Urinary tract tuberculosis

Tuberculosis of the urinary tract in the structure of extrapulmonary tuberculosis incidence reaches 30-50%. This is noted in most publications of recent decades.

The continuing interest of clinicians in the problem of tuberculosis of the urinary tract and genital organs is associated not only with the persistently high prevalence of this disease. The social significance of specific inflammatory lesions is largely determined by the age structure of the affected contingents, and the proportion of patients with nephrotuberculosis aged 20 to 40 years in the 1930-60s was dominant and reached 60-67%. Currently, there is a tendency towards an increase in the prevalence of tuberculosis of the urinary tract and genital organs among older age groups. The proportion of patients aged 20-40 years has decreased to 45.7-56.2%. There is a reliable decrease in the number of patients under 20 years of age and an increase in patients over 50 years of age. Thus, tuberculosis of the urinary tract and genital organs mainly remains the lot of people of working age.

Tuberculous lesions are the cause of kidney removal in 21-34.5% of cases both in previous years and at present. In this case, mainly destructive forms of the disease are detected. The issue of distribution of patients with nephrotuberculosis by gender is traditionally considered in all studies on the problems of phthisiourology. Most clinicians indicate the same frequency of tuberculosis of the urinary tract among both sexes. In recent years, a certain predominance of female patients has been noted (55%).

Symptoms urinary tuberculosis

Symptoms of renal tuberculosis are very diverse, variable and have no pathognomonic signs. The only specific feature of renal tuberculosis is the presence of Mycobacterium tuberculosis in the urine. In many patients, the disease proceeds for a long time under the guise of chronic pyelonephritis. urolithiasis, polycystic disease, tumor, cystitis and other diseases, and in some patients, subjective symptoms of urinary tract tuberculosis are absent for a long time. The general condition of most patients remains satisfactory even with polycavernous renal tuberculosis.

Forms

Tuberculosis of the ureter

Specific ulcers that tend to scar quickly appear on the mucous membrane of the ureter. Most often, such ulcers, and subsequently strictures, are localized in the pelvic section of the ureter and in the region of the ureteropelvic segment. Ureteral damage causes constant dull pain in the lumbar region and a sharp impairment of kidney function, up to its complete death. Very often, nonspecific chronic pyelonephritis develops in the presence of ureteral tuberculosis.

When kidney tuberculosis is combined with pyelonephritis, pain in the lumbar region, increased body temperature, chronic renal failure are more often observed; in some patients, morphologically nonspecific inflammation prevails over specific inflammation. Usually, late stages of nephrotuberculosis correspond to late stages of pyelonephritis, and often kidney death occurs not so much from tuberculosis as from pyelonephritis. When nephrotuberculosis is combined with chronic pyelonephritis, latent and active phases of the disease alternate.

Diagnosis of ureteral tuberculosis is based on X-ray examination data: expansion or narrowing of the ureter (signs of periureteritis). An indirect sign of ureteral tuberculosis is the presence of an insurmountable obstacle when attempting to catheterize it, with periureteritis, displacement and deformation of the ureteral orifice and asymmetry of the bladder during cystography.

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Tuberculosis of the bladder

Tuberculosis of the prevesical ureter is usually accompanied by specific changes in the mucous membrane of the bladder. Edema, hyperemia, and then ulceration occur in the area of the bladder orifice of the ureter. In other parts of the bladder, cystoscopy reveals areas of focal hyperemia, rashes of tuberculous nodules, and ulcers.

Patients complain of progressive, despite the treatment, urination disorders. They often undergo long-term treatment for chronic non-specific cystitis, and only cystoscopic examination and detection of tuberculosis mycobacteria in the urine helps establish the correct diagnosis.

Complications and consequences

The clinical course of urinary tract tuberculosis is significantly affected by the functional state of the kidneys. Chronic renal failure is a common complication of urinary tract tuberculosis, occurring in 15-64% of cases. According to research data, chronic renal failure was detected in 40.3%, including the latent stage - in 10.3%, compensated - in 24.6%, intermittent - in 3.3% and terminal - in 2.1% of patients. In tuberculosis of a single kidney, chronic renal failure was observed in most patients.

Impaired renal function in patients with urinary tract tuberculosis depends not only on the extent of renal tissue destruction, but is primarily associated with impaired urine passage in urinary tract stenosis. With specific damage to the ureter, hydronephrotic transformation occurs, and destructive changes in the kidney progress. Prevention of chronic renal failure in nephrotuberculosis is the detection of the initial stage of the disease and early restoration of urine outflow using minimally invasive technologies (percutaneous puncture nephrostomy, internal drainage of the kidney with a self-retaining stent).

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