泌尿、男生殖系結(jié)核(存儲(chǔ)版)
【正文】 Pathogenesis C. Prostate and seminal vesicles: ? The passage of infected urine through the prostatic urethra leads to invasion of the prostate and one or both seminal vesicles. ? There is no local pain. ? The primary hematogenous lesion in the genitourinary trace is in the prostate. ? Prostatic infection can ascend to the bladder and descent to the epididymis. Pathogenesis D. Epididymis and testis: ? Tuberculosis of the prostate can extend the epididymis. ? This is a slow process, there is usually no pain. ? If the epididymal infection is extensive and an abscess forms, it may rupture through the scrotal skin, thus establishing a permanent sinus, or it may extend into the testicle. Pathology ? 病理型腎結(jié)核 : ? 結(jié)核早期病變 , 結(jié)核菌通過血行傳播至腎皮質(zhì) —結(jié) 核結(jié)節(jié)和結(jié)核肉芽腫形成。 ? 80%累及雙腎，但大多數(shù)能自行愈合，形成斑痕或鈣化。 ? 極少數(shù)情況下，腎實(shí)質(zhì)大部或全部被膿腫取代， 形成結(jié)核型膿腎或腎積膿。 ? 機(jī)體低抗力低時(shí)：以破壞為主 —潰 瘍和膿腫 ? 機(jī)體低抗力高時(shí)：以修復(fù)反應(yīng)為主 —纖 維化和鈣化 Pathology 病理型腎結(jié)核 臨床型腎結(jié)核 腎積膿 輸尿管結(jié)核 腎自截 膀胱結(jié)核 前列腺結(jié)核 附睪結(jié)核 Clinical findings ? Tuberculosis of the genitourinary tract should be considered in the presence of any of the following situations: 1. Chronic systitis that refuses to respond to therapy. 2. The finding of without bacteria in culture of the urinary sediment. 3. Gross or micorscopic hematuria. 4. Enlarged epididymis with a beaded or thickened 5. A chronic draining scrotal sinus 6. Induration or nodulation of the prostate and thickening of one or both seminal vesicles. Clinical findings ? The diagnosis rests on the demonstration of tubercle bacilli in the urine by culture. ? The extent of the infection is determined by: 1. The palpable findings in the epididymises, prostate and seminal vesicles 2. The renal and ureteral lesions as revealed by IVP 3. involvement of the bladder as seen through the cystoscope 4. The degree of renal damage as measured by loss of function. 5. The presence of tubercle bacilli in one or both kidneys. Clinical findings A. Symptoms: ? There is no classic clinical picture of renal tuberculosis ? Most symptoms of this disease, are vesical in origin (cystitis) Clinical findings A. Symptoms: 1. Frequency: the earliest symptoms of renal tuberculosis may arise from sec
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