泌尿、男生殖系结核

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1、UrologicandMaleGenitalTuberculosisYiLinDepartmentofurologyTianjinMedicalUniversity概述泌尿、男生殖系结核(urologicandmalegenitaltuberculosis)结核杆菌侵犯泌尿、男性生殖器官引起的慢性特异性感染。约占全部肺外结合的14%与经济落后、医疗水平底有关好发年龄20~40岁青壮年男性大于女性，2：1左右概述原发性结核病:首次感染结核菌,引起的结核病-肺结核继发性结核病:有结核菌感染后,已建立细胞免疫和变态反应后发生的结核病.发病

2、机理人体首次感染结核菌—机体无免疫力—巨噬细胞不能杀死结核菌—结核菌蔓延—经淋巴或血液播散到全身—在各组织中着床—潜伏灶—一般情况下不发病—机体免疫力地下时或营养不良时—潜伏菌大量繁殖—发病概述感染途径：4种1.血性感染：最常见2.接触感染：通过性生活或污染物传播，少见3.淋巴感染：罕见4.直接蔓延：罕见泌尿、男生殖系统内部传播：1.顺行蔓延：肾—输尿管—膀胱2.逆行蔓延：膀胱—健侧输尿管—健侧肾脏血行传播顺行传播逆行传播EtiologyThekidneyandpossiblytheprostatearetheprimarysite

3、softuberculousinfectioninthegenitourinarytract.Allothergenitourinaryorgansbecomeinvolvedbyeitherascent(prostatetobladder)ordescent(kidneytobladder,prostatetoepididymis).Thetestismaybecomeinvolvedbydirectextensionfromepididymalinfection.PathogenesisA.kidneyandureter:Ash

4、owerofTBhitstherenalcortex,theorganismsmaybedestroyedbynormaltissueresistance.Onlyscarsarefoundinthekidney.However,ifenoughbacteriaofsufficientvirulencebecomelodgedinthekidneyandarenotovercome,aclinicalinfectionisestablished.PathogenesisA.kidneyandureter:Tuberculosisof

5、thekidneyprogressesslowly;itmaytake15~20yearstodestroyakidneyinapatientwhohasgoodresistancetotheinfection.Therefore,thereisnorenalpainandlittleornoclinicaldisturbanceofanytypeuntilthelesionhasinvolvedthecalycesorthepelvis.Itisonlyatthisstagethatsymptoms(ofcystitis)arem

6、anifested.PathogenesisA.kidneyandureter:Asthediseaseprogress,acaseousbreakdownoftissueoccursuntiltheentirekidneyisreplacedbycheesymaterial.Calciummaybelaiddowninthereparativeprocess.Theureterundergoesfibrosisandtendstobeshortenedandstraightened.Thischangeleadstoa“golf-

7、hole”(gaping)ureteralorifice,typicalofanincompetentvalve.TuberculosisofkidneyandureterTuberculosisofkidneyandureterTuberculosisofkidneyPathogenesisB.bladder:Vesicalirritabilitydevelopsasanearlyclinicalmanifestationofthediseaseasthebladderisbathedbyinfectedmaterial.Tube

8、rclesformlater,usuallyintheregionoftheinvolvedureteralorifice,andulcerate—bleeding.Bladderbecomesfibrosedandcontracte