Diseases of the urinary system are quite common. They can affect the kidneys, urinary tract, bladder. Of all the existing diseases, it is worth highlighting and considering tuberculosis of the genitourinary system. Every person needs to know about this disease, because no one is immune from the disease.
Read more about TB affecting the urinary system
Probably there is no such person who has not heard about tuberculosis. This is a common disease in which bacteria called Koch's rods infect the lungs. However, these microorganisms can live not only in these organs. Specialists know extrapulmonary forms of the disease. The first place among them is tuberculosis of the genitourinary system.
How is this disease transmitted? Koch's sticks enter the urinary system via the hematogenous route. Based on this, we can conclude that at first a person becomes infected with ordinary tuberculosis from a patient who releases pathogens into the environment. In the future, Koch's sticks can get into the urinaryblood flow system. Thus, the routes of infection are first airborne and then hematogenous.
Tuberculosis of the genitourinary system in women and men begins with kidney damage. Of these, the infectious process spreads through the renal tubules, vessels into the renal pelvis. Then the ureters and bladder are affected. Tuberculosis foci occur in both kidneys, but, as practice shows, the pathological process progresses only in one of these paired internal organs.
How does the disease develop? Koch's sticks, when they enter the kidneys, affect the cortical and medulla. Tubercles appear in the organ. They gradually ulcerate, caseous decay occurs. As a result, cavities are formed. Around them, inflammatory processes develop, tubercles appear. All this can lead to complete destruction of the kidney with the formation of pyonephrosis.
With further development, tuberculosis of the genitourinary system in women and men affects the fibrous and fatty capsule of the internal organ. Tubercles and ulcers appear on the renal pelvis, ureter. Because of this, the walls thicken, become infiltrated, edematous. Ulcers are further healed, structures are formed that interfere with the outflow of urine.
In the absence of adequate treatment, the infection passes from the kidneys to the bladder. The pathological process first begins in the area where the ureters are located. Tuberculous tubercles appear on the mucous membrane of the internal organ. They are subject to further decay. In their place, ulcers and scars form. Later, the bladder becomeswrinkled due to the fact that the affected walls of the internal organ are replaced by sclerotic tissue.
Tuberculosis of the genitourinary system: a brief description of the classification of the disease
Specialists in practice apply a classification that distinguishes several stages of the disease:
- The first stage of the disease is characterized by infiltrative tuberculosis of the kidneys, i.e. non-destructive.
- At the second stage, initial destruction is observed, i.e., single small cavities appear. In diameter, they do not exceed 1 centimeter.
- At the third stage, limited destruction is observed. A large cavity or polycavernous tuberculosis appears in one of the segments of the kidney.
- The fourth stage is characterized by total or subtotal destruction.
Clinical picture of the disease
Tuberculosis of the genitourinary system can manifest itself in different ways. No wonder this disease in the medical literature is called one of the most frequent "hoaxers" among diseases of the bladder, kidneys and urinary tract. The associated complications often affect the manifestations of tuberculosis. It could be pyelonephritis, chronic renal failure.
Symptoms of kidney tuberculosis are divided into 2 groups:
- general signs that are observed when the general condition of a sick person changes;
- local signs, subdivided, in turn, into subjective (those that the patient feels) and objective (identified by specialists during the examination).
Common signs of urinary tract tuberculosis
When 20-30% of people get sick, their body temperature rises. Basically, it fluctuates between 37-38 degrees. In some patients, in the presence of additional diseases, complications, a temperature equal to 38-39 degrees is noted, chills appear.
Approximately 5-18% of sick people have arterial hypertension (increased blood pressure). Previously, experts believed that this symptom is a consequence of the associated pyelonephritis. It has now been proven that arterial hypertension is a sign that may indicate kidney tuberculosis. It should be noted that the frequency of detection of this symptom depends on the nature of the disease. For example:
- with tuberculosis of the parenchyma of the kidney, hypertension affects about 1.1% of sick people;
- with tuberculosis of the renal papilla - 3.2%;
- with tuberculous pyonephrosis and polycavernous tuberculosis - 18.3%.
Local subjective symptoms of the disease
Often people ask the question: “Symptoms, if there is tuberculosis of the genitourinary system, what?” The sensation that may arise is painful and frequent urination. Experts in the 50-60s of the last century identified this symptom in all people. Then there was a tendency to reduce the frequency of manifestation of the symptom. In the 60s and 70s, only 48% of people complained of impaired urination, and in the 80s, only 43% of patients. In recent years, the symptom has been observed less frequently. This is explaineda decrease in the incidence of lesions of the bladder mucosa.
Quite common signs are pain in the lumbar region that occurs when tuberculosis of the genitourinary system begins to develop. These symptoms are observed in about half of sick people. Pain is usually unilateral. Only 15–20% of sick people report discomfort localized on both sides.
By its nature, the pain is acute, similar to renal colic. It occurs due to a violation of the excretory function as a result of blockage of the ureters with blood clots, a purulent plug, and swelling of the mucous membrane. Renal colic is a symptom that is observed not only in tuberculosis of the urinary system. It is also present in other diseases. One of them is urolithiasis. A urological examination is performed to make an accurate diagnosis.
Local objective signs
The above signs that tuberculosis of the genitourinary system has are symptoms that are subjective. Objective signs include leukocyturia. This term refers to an increased number of white blood cells in the urine. Leukocyturia is the earliest sign of the disease. However, it is not mandatory. If leukocytes are not detected during the urine test, this is not considered confirmation of the absence of the disease.
Signs of urogenital tuberculosis include erythrocyturia. In medicine, this term refers to an increased level of red blood cells in the urine. In recent yearsthis sign is detected quite often - in about 70-75% of sick people. The incidence of erythrocyturia is associated with the development of a destructive process in the kidney.
An early objective symptom of tuberculosis is proteinuria (detection of protein in a urine test). It is detected in 85-95% of sick people. There are several opinions about the occurrence of proteinuria:
- Some experts believe that it is not associated with tuberculosis of the urinary system. The source of protein, in their opinion, are red blood cells.
- Other researchers claim that protoinuria is caused by dystrophic changes occurring in the tubules and glomeruli of the kidneys.
Every year more and more doctors discover another sign of tuberculosis. This is nonspecific bacteriuria. Infection can be detected at all stages of the disease. Most often it is found in cavernous forms. The causative agents of nonspecific urinary infections are different. E. coli, and staphylococci, and streptococci, and sticks of blue-green pus come to light. Mixed flora is not uncommon.
The most reliable symptom of the disease is the detection of Koch's sticks in the urine. However, it is not always possible for specialists to detect the main causative agent of the disease. Even modern methods of bacteriological research do not help. The fact is that some people take antibiotics prescribed by a doctor for existing ailments or drink these medicines while self-medicating. As a result, Mycobacterium tuberculosis loses the ability to reproduce and grow. After sowing, they, of course, for this reason are not detected. It makes it hardidentification of the pathogen in the body of a sick person.
Features of tuberculosis of the urinary system in children and the elderly
This disease mainly affects adults. Children are much less likely to be diagnosed with tuberculosis of the genitourinary system. A frequent and early symptom that occurs in them is polyuria, that is, an increase in the volume of urine excreted. There are other signs, but they are often associated with other diseases. Another important feature of tuberculosis in children is that girls are more likely to have a non-destructive form of the disease, while boys have a destructive form.
Tuberculosis of the urinary system affects many people in old age. This is due to a decrease in immune defense, the appearance of various ailments. The symptoms of tuberculosis are affected by concomitant and urological diseases. These include: hypertension, diseases of the gastrointestinal tract, urolithiasis, nonspecific pyelonephritis, etc. Because of this, tuberculosis of the urinary system is not always detected. Its symptoms masquerade as signs of the diseases listed above.
Features of the course of the disease in women and men
How tuberculosis of the genitourinary system manifests itself depends on gender. In women, symptoms include less severe pain. Men are stronger. They are much more likely to develop genital tuberculosis. Statistics show that such progression in women is observed only in 7% of cases, and in men - in 31%.
Considering tuberculosis of the genitourinary system in men, the symptoms of this disease, it is worthnote that Koch's sticks first affect the prostate (prostate gland). Other organs and structures of the reproductive system are then involved in the pathological process: seminal vesicle, testicle, epididymis. In rare cases, the penis is affected. Ulcers appear on it, the disease affects the peripheral lymph nodes. Similar signs observed on the penis require differential diagnosis with oncological disease.
Tuberculosis of the genitourinary system: diagnosis
Clinical methods are used first in making a diagnosis. They do not allow to reliably determine whether a person has tuberculosis or not. However, thanks to them, experts detect suspicious signs. Clinical research methods include interviewing a sick person, conducting an examination, palpation of painful places.
Laboratory methods play an important role in diagnosis:
- Sick people take a blood test. It does not reveal any specific signs inherent in urinary tuberculosis, but may show leukocytosis and an increase in the erythrocyte sedimentation rate. This will indicate the presence of an inflammatory process in the body.
- Urine tests are ordered. This is the main laboratory method for diagnosing tuberculosis. In the urine during the disease, Koch's sticks, other infections (if any or the development of complications) are found. Tests may show proteinuria, leukocyturia, erythrocyturia.
Specialists note the importance of using all possible research methods, their combination and repeatedapplications.
The list of diagnostic methods includes tuberculin diagnostics. Its essence lies in the subcutaneous injection of a special condensed cultural fluid. It's called tuberculin. Tuberculin diagnostics has indications and contraindications. The indications include: suspicion of tuberculosis of the genitourinary system, assessment of the effectiveness of the specific treatment carried out, control of the activity of the process. Contraindications are individual intolerance.
When diagnosing tuberculosis, it is possible to use endoscopic methods of research:
- One of them is cystoscopy. With this method, an endoscope, which is a catheter with lighting and optical systems, is inserted through the urethra into the bladder. Nonspecific signs of tuberculosis are diffuse or focal hyperemia of the mucous membrane of the internal organ in question. Specific symptoms detected by cystoscopy are tuberculous tubercles, scars formed at the site of ulcers.
- In some cases, when it is impossible to make an accurate diagnosis and there are some doubts, an endovesical biopsy is performed. It collects material for research. The result may confirm the presence of tuberculosis or a bladder tumor. A negative result does not rule out TB.
Survey radiography and tomography are used as auxiliary research methods. Through these research methods, experts learn aboutparameters of the kidneys, the state of the perirenal tissue, reveal foci of calcification and ossification in the organs of the urinary system, in the lymph nodes of the retroperitoneal space. Applicable for tuberculosis renal angiography. With its help, destructive changes in the kidneys are established, the architectonics of the renal vessels are studied, the possibility of performing an organ-preserving operation and the volume of the renal tissue to be resected are determined.
Sometimes an ultrasound scan is ordered. This is a non-invasive research method. Ultrasound allows you to evaluate the pyelocaliceal system, timely detect kidney stones, sclerotic changes, foci of calcification, cavities, cystic formations. At the same time, it is impossible to make an accurate diagnosis based on the echostructure of the lesions. Assessing the results of ultrasound, one can only assume the presence of tuberculosis.
Treatment regimens for the disease
Treatment of tuberculosis of the genitourinary system is prescribed depending on the stage:
- In the initial stages, drug treatment is used. Patients are prescribed tuberculostatic drugs in combination with macrolides and fluoroquinolones, immunocorrectors, proteolytic enzymes. The choice of drugs is carried out by the doctor, taking into account the sensitivity of the detected Mycobacterium tuberculosis and the effectiveness of the therapy used.
- At the III stage of the disease, drug treatment is combined with organ-preserving surgery. The patient may be assigned a kidney resection or cavernotomy (opening the cavity).
- At the last stagediseases are treated with medication and nephrectomy (removal of the affected kidney).
Neprectomy among patients with tuberculosis of the urinary system is carried out quite often. This is due to the late appeal to specialists for medical help, uncontrolled standard treatment. After nephrectomy, postoperative complications are possible, but they are extremely rare. These include hematomas, suppuration of subcutaneous fat, purulent and long-term healing fistulas, hernias.
Tuberculosis of the genitourinary system in men, namely the genital organs, is more difficult to treat. It is less amenable to conservative therapy. For treatment, specific anti-tuberculosis drugs are prescribed in the same dosage as for tuberculosis of the urinary system. In addition, with this disease, immobilization of the scrotum with the help of tight-fitting swimming trunks, the use of novocaine blockades of the spermatic cord (in combination with streptomycin) are indicated. Tuberculosis of the male genitourinary system is treated for 2 or 3 months. If the results are unsatisfactory, then resection of the epididymis or epididymectomy is performed. With a total lesion of the testicle, an operation is performed to remove it. If tuberculosis affects the prostate gland and seminal vesicles, then conservative treatment is prescribed.
In conclusion, it is worth noting that tuberculosis of the genitourinary system develops approximately 10–15 years afterthe occurrence of pulmonary or osteoarticular tuberculosis. If symptoms occur, it is recommended to seek help from specialists and not delay the visit, because due to the progression of the disease, the kidney may need to be removed in the future. In the early stages, this outcome can be prevented.
