bladder tuberculosis
Introduction
Introduction 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. Most of the patients with tuberculous cystitis have frequent urination, and the urinary frequency gradually worsens with urgency, dysuria, and hematuria. Urination gradually increases from 3-5 times/day to 10-20 times/day. If the bladder symptoms are aggravated, the mucosa has extensive ulcers or bladder contracture, and the volume is reduced, the urination is dozens of times a day, even urinary incontinence, the patient is very pain.
Cause
Cause
(1) Causes of the disease
Bladder tuberculosis is part of the urinary system tuberculosis, mostly from kidney tuberculosis, due to tuberculosis and urine contamination from the submucosal ureter.
(two) pathogenesis
The pollution of renal tuberculosis and the spread of ureteral tuberculosis along the submucosa make the bladder triangle area appear hyperemia and edema, and tuberculous nodules gradually appear. The triangle was first affected and quickly spread to the entire wall of the bladder. Tuberculosis nodules merged, and the bean dregs formed and formed ulcers. If the ulcer invades the bladder muscle layer extensively, severe fibrosis will still occur in the bladder muscle layer even after the kidney is removed. This causes the bladder muscles to lose their ability to stretch, reduce their capacity, and form a tuberculous small bladder - bladder contracture.
When the tuberculous ulcer of the bladder is severe, a small number of cases can penetrate the whole layer of the bladder, invade and penetrate other organ tissues, and form tuberculous bladder spasm, such as vesicovaginal fistula and bladder rectal fistula. There is also a perforation at the top of the bladder, and urine flows into the abdominal cavity to form an acute abdomen. After the bladder contracture, due to the shrinking capacity of the bladder, the ability to regulate the intravesical pressure is lost. The internal pressure is often in a relatively high state, the volume is increased, and the internal pressure is repeatedly strengthened, resulting in accumulation of water in the upper urinary tract.
In addition, the scar tissue formed by bladder tuberculosis can cause ureteral stenosis, as well as fibrosis of the bladder tissue, loss of sphincter effect and incomplete closure of the ureteral orifice, which is also a factor that causes changes in upper urinary tract water. These conditions can occur during the active period of bladder disease, and 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 and erosion. Patients with urinary tract violent burning at the end of urination, severe cases can form tuberculous urethral stricture or urethral fistula.
Examine
an examination
Related inspection
Urine routine cystoscopy urine analysis
In addition to frequent urination, more often accompanied by dysuria, pyuria, hematuria, etc., after anti-tuberculosis treatment can be improved. In addition to frequent urination and urinary incontinence, the symptoms of bladder contracture often have no dysuria, pyuria, hematuria, etc. After the anti-tuberculosis treatment, the symptoms can not be improved, and sometimes the bladder disease is further fibrotic, and the symptoms are aggravated.
Mycobacterium tuberculosis antigen, antibody test, intravenous urography, cystography, urine routine, serous effusion protein, plasma cells, lymphocyte transformation rate, effusion 2-microglobulin, serous effusion pathogen, pulp Membrane effusion of glucose.
1. Urine examination There are a lot of red blood cells and pus cells in the urine. If there is no mixed infection, the middle urinary bacteria culture is negative, and the tuberculosis culture is 60% positive.
2, X-ray examination of excretory urography, 85% showed side renal tuberculosis. In advanced cases, there is contralateral hydronephrosis and renal dysfunction. In the case of cystography, the edge of the bladder was rough and not smooth. In cystography, the bladder volume was reduced to less than 50 ml, and some patients had vesicoureteral reflux on the contralateral side.
3, cystoscopy early ureteral orifice around the edema congestion and tuberculous nodules, gradually spread to the triangle and contralateral ureteral orifice, and even to the whole bladder. Tuberculous nodules rupture, forming granulation wounds, with necrotic bleeding. There is a clear boundary between the diseased mucosa and the normal bladder mucosa.
Diagnosis
Differential diagnosis
Differential diagnosis
1. Non-specific cystitis is common in women, especially newly married women. Both have frequent urination, urgency, dysuria, hematuria and pyuria. However, if cystitis is accompanied by pyelonephritis, the patient has fever and low back pain, tenderness in the suprapubic area, and positive culture of urinary bacteria in the middle. Excretory urography, no destructive lesions of the kidney. After treatment with antibiotics, the effect is obvious.
2, urethral syndrome is seen in women, in addition to frequent urination, urgency, dysuria, and more with lower abdomen or suprapubic area pain, genital itching. Often due to fatigue, lack of drinking water or sexual intercourse, resulting in an acute attack. Cystoscopy, the bladder mucosa is smooth, the color is dark, and the blood vessels are clear. Some are vague but still recognizable.
The blood vessels in the triangle area are unclear and structurally disordered, and become pale due to repeated inflammation damage. Excretory urography, no abnormal findings in the kidneys.
3, urethritis has frequent urination, urgency, dysuria. The pain radiates to the head of the penis. But urethritis is urinary hematuria. In severe cases, there is purulent discharge in the urethra, which is obvious in the morning. Cystoscopy: no inflammatory changes in the bladder, no tuberculous nodules. The effect of treatment with antibiotics is obvious.
4, bladder stones are more common in children, due to the stimulation and damage of stones, there are frequent urination, urgency and dysuria. However, bladder stones have difficulty in urinating, which is characterized by sudden interruption of urine, difficulty in urinating and pain after changing position. The flat area of the bladder area shows opaque shadows. Cystoscopy can directly see the stones.
