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Tuberculosis of the urinary tract
Last reviewed: 23.04.2024
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Tuberculosis of the urinary tract in the structure of the incidence of extrapulmonary tuberculosis, 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 genitals is associated not only with the high prevalence of this disease. The social significance of specific inflammatory lesions is largely determined by the age structure of the suffering contingents, and the proportion of patients with nephrotuberculosis aged 20 to 40 years in the 1930-60's. Was dominant and reached 60-67%. Currently, there is a trend towards an increase in the prevalence of urinary tract tuberculosis and genital tracts among older age groups. The proportion of patients aged 20-40 years decreased to 45.7-56.2%. There is a significant decrease in the number of patients younger than 20 years and an increase in patients older than 50 years. In this way. Tuberculosis of the urinary tract and genitals is basically the lot of people of working age.
Tuberculosis is the cause of removal of the kidney in 21-34.5% of cases, both in past years, and now. In this case, mainly destructive forms of the disease are identified. The issue of the distribution of patients with nephrotuberculosis by sex is traditionally considered in all studies on the problems of phthisiourology. Most clinicians point to the same frequency of urinary tract tuberculosis among both sexes. In recent years, there has been some predominance of female patients (55%).
Symptoms of the tuberculosis of the urinary tract
The symptoms of kidney tuberculosis are very diverse, changeable and have no pathognomonic traits. Specific for tuberculosis of the kidneys is only the presence of mycobacterium tuberculosis in the urine. In many patients, the disease lasts for a long time under the mask of chronic pyelonephritis. Urolithiasis, polycystosis, tumor, cystitis and other diseases, and in some patients the subjective symptoms of urinary tract tuberculosis for a long time are completely absent. The general state of the majority of patients remains satisfactory even in the case of polycavernous tuberculosis of the kidneys.
Where does it hurt?
Forms
Ureteral tuberculosis
On the mucous membrane of the ureter, specific ulcers develop, with a tendency to rapid scarring. Most often such ulcers, and later strictures, are localized in the pelvic ureter and in the region of the ureteropelvic segment. The defeat of the ureter is the cause of constant blunt pain in the lumbar region and a sharp disruption of the kidney function, until its complete death. Very often, with tuberculosis of the ureter, non-specific chronic pyelonephritis develops.
When kidney tuberculosis is combined with pyelonephritis, pain in the lumbar region, an increase in body temperature, chronic renal failure are observed more often, in some patients the morphologically nonspecific inflammation predominates over the specific. Usually late stages of nephrotuberculosis are also associated with late stages of pyelonephritis, and often kidney failure occurs not so much from tuberculosis as from pyelonephritis. When the nephrotuberculosis is combined with chronic pyelonephritis, the latent and active phases of the disease alternate.
Diagnosis of ureteral tuberculosis is based on X-ray findings: enlargement or narrowing of the ureter (signs of periureteritis). An indirect sign of tuberculosis of the ureter is the presence of an insurmountable obstacle when trying to catheterize it, with periureteritis, displacement and deformation of the ureteral orifice and asymmetry of the bladder in cystography.
[Tuberculosis of the bladder
Tuberculosis of the pre-tubular ureter is accompanied, as a rule, by specific changes in the mucous membrane of the bladder. In the region of the bladder mouth of the ureter, there is edema, hyperemia, and then ulceration. In other parts of the bladder, cystoscopy is used to identify areas of focal hyperemia, rash of tubercle tubercles, ulcers.
Patients complain of progressive, despite ongoing treatment, disorders of urination. Often they are treated for a long time from chronic nonspecific cystitis and only cystoscopic examination and finding in the urine of tuberculosis mycobacteria helps to establish the correct diagnosis.
Complications and consequences
The clinical course of tuberculosis of the urinary tract is significantly affected by the functional state of the kidneys. Chronic renal failure is a frequent complication of urinary tract tuberculosis, occurring in 15-64% of cases. According to the research, chronic kidney failure was detected in 40.3%, including latent stage - in 10.3%, compensated - in 24.6%, intermittent - in 3.3% and terminal - in 2.1% of patients. With tuberculosis of the only kidney, chronic renal failure was observed in most patients.
Violation of kidney function in patients with urinary tract tuberculosis depends not only on the extent of destruction of the kidney tissue, but primarily due to the violation of the passage of urine with stenosis of the urinary tract. With a specific ureteral lesion, hydronephrosis transformation occurs, and destructive changes in the kidney progress. Prevention of chronic renal failure in nephrotuberculosis - the identification of the initial stage of the disease and early recovery of urine outflow with the use of minimally invasive technologies (percutaneous puncture nephrostomy, internal drainage of the kidney self-retaining stent).
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