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Tuberculosis of the urinary system usually appears secretly, without any discernible specific initial symptoms and no discernible gateway to the entry and origin of the germ. The most common source of infection is the blood-borne sowing of tuberculous bacilli, which gives rise to the process of tuberculosis development, first in one kidney, and then bilaterally.
Definition of tuberculosis of the urinary system
Tuberculosis of the urinary system is one of the most common types of extrapulmonary tuberculosis. White people and people in the 45-55 age group are at high risk. Men suffer from this ailment more often. It usually develops without any disturbing symptoms. Its source is the blood-borne sowing of tuberculosis bacilli. Ailments can develop in the bladder, kidneys, ureter and even the genitals. Tuberculosis of the urinary system is dangerous because it does not give any specific symptoms for a long time. Over time, however, pain while urinating, hematuria and a burning sensation in the urethra begin to appear. This type of tuberculosis can eventually lead to kidney failure and death.
Tuberculosis of the urinary system – pathogenesis
Tuberculosis of the urinary system is a consequence of the spread of mycobacteria through the bloodstream as a result of primary infection. The primary focus of the infection is in the lung or other organ. The disease may become active many years after infection (therefore the disease rarely occurs in children).
The mycobacteria of tuberculosis most often multiply in the cortical layer of the kidneys because it is very well oxygenated and innervated. Mycobacteria may remain dormant for many years and become noticeable only when immunity decreases. Although tuberculous lesions usually occur in both kidneys, the disease usually progresses in one kidney. With time, it begins to necrosis and decay of the primary focus, which causes the bacteria to enter other structures of the urinary system.
General symptoms of tuberculosis of the urinary system
As previously mentioned, the symptoms of tuberculosis are not very specific, which makes it somewhat difficult to make a proper diagnosis. The disease is very discreet, and its first symptoms may appear even twenty years after the infection! People with tuberculosis of the urinary tract usually have the following complaints:
- excessive sweating
- high temperature,
- general weakness (of unknown origin),
- frequent urination,
- urination disorders,
- very rare mictia,
- discomfort in the lumbar region of the spine,
The most common localization of tuberculosis of the urinary system
1. Renal tuberculosis
The first symptoms (not yet suggestive of renal tuberculosis) may be recurrent low-grade fever or fever, and general weakness, initially without any urinary symptoms. Over time, symptoms suggestive of urethritis and cystitis (frequent, painful and scanty urination) or sudden haematuria, sometimes preceded by aches or pains in the lumbar region, may appear.
Diagnosis. Suspicion of tuberculosis in the urinary system and the need for tests in this direction (ordinary and specialized bacteriological examination of urine with culture and biological test) suggest persistently recurring (not otherwise justified) symptoms of urinary bladder disease with periodic hematuria or proteinuria. Final proper diagnosis requires further specialized diagnostic tests.
The course of morphological tuberculous changes in the kidney resembles that of the primary pulmonary focus. After the formation of cheese necrosis in the infiltrate, it can get into the urinary tract and then out with the urine. Hence, the urine and the vessels into which the patient urinates may be an epidemiological source of subsequent infection of other people with mycobacterium tuberculosis. Early diagnosis of tuberculosis of the kidney (kidney) can be treated quite effectively.
Treatment: is usually long-lasting, requiring regular and systematic medication and monitoring. In more advanced conditions, with extensive destruction of the kidney parenchyma (especially when the discussed process concerns only one kidney), surgical treatment is indicated.
2. Tuberculosis of the urinary bladder
It is usually a secondary process that descends through the urinary tract from the kidney. With long-term excretion of mycobacteria in the urine, they eventually settle in the bladder mucosa, initiating a specific tuberculosis process there. Bladder tuberculosis is usually located near the opening of the ureters.
Patients usually complain of recurrent and persistent cystitis.
Diagnosis. It requires specialized tests, both medical and laboratory and bacteriological.
Treatment: is anti-tuberculosis; it should be long-term, systematic and combined (ie 2-3 anti-tuberculosis drugs simultaneously).
Tuberculosis of the urinary system – diagnosis
In the diagnosis of tuberculosis of the urinary system, radiological examination of lesions and assessment of their location are very important. Thanks to the overview photos of the abdominal cavity, it is possible to reveal any calcifications in the urinary tract or kidney projection. It is also important to perform an X-ray examination of the spine and chest, because in many cases there are additional changes in the lungs.
Urografia — it remains the most important test performed in the diagnosis of tuberculosis of the urinary system. In over 90 percent. reveals any irregularities. Urography in the early stage of tuberculosis is normal, but with the development of the disease, some distortions in the structure of the renal calyx and narrowing of the ureters can be noticed.
Computed tomography – it is an examination that allows to detect small focal changes; sometimes it is important in excluding neoplastic disease.
Ultrasound examination – is a non-invasive test that allows you to monitor pathological changes developing in the bladder and kidneys.
Isotope renography – it is a very sensitive research method that reveals disorders in the functioning of the kidneys, even when the lesions are not very severe. These disorders may indicate that it is difficult to drain urine.
Urinary tuberculosis – treatment
Surgical treatment still plays an important role in the treatment of tuberculosis of the urinary system, which turns out to be necessary in up to 80% of patients. patients. The most common are plastic surgery of narrowed ureters and scarred bladder. In patients who systematically recur purulent infections of the kidney damaged by tuberculosis, partial or complete nepherectormia is necessary.
If there are severe calcifications on the kidney, it may be removed.
Corticotherapy is also underway to prevent narrowing of the ureters. It is also necessary in patients with tuberculous interstitial nephritis.
IMPORTANT: After treatment of tuberculosis of the urinary system is completed, bacteriological urine tests should be performed for four years (every 6 months). It is also recommended to perform urography to assess the urinary tract (6 and 12 months after the end of treatment).