Ureteral tuberculosis
Introduction
Introduction to ureteral tuberculosis Ureteral tuberculosis is a tuberculosis caused by tuberculosis of renal tuberculosis descending to the ureter. It first invades the ureteral mucosa, gradually invades the submucosa and muscle layer, and forms an ulcer. The fibrosis of the base of the ulcer makes the ureteral lumen narrow or even completely occluded. More common in the bladder wall of the ureteral bladder junction, followed by the ureteropelvic junction, other parts can also occur, can be segmental stenosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary tract obstruction
Cause
Ureteral tuberculosis
Cause (30%):
Tuberculosis of ureter is secondary to renal tuberculosis. Mycobacterium tuberculosis first invades the ureteral mucosa and develops deep into the submucosa and myometrium. Eventually fibrosis occurs, resulting in ureteral stricture, hardening, thickening and stiffness, and even Complete obstruction.
Pathogenesis (25%) :
Urinary tuberculosis infection occurs in the kidney first, and the lesion is mainly in the renal medulla and renal nipple. It develops progressively, causing tissue destruction, forming a cavity, and the cavity is destroyed and enlarged. It is connected with the renal pelvis, Mycobacterium tuberculosis and its tuberculosis. The substance is discharged into the bladder with urine, and the tuberculosis descends to the ureter, causing tuberculosis. The ureteral stricture is more common in the bladder wall segment of the ureteral bladder junction, followed by the pelvic ureteral junction, and other parts may occur, which may be segmental stenosis. .
Prevention
Ureteral tuberculosis prevention
1. The fundamental measure to prevent genitourinary tuberculosis is to prevent tuberculosis. Due to the progress of molecular biology in recent years, the US Center for Disease Control (1989) proposed a strategic plan to eliminate tuberculosis within 20 years, and humans may use new methods of prevention, diagnosis and treatment. To eliminate tuberculosis.
2, regularly open the window to ventilate, keep the indoor air fresh. Cultivate good hygiene habits, such as the implementation of the system of food, the special equipment for washing utensils, washing hands frequently, changing clothes frequently, and disinfecting regularly.
Complication
Ureteral tuberculosis complications Complications, urinary tract obstruction, hydronephrosis
The main complication of tuberculous ureteral stricture is the upper urinary tract obstruction, which leads to renal failure in the late stage of hydronephrosis.
Symptom
Symptoms of ureteral tuberculosis Common symptoms Low back pain with frequent urination, urine... Hematuria hypothermia ureteral stricture sputum pain ureteral obstruction fatigue
Patients have a history of tuberculosis or renal tuberculosis, early urinary frequency, urgency, dysuria and hematuria symptoms, late ureteral obstruction may have low back pain, and even skin sinus, with low fever, fatigue and other symptoms, when there is severe hydronephrosis, you can Touching the enlarged kidney, the kidney area has aching pain.
Examine
Ureteral tuberculosis examination
Cystoscopy
Visible bladder mucosal congestion or tuberculous nodules, obvious around the ureteral orifice.
2.IVU inspection
Early ureteral tuberculosis is mainly characterized by ureteral dilatation, varying thickness, irregular margins, loss of natural morphology, sometimes beaded, late manifestation of contracture and stiffness, can have cord-like calcification, severe ureteral stricture can cause the affected kidney and ureter Without visualization, retrograde angiography can show ureteral lesions.
3. CT examination
Only a wide range of continuous scans can show the stenosis of the middle and distal ureters. Otherwise, it can only show the expansion of the renal pelvis and ureter. For the proximal ureteral stricture, CT can often show the thickening of the ureteral wall while showing renal tuberculosis. The lumen is reduced, and CT can also show calcification of the ureteral wall and differentiate it from ureteral stones.
4. MRI examination
It can well show the dilated ureter and ureteral stenosis, which can replace the traditional IVU to a certain extent. On the display of renal tuberculosis, MRI has no obvious advantage over CT.
Diagnosis
Diagnostic identification of ureteral tuberculosis
diagnosis
Ureteral tuberculosis is often secondary to renal tuberculosis, clinical manifestations are often similar, confirmed by medical history, laboratory and imaging examination, IVU has important value in understanding the degree of renal function and destruction and ureteral stricture.
Differential diagnosis
Ureteral tumor
Benign lesions in ureteral tumors are ureteral polyps, malignant lesions are ureteral cancer, and ureteral tuberculosis causes lesions above the ureteral dilatation, hydronephrosis and renal dysfunction. The characteristics of ureteral tumors are patients with painless hematuria; excretion And retrograde urography, showing filling defects in the ureteral lesions, ureteral dilatation above the lesion, smooth mucosa, unlike ureteral tuberculosis, a wide range of lesions, worm-like, beaded changes, ureter can be due to stagnant water The sample changes, but there is no stiff performance, and the exfoliated cells in the urine can be tested positive.
2. Ureteral stenosis
Caused by non-specific infection, multiple secondary to pyelonephritis, cystitis, excretory and retrograde urography showed localized stenosis of ureteral inflammation, ureteral dilatation above the stenosis, hydronephrosis, should be identified, but renal pelvis, kidney no destructive change; urine culture was positive, while M. tuberculosis culture was negative, cystoscopy showed edema of the bladder mucosa, congestion, but no tuberculous nodules, granulation wounds and ulcers, its clinical manifestations of ureteritis, due to The ureteral peristalsis occurs with paroxysmal cramps, while the ureteral tuberculosis has frequent urination, urgency, and dysuria as the main clinical manifestations.
3. Ureteral inflammation
The cause of inflammation around the ureter is unknown. The lesions occur as retroperitoneal fibrous tissue hyperplasia. The hyperplastic tissue surrounds one or both sides of the ureter. It is common at the junction of the ureter and pelvis and the bifurcation of the iliac vessels, but it can also involve the ureter or even the kidney above the pelvis. Because the fibrous tissue surrounds the ureter, the ureter is narrow, the ureter is stiff, and the hydronephrosis is needed. The two need to be identified. The inflammation around the ureter is rare. There are fewer frequent urination, urgency, dysuria, excretion and retrograde urography. Displaced to the midline, the lumen is thinner, but the ureteral lumen is smooth, no worm-like and beaded changes, no lesions in the kidney; cystoscopy no bladder nodules, granulation wounds and ulcers, urine examination pus The cells are rare, no rice soup like pyuria.
