Tuberculosis of male and female genital organs

Tuberculosis of male genitalia occurs at a frequency of 11.1-79.3%. Tuberculosis of female genital organs can occur under the guise of cystic ovarian formations, appendicitis, ectopic pregnancy.

Forms

Tuberculosis of the genital organs in men

Isolated lesions of the scrotum organs (appendages of the testicles, testicles, vas deferens) are noted in 30% of cases, and tuberculosis of the genital organs, placed intragastric (prostate gland, seminal vesicles) - in 15.6%. The combined tuberculosis of genital organs and scrotum organs was revealed in 54.4% of cases. Tuberculosis of the reproductive system in children is practically not met, very rarely observed in young men until they reach puberty. Thus, men are exposed to these diseases during the period of the greatest sexual activity, i.e. At the age from 21 to 50 years.

The combination of tuberculosis of genital organs and urinary anatomical structures is met in men in 11.1-79.3%. The frequency of combination of tuberculosis of male genital organs with tuberculosis of other localizations, according to different authors, varies widely. Most often, tuberculosis of the genitals is combined with tuberculosis of the urinary system (34.4%) and pulmonary tuberculosis (14.4%). According to the sectional data, tuberculosis of genital organs in men occurs in 4.7-21.7% of deaths from pulmonary tuberculosis, but only 0.4% among those who died from other diseases.

[1], [2], [3]

Classification of tuberculosis of genital organs in men

• Localization: epididymis, testis, vas deferens, seminal vesicle, prostate, urethra, penis.
• Form: productive, destructive (abscess, fistula).
• Phase: exacerbation, fading.
• The degree of compensation of body function: compensated; subcompensated; decompensated.
• Bacillarity: VC (+), VC (-).

[4], [5], [6]

Tuberculosis of the genital organs in women

The high incidence of women of childbearing age and children, as well as high rates of tuberculosis in pathoanatomical studies characterize the unfavorable epidemiological situation and indicate an inadequate intravital detection of tuberculosis. The importance of the affected problem is evidenced by statistics. More than 650 million women are infected with tuberculosis and 3 million are ill every year. Due to the lack of screening diagnostic tests, the disease is detected in the late stages with irreversible anatomical changes and in 1/3 of cases in the general treatment network on the operating table. The incidence of genital tuberculosis in women is 3.2-3.5 per 100 thousand of the population. 

Tuberculosis of the genital organs in women can hide under the mask ovarian cysts, acute appendicitis, peritoneal carcinoma, omentum, ovaries, ectopic pregnancy, etc. Although tuberculosis of the genital organs in women does not exceed 1% in the population and takes 3-4 th place among extrapulmonary forms, this disease entails social, psychological consequences and deserves close attention of gynecologists, phthisiatricians, pediatricians and oncologists. They note the rejuvenation of patients' contingents, they often register polyorganous forms of tuberculosis involving not only the structures of the genital sphere, but also the osteoarticular system, kidneys, eyes, etc.

Tuberculosis of the genital organs in women ranks 7th among diseases of the female sexual sphere. Among patients with pulmonary and other forms of tuberculosis, tuberculosis of genital organs in women is revealed in 10-30% of cases. In the risk groups, tuberculosis of genital organs in women is diagnosed in 10-20% of patients. The disease begins at a young age during the primary hematogenous dissemination of tuberculosis. Hematogenous generalization can occur against the background of progression or healing of the main focus. Primary foci, in addition to the lungs, can be located in various organs. With primary hematogenous dissemination, the primary focus in the lung can not be seen further in the future and disappears without a trace. However, 15-20% of patients still have traces of the transferred process in the form of an increase in the intrathoracic lymph nodes, thickening of the pleura, small calcifications, etc.

Tuberculosis salpingitis

With hematogenous lesions of anatomical structures, the process begins in those departments where there is sufficient blood supply and a large area of microcirculation - these are the fimbrial parts of the fallopian tubes, the mucosa and the submucosa of the oviducts. The process acquires latent flow, if there are no provoking factors, and only infertility can be the only complaint of patients. The initial stage of the disease is most difficult to diagnose and proceeds under the flag of chronic adnexitis. At this stage, tubular pregnancy is also common. In the fallopian tubes, the contractility of the muscle tissue is disturbed, they become rigid, edematous, then the fimbrial ones are closed and the ampullar divisions expand. The accumulation of exudate promotes the formation of saktosalpinks. If the lumen of the tube is filled with caseous-necrotic masses, there is a casei of the uterine tube.

Tuberculosis salpingo-oophoritis

With further progression, the adjacent ovaries, the second fallopian tube, the intestine, the omentum, and the bladder may be involved in the inflammatory process. Tubo-ovarian formations can be formed. This formation with caseous decay inside itself is the source of infection. The processes of infiltration, scarring, calcification can go parallel to each other and cause a diverse morphological and clinical picture. The spread of the process is facilitated by a mixed infection, which is often present in the lesion of female anatomical n.

Tuberculous oophoritis

In one third of cases, the ovaries are affected. It can occur by hematogenous, lymphogenous or by extension. The white membrane of the ovary is a dense tissue and is more resistant to penetration of mycobacteria than the tissues of the fallopian tubes and uterus. The cortical layer of the ovary can be affected with the formation of multiple tubercles or ovarian casement with a dense capsule. The formed caseous focus itself is a source of tuberculosis infection, from which the hematogenous-lymphogenous screening or by contact occurs. The course of isolated tuberculosis of the ovary is favorable, since the process rarely spreads further.

Tuberculous endometritis and metroendometritis

With progression, the process extends to the uterine cavity. This is facilitated by provoking factors - intrauterine interventions, spontaneous abortions, tubal pregnancy, artificial abortions, after birth, the placental site can be affected. The course of tubercular endometritis depends on the depth of the lesion. When involved in the process of the functional layer of the endometrial mucosa, the course is favorable, as monthly rejection of it prevents the further spread of tuberculosis. Timely treatment and physiological characteristics contribute to cure. 

When the process spreads to the basal and muscular layers of the uterus, the healing process is prolonged and can result in the formation of intrauterine fusion, complete or partial obliteration of the uterine cavity and fallopian tubes. This is facilitated by intrauterine interventions. Primary hematogenous dissemination can occur especially unfavorably when an adhesive process occurs, when the uterine cavity is obliterated during the onset of menarche and a primary amenorrhea of uterine genesis occurs. Chronic inflammation promotes the development of hyperplastic endometrium, which is observed in 70-84% of our patients - glandular hyperplasia, glandular-cystic hyperplasia, polyendosis of the endometrium.

Tuberculosis of cervix and vagina

Tuberculosis of the cervix and vagina is more common in women of older age groups, they are the final stage of tubercular lesion of the genital organs. Tuberculosis of the genitals, but in the vaginal part of the cervix, can look like pseudo-erosion or a site of hyperemia around the external throat. In the dome of the vagina and on the vaginal portion of the cervix, prosovous eruptions can be seen in the form of single lesions or ulcers merging into the sites. Diagnosis of tuberculosis of the cervix and vagina is to carry out bacteriological, cytological and morphological methods.

Peritoneal tuberculosis

Particularly it is necessary to single out the processes with the predominant lesion of the peritoneum, including the covering organs of the small pelvis. Fallopian tubes may not be altered, but in this case infertility is caused by a violation of the villous epithelium of the peritoneum, which facilitates the transport of gonads. In the exudative phase on the serous surface of the pelvic organs, small prosovous eruptions and serous exudate can be observed. These phenomena can be accompanied by ascites. Patients often fall on the operating table with suspicion of ovarian cancer. In the proliferative phase, in the small pelvis, multiple pockets are formed, cysts filled with serous fluid, which can vary in size depending on the day of the menstrual cycle or due to other factors and cause an appropriate clinical picture. The formation of planar adhesions between neighboring organs contributes to the development of pain syndrome, makes diagnosis and treatment more difficult. Tuberculosis of the peritoneum is most often manifested in the reproductive age.