【正文】 nt ( kidney to bladder, prostate to epididymis). ? The testis may bee involved by direct extension from epididymal infection. Pathogenesis A. kidney and ureter: ? A shower of TB hits the renal cortex, the anisms may be destroyed by normal tissue resistance. ? Only scars are found in the kidney. ? However, if enough bacteria of sufficient virulence bee lodged in the kidney and are not overe, a clinical infection is established. Pathogenesis A. kidney and ureter: ? Tuberculosis of the kidney progresses slowly。 Pathology ? 臨床型腎結(jié)核 : ? 因細菌數(shù)量大，毒性高而機體抵抗力弱，結(jié)核結(jié)節(jié)融合、擴大，逐漸向隋質(zhì)發(fā)展并在腎乳頭處破潰，患者出現(xiàn)臨床癥狀 。 Pathology ? 輸尿管結(jié)核 : ? 輸尿管結(jié)核最常見于下段，其次上段。 2. 部分腎切除： 局限在一極的病變 。 ? 輸精管增粗，呈串珠伏。 Conclusions ? Tuberculosis is the most important, most monly missed type of specific genitourinary infection． ? It should always be considered in any case of pyuria without bacteriuria or in any resistant urinary tract infection that does not respond to treatment． Conclusions ? Genitourinary tuberculosis is always secondary to pulmonary infection， though in many cases，the primary focus has already healed or is in a subclinical form． ? Infection occurs via the hematogenous route． Conclusions ? The kidneys and (less monly) the prostate are principal sites of urinary tract involvement, though all other segments of the genitourinary system can be affected． 。 Tuberculosis of epididymis 附睪結(jié)核應(yīng)與慢性附睪炎鑒別 . 治疔原則 1. 與腎結(jié)核相同 ， 早期可采用藥物治療 。 4. 整形手術(shù)： 矯正輸尿管狹窄手術(shù) 膀胱攣縮可采用回腸或乙狀結(jié)腸膀胱擴大術(shù) 尿路改道 Treatment ? For a severely contracted bladder, enterocystoplasty will increase vesical volume． Treatment ? 一側(cè)腎結(jié)核（功能已喪失），對側(cè)腎積水如何處理？ ? 根據(jù)積水側(cè)功能情況進行治疔！ 1. 功能尚佳者可先切除結(jié)核病腎，再解除積水梗阻。 ? 輸尿管完全閉塞，尿液不能排入膀胱，臨床癥狀減輕 Pathology ? 腎自截（ autonephrectomy) : ? 輸尿管結(jié)核的嚴重表現(xiàn) ? 但壞死物質(zhì)不能排除，腎臟廣泛破壞，功能損害至全部喪失。 ? 左、右側(cè)發(fā)病率無差別。 Urologic and Male Genital Tuberculosis Yi Lin Department of urology Tianjin Medical University 概 述 ? 泌尿、男生殖系結(jié)核 (urologic and male genital tuberculosis) ? 結(jié)核桿菌侵犯泌尿、男性生殖器官引起的慢性特異性感染。 ? 從病理型腎結(jié)核 —臨 床型腎結(jié)核 ? 病史長，一般 5 年 ? 90%為單側(cè)。 ? 病變由粘膜向全層侵犯 —導(dǎo)致輸尿管壁增厚、變硬、輸尿管縮短、狹窄、收縮功能下降。 3. 病灶清除術(shù) : 適合于結(jié)核膿腫 ， 一般穿刺解決 。 ? 直腸指檢，前列腺有