【正文】 e 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. 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。 ? 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。 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 。 ? 多從尾部開始發(fā)病。 ? 膿腫也可局限在腎實質(zhì)，形成閉合性濃重。 ? 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。 ? 前列腺結(jié)核和附睪結(jié)核 : ? 少見。 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