泌尿、男生殖系結(jié)核-免費(fèi)閱讀
【正文】 Treatment ? In unilateral epididymal involvement, epididymectomy plus contralateral vasectomy is indicated to prevent descent of the infection from the prostate to that an ? bilateral epididymectomy should be done if both sides are involved． Tuberculosis of epididymis Tuberculosis of prostate ? 常無自覺癥狀。 ? 50~70%合并男生殖器結(jié)核 ? 附睪和前列腺結(jié)核常同時(shí)存在 Tuberculosis of epididymis ? 大多為單側(cè)，起病緩慢。 ? 前列腺結(jié)核和附睪結(jié)核 : ? 少見。 ? 膿腫向伸盞破潰，進(jìn)入腎盂、輸尿管、膀胱 —導(dǎo)致繼發(fā)性結(jié)核。 ? 結(jié)核結(jié)節(jié) : 類上皮細(xì)胞、多核巨細(xì)胞、淋巴細(xì)胞、漿細(xì)胞、成纖維細(xì)胞等組成。 ? 雖然有鏡下血尿、可找到結(jié)核菌，但無臨床癥狀，IVP正常。 ? 膿腫也可局限在腎實(shí)質(zhì)，形成閉合性濃重。 Pathology ? 泌尿系結(jié)核的病理特點(diǎn)： ? 組織破壞和修復(fù)混合存在。 ? 多從尾部開始發(fā)病。 ? 有時(shí)有血精，射精痛 ? DRE： 前列腺表面有結(jié)節(jié)，無明顯觸痛 Tuberculosis of prostate ? 診斷： ? 反復(fù)的血精或其它部位有結(jié)核病變 —警 惕結(jié)核。 3. 若睪丸有病變 ， 病變靠近附睪 ， 則可連同附睪將睪丸部分切除 。 Prognosis ? In a high percentage of cases, ? Cure is obtained by medical means. ? Unilateral renal lesions have the best prognosis. Male genital tuberculosis ? 主要來源于其他部位的結(jié)核病灶，經(jīng)血行感染而來。 ? 膀胱結(jié)核潰瘍向外穿透 —可 形成膀胱陰道瘺或膀胱直腸瘺。結(jié)核結(jié)節(jié)相互融合，形成干洛樣壞死、液化，形成膿腫。 it may take 15~20 years to destroy a kidney in a patient who has good resistance to the infection. ? Therefore, there is no renal pain and little or no clinical disturbance of any type until the lesion has involved the calyces or the pelvis. ? It is only at this stage that symptoms ( of cystitis) are manifested. Pathogenesis A. kidney and ureter: ? As the disease progress, a caseous breakdown of tissue occurs until the entire kidney is replaced by cheesy material. ? Calcium may be laid down in the reparative process. ? The ureter undergoes fibrosis and tends to be shortened and straightened. This change leads to a “golfhole” (gaping) ureteral orifice, typical of an inpetent valve. Tuberculosis of kidney and ureter Tuberculosis of kidney and ureter Tuberculosis of kidney Pathogenesis B. bladder: ? Vesical irritability develops as an early clinical manifestation of the disease as the bladder is bathed by infected material. ? Tubercles form later, usually in the region of the involved ureteral orifice, and ulcerate—bleeding. ? Bladder bees fibrosed and contracted, this leads to marked frequency. ? Ureteral reflux or stenosis and hydronephrosis.
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