《泌尿生殖道结核》ppt课件

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1、TuberculoisofTheGenitourinaryTractHongshunMaDepartmentofUrologyTianjinFirstCentralHospitalTuberclebacillimayinvadeoneormoreoftheorgansofgenitourinarytractandcauseachronicgranulomatousinfectionthatshowsthesamecharacteristicasTBinotherorgans.60%ofpatientsarebetweentheageo

2、f20-60.AlittlemorecommoninmalesthaninfemalesEtiologyMycobacteriumtuberculosisLungs--hematogenous--GenitourinaryOrgansKidneyandprostate---primarysitesofTBinfectionPathogenesis&Pathology1Kidney&UreterThetuberclebacillihitstherenalcortex.PathologicalTB.ClinicalTB.TBgranul

3、omatousCasceation(cheesyMaterial),CalcificationPelvis,calyces,andureter---thickend,ulcerationHydronephrosisAutonephrectomy“golfhole”(gaping)Pathogenesis&Pathology2BladderThemucosamaybeinflamed.TuberclesUlcerateFibrosedandContractedUreteralrefluxorStenosisPathogenesis&Pa

4、thology3ProstateSeminalVesiclesEpidydimisandTestisClinicalFindings1Chroniccystitisrefusestorespondtotherapy.Pyuriawithoutbacteria.HematuriaAnontender,enlargedepidydimisAchronicdrainingscrotalsinusIndurationornodulationofprostateandthickeningseminalvesiclesClinicalFindin

5、gs2SymptomsVesicalirritabillity:burning,frequency,urgency,nocturia,hematuria.Flankpain:dullacheorcolicPainlessswellingoftheepididymisorchronicdrainingsinus.Nonspecificcomplaints:persistentfever,nightsweats.ClinicalFindings3SignsEnlargementortendernessofkidney.Externalge

6、nitallaProstateLaboratoryFindingsPersistentpyuriaTuberclebacilliculturesBloodcountErythrocytesedimentationrateRenalfunctionTuberculintestImaging1ChestfilmPlainfilmofabdomenExcretoryurograms:1)“moth-eaten”2)obliterationofcalyces3)dilatationofcalyces4)abscesscavities5)ure

7、teralstrictures,shorteningandstraightening6)absenceoffunctionalkidneyRetrogradeurographyImaging2UltrasonographyCTMRIInstrumentalexaminationCystoscopy“golf-hole”BiopsyDifferentialdiagnosisChronicnonspecificcystitisandpyelonephritisNonspecificepididymitisRenalstonesUrolog

8、ictumorComplicationsPerinephricabscessRenalstonesHydronephrosisUremiaTreatment1AntituberculosisdrugsTreatment2