Genitourinary tuberculosis. Definition

Medical Definition: genitourinary tuberculosis

Chronic urinary tract infection caused by various types of MicobacteriuEs always secondary to a primary infection in another organ (usually lung), with a latency average eight to ten years. It affects mainly young adults (60% have 20 to 40 years). The germs involved are: Mycobacterium tuberculosis, the most common, the most virulent, Mycobacterium kansasii, some virulent, contagious poorly (only five reported cases of renal tuberculosis), Mycobacterium bovis, very rare, due to pasteurization milk. Between 1 and 27% are atypical pathogens. The infection reaches the kidneys via the blood, is set in the cortex, causing a severe reaction that usually cure. If not, reach the renal papilla, resulting in inflammatory-exudative lesions and spreads to the urinary bladder and, less frequently, the prostate and the epididymis via canalicular (there may be hematogenous spread to prostate and epididymis). At this time, the disease does not heal spontaneously. If there is an epididymal involvement and not treated, fistulized to scrotum. Irritative bladder symptoms (urinary frequency and burning) that does not yield to conventional medical treatment and hematuria are the hallmarks of the disease. In the urine is pyuria, negative conventional culture and the presence of acid-fast bacilli. Diagnosis is made by culture of Koch bacillus in the middle of Löwelstein-Hensen. Based intravenous urography in the diagnosis of disease. 90% of cases have obvious lesions in the kidney, ureter 43% and 33% in the bladder. The early lesions show only a slight change calyceal. Much more characteristic is the appearance of caverns that are characterized by the growth and deformation of a calyx, calyceal stenosis, in the most extreme cases, disables the cup and turns into a spike pathognomonic of the disease tuberculosis. The lesions may calcify early or late (the 25-37% do), in advanced lesions with loss of function, kidney calcification are typical (kidney mastic). The ureteropelvic junction stenosis and ureteral terminal is a feature of the disease. In the bladder, ulceration and contraction cause a significant decrease in functional capacity (bladder trigonal). The standard model of treatment lasts six months (pyrazinamide 25 mg / kg / day, rifampin 600 mg / day and isoniazid 300 mg / day for four months, continuing isionacida rifampicin and 300 mg a day for two months). Occasionally, corticosteroids are used in stenotic lesions or surgery in obstructive cases.

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