dysuria and other urinary tract irritation symptoms, but the pain and tenderness of the suprapubic bladder area is particularly obvious, most of the urine routine examination is normal, very few pus cells, no antacid Bacillus growth, IVU showed no hydronephrosis and renal destructive lesions, can be identified.
5. Glandular cystitis: clinical manifestations of urinary frequency, urgency, dysuria and other urinary tract irritation, but IVU without hydronephrosis and renal destructive lesions, cystoscopy without tuberculosis nodule formation and mucosal biopsy may have Help with differential diagnosis.
