urethral tuberculosis
Introduction
Introduction to urethra tuberculosis Tuberculosis of urethra is less common, mainly in men, with more complicated renal tuberculosis or prostate, seminal vesicle tuberculosis. Urethral tuberculosis can cause urethral stricture and obstruction, which can worsen kidney tuberculosis and worsen damage. Urinary tract tuberculosis is secondary to severe genitourinary tuberculosis. It is difficult to treat. If the genitourinary tuberculosis can recover and the urethral stricture is smaller, the prognosis is better. basic knowledge The proportion of illness: 0.003% Susceptible population: mainly occurs in men Mode of transmission: transmission through the respiratory tract Complications: urethral stricture, bladder tuberculosis, ureter tuberculosis, kidney tuberculosis
Cause
Urinary tract tuberculosis
Causes:
Mostly due to prostate and seminal vesicle tuberculosis directly spread to the posterior urethra, or due to urinary tuberculosis, penile tuberculosis caused by urinary tract infection. Tuberculosis infection precedes the formation of tuberculous nodules on the mucosa, and the nodules enlarge and fuse to form an ulcer. The base of the ulcer is composed of granulation tissue, and the granulation tissue fibrosis causes stenosis obstruction.
Penile tuberculosis (35%):
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.
Prostate tuberculosis (30%):
Prostate tuberculosis is part of the entire genitourinary tuberculosis, and genitourinary tuberculosis is part of systemic tuberculosis. The most common form of urogenital tuberculosis is kidney tuberculosis. Most other organs are secondary to kidney tuberculosis, including prostate tuberculosis. The more severe the disease of renal tuberculosis, the higher the possibility of male tuberculosis.
Prevention
Urinary tract tuberculosis prevention
1. Strengthen health education so that young people understand the harms and ways of infection of tuberculosis. Develop good health habits that don't spit. The TB patients are burned or disinfected.
2. Regular physical examination of adolescents should be carried out to achieve early detection, early isolation and early treatment. In addition, BCG vaccine should be given to infants and young children on time to make the body immune and reduce the occurrence of tuberculosis.
3. Found that there are symptoms such as low fever, night sweats, and blood clots in dry cough, so go to the hospital for examination. After the diagnosis of tuberculosis, it should be treated immediately with streptomycin, remi-salt, and ethambutol. At the same time, we must also pay attention to increase nutrition to enhance physical fitness. As long as it is found to be timely and completely treated, tuberculosis can be completely cured.
4. Tuberculosis is a disease transmitted by the tubercle bacillus through the respiratory tract. It is mainly transmitted by the patient's cough, sneezing and flying droplets when speaking loudly. Therefore, in order to avoid infection, it is necessary to develop good hygiene habits. When sneezing, use a handkerchief to cover your mouth and avoid facing others; the room should be ventilated frequently, and people in densely populated areas should pay more attention; more exercise should be done to improve immunity.
Complication
Urinary tract tuberculosis complications Complications urethral stricture bladder tuberculosis ureter tuberculosis kidney tuberculosis
Complications of urethral tuberculosis include urethral stricture obstruction. In severe cases, urethral tuberculosis can spread to the surrounding area, leading to urethral skin spasm or urethra rectal (vaginal) spasm. Ascending infection can lead to bladder tuberculosis, bladder contracture, ureteral tuberculosis, and kidney tuberculosis. Through the blood circulation can spread to various tissues and organs throughout the body, causing peritoneal tuberculosis, tuberculosis and bone tuberculosis. Therefore, patients with urethral tuberculosis should be B-ultrasound, CT, MRI to determine whether there are tuberculosis in other parts.
Symptom
Urinary tract tuberculosis symptoms common symptoms diffuse infiltration of the urethra, hematuria, urinary tract, urinary tract, urinary frequency, urinary tract bleeding
1. frequent urination, dysuria, urethral bleeding or hematuria.
2. Difficulties in urination, including thinning of the urinary line, shortened range, and weak urination.
3. The perineum is sputum and thick, hard, cord-like urethra or urethral fistula.
4. Reproductive system examination, often with the prostate, seminal vesicles, epididymis tail with hard nodules, and can be found in the vas deferens with bead-like nodules.
Examine
Urinary tract tuberculosis examination
Urine routine
About 90% of patients can find abnormal urine, and urine is generally acidic. Microscopic pyuria and hematuria are most common with a small amount of urinary protein. Urine routine examination is an important clue for early screening of renal tuberculosis.
2. Urine smear for tuberculosis
To take 24h urine or direct smear of the first urine sediment in the morning, for acid-fast staining to find tuberculosis, even 3 times, 50% to 70% of patients can be found tuberculosis. However, it should be noted that if the smear is positive, it cannot be completely determined. Because of the contamination of urine by smear bacteria or other acid-fast bacilli, it is morphologically difficult to distinguish from Mycobacterium tuberculosis, resulting in false positives. In particular, it cannot be diagnosed by relying on one positive result. Therefore, when collecting urine samples, the vulva and urethral opening should be washed to avoid contamination. All anti-tuberculosis drugs should be stopped 1 week before the examination to improve the positive rate of urine test.
3. Urine tuberculosis culture
It is an important basis for the diagnosis of renal tuberculosis and can be monitored for bacterial resistance. It is generally believed that morning urine specimens are superior to 24h urine, because morning urine is easy to collect and there is less chance of contamination. However, because tuberculosis excretion into the urine is interstitial, at least 3 days before the application of anti-tuberculosis treatment, morning urine is used for tuberculosis culture, and the positive rate can reach 80% to 90%. Some scholars have proposed collecting 6 morning urine cultures better.
4. Immunological methods
Immunological diagnosis is based on the principle of specific reaction between antigen and antibody to detect antigen, antibody, antigen-antibody complex in serum and urine, and help diagnose tuberculosis. Commonly used detection methods are radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA). Hubei Medical College used ELISA to measure tuberculosis antibody to diagnose renal tuberculosis, and the coincidence rate with pathological diagnosis was 82%. If the simultaneous determination of antigen and antibody positive rate reached 96.5%, it was close to tuberculosis culture.
5. Urethral angiography can show the location, length and stenosis of the urethral stricture.
6. Transurethral biopsy, histological examination can confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of urethra tuberculosis
diagnosis
Urogenital tuberculosis patients with frequent urination, fine urinary tract, dysuria, urinary retention and other symptoms of urethral stricture, and no history of trauma and gonorrhea, physical examination of urethral thickening, you should consider the possibility of urethra tuberculosis, further examination can be done urethrography , urethroscopic examination, if necessary, biopsy, combined with laboratory and imaging examination, can confirm the diagnosis.
Differential diagnosis
1. Urethral stricture: also manifested as thinning of the urinary tract, may be associated with frequent urination, urgency, and even urinary retention, but urethral stricture often has a history of urethral trauma or surgery, urethra angiography can be seen in the urethral stricture.
2. Trichomonas urethritis: also manifested as frequent urination, urgency, dysuria with urethral drip, but patients without a history of urinary tuberculosis, no dysuria, and triceps can be found in urine and secretions.
3. gonococcal urethritis: also manifested as frequent urination, urgency, dysuria, late dysuria, but the patient has a history of unclean sexual intercourse, urethral secretions can find gonococcus.
4. Bladder tuberculosis: also showed frequent urination, urgency, dysuria, history of urinary tuberculosis, but no dysuria, urethrography without urethral stricture.
