Tuberculosis of the genitourinary system: symptoms, diagnosis, ways of infection

Diseases of the urinary system are quite common. They can affect the kidneys, urinary tract, bladder. Of all the existing diseases, it is worth highlighting and considering tuberculosis of the genitourinary system. About this disease you need to know every person, because of the ailment no one is immune.

More about tuberculosis affecting the urinary system

Probably, there is no such person who would not have heard of tuberculosis. This is a common disease in which bacteria called Koch chopsticks affect the lungs. However, not only in these organs can live the named microorganisms. Specialists know extrapulmonary forms of the disease. The first place among them is tuberculosis of the genitourinary system.

How is this disease transmitted? In the urinary system, Koch's sticks get hematogenous. Proceeding from this, it can be concluded that at first a person is infected with ordinary tuberculosis from a patient emitting pathogenic microorganisms to the environment. In the future, Koch sticks can get into the urinary system with a blood flow. Thus, the pathway of infection is first airborne, and then hematogenous.

Tuberculosis of the genitourinary system in women and men begins with kidney damage. Of these, the infectious process spreads through the renal tubules, vessels to the renal pelvis. Then the ureters, the bladder are affected. Foci of tuberculosis occur in both kidneys, but, as practice shows, the pathological process progresses only in one of these paired internal organs.

How does the disease develop? Kokh sticks, when ingested into the kidneys, affect the cortical and brain substance. In the organ there are tubercles. They gradually ulcerate, there is a caseous decay. As a result, caverns are formed. Around them develop inflammatory processes, there are tubercles. All this can lead to complete destruction of the kidney with the formation of pionephrosis.

With further development, tuberculosis of the urogenital system in women and men affects the fibrous and fat capsule of the internal organ. Bumps and ulcers appear on the renal pelvis, ureter. Walls because of this thicken, become infiltrated, edematous. Ulcers are subsequently scarred, structures are formed that interfere with the outflow of urine.

In the absence of adequate treatment, the infection passes from the kidneys to the bladder. The pathological process first begins in the area where the ureters are located. On the mucous membrane of the internal organ there are tubercular tubercles. They are further decomposed. In their place, ulcers and scars are formed. In the future, the bladder becomes wrinkled due to the fact that the affected walls of the internal organ are replaced by a sclerotic tissue.

Tuberculosis of the urogenital system: briefly on the classification of the disease

Experts in practice apply a classification that distinguishes several stages from an ailment:

• Inflammatory tuberculosis of the kidneys is characteristic of the first stage of the disease, that is, it is non-destructive.
• At the second stage, there is an initial destruction, ie, single caverns of a small size appear. In diameter, they do not exceed 1 centimeter.
• At the third stage there is a limited destruction. In one of the segments of the kidney there is a large cavern or poly-cavitary tuberculosis.
• The fourth stage is characterized by total or subtotal destruction.

Clinical picture of the disease

Tuberculosis of the genitourinary system can manifest itself in different ways. No wonder this illness in the medical literature is called one of the most frequent "hoaxers" among diseases of the bladder, kidneys and urinary tract. The manifestations of tuberculosis are often affected by the complications that have joined up. It can be pyelonephritis, chronic renal failure.

Symptoms of kidney tuberculosis are divided into 2 groups:

• General signs that are observed when the general condition of a sick person changes;
• Local signs, subdivided, in turn, into subjective (those that feel sick) and objective (identified by specialists during the survey).

Common signs of urinary tuberculosis

When the disease in 20-30% of people increases body temperature. In general, it varies between 37-38 degrees. In some patients, in the presence of additional diseases, complications, a temperature equal to 38-39 degrees, a chill appears.

Approximately 5-18% of patients have arterial hypertension (increased blood pressure). Previously, experts believed that this symptom is a consequence of the adherent pyelonephritis. Now it is proved that arterial hypertension is a sign that can indicate tuberculosis of the kidneys. It should be noted that the frequency of detection of this symptom depends on the nature of the ailment. For example:

• With tuberculosis kidney parenchyma, hypertension affects about 1.1% of sick people;
• With tuberculosis of the renal papilla - 3.2%;
• With tuberculosis pionefrosis and poly-cavaron tuberculosis - 18.3%.

Local subjective symptoms of the disease

Often people ask the question: "Symptoms, if there is tuberculosis of the genitourinary system, which ones?" The sensation that can arise is a painful and frequent urination. Specialists in the 50's and 60's of the last century identified this feature in all people. Then there was a tendency to decrease the frequency of manifestation of the symptom. In the 60-70s, only 48% of people complained of impaired urination, and in the 1980s only 43% of patients. In recent years, the symptom is observed less often. This is due to a decrease in the frequency of the mucous membrane of the bladder.

Quite often the signs are pain in the lumbar region, which arise when the tuberculosis of the urogenital system begins to develop. These symptoms are noted in themselves about half of sick people. Pains are usually unilateral. About unpleasant sensations, localized from two sides, declare only 15-20% of sick people.

By its nature, the pain is acute, similar to renal colic. It arises because of a violation of excretory function as a result of blockage of the ureters with blood clots, a purulent cork, swelling of the mucous membrane. Renal colic is a symptom that is observed not only with tuberculosis of the urinary system. It is peculiar to other diseases. One of them is urolithiasis. To make an accurate diagnosis, a urological examination is performed.

Local objective signs

The above signs, which has tuberculosis of the genitourinary system, are symptoms that are subjective. Objective signs include leukocyturia. This term indicates an increased number of white blood cells in the urine. Leukocyturia is the earliest symptom of the disease. However, it is not mandatory. If in the course of the urine analysis the white blood cells are not detected, then this is not considered a confirmation of the absence of the disease.

Signs of tuberculosis of the genitourinary system include erythrocyturia. In medicine, this term means an increased level of erythrocytes in the urine. In recent years, this symptom is detected quite often - approximately in 70-75% of sick people. The frequency of erythrocyturia is associated with the development of a destructive process in the kidney.

The early objective symptom of tuberculosis is proteinuria (protein detection in urine analysis). It is detected in 85-95% of sick people. There are several opinions about the occurrence of proteinuria:

1. Some experts believe that it is not associated with tuberculosis of the urinary system. The source of protein, in their opinion, are red blood cells.
2. Other researchers argue that protoinuria is caused by dystrophic changes occurring in the tubules and glomeruli of the kidneys.

Every year more and more doctors discover one more sign of tuberculosis. It's about nonspecific bacteriuria. Infection can be detected at all stages of the disease. Most often it is found in cavernous forms. The causative agents of a nonspecific urinary infection are different. Egg sticks, staphylococci, streptococci and sticks of blue-green pus are also detected. It is not uncommon to have a mixed flora.

The most reliable symptom of the disease is the identification of Koch's rods in the urine. However, it is not always possible for specialists to detect the main causative agent of the disease. Even modern methods of bacteriological research do not help. The fact is that some people take antibiotics on the prescription of a physician from existing ailments or drink these medicines while practicing self-medication. As a result, mycobacteria tuberculosis lose the ability to reproduce and grow. After sowing, naturally, they are not found for this reason. This makes it difficult to identify the pathogen in the body of a sick person.

Features of tuberculosis of the urinary system in children and the elderly

This disease mainly affects adults. Children are much less likely to be diagnosed with urogenital tuberculosis. A frequent and early symptom arising from them is polyuria, that is, an increase in the volume of excreted urine. There are other signs, but they are often associated with other diseases. Another important feature of tuberculosis in children is that girls are more likely to have a non-destructive form of a disease, and boys are destructive.

Tuberculosis of the urinary system affects many people in old age. This is due to a decrease in immune defense, the appearance of various ailments. Symptoms of tuberculosis affect concomitant and urological diseases. These include: hypertension, diseases of the gastrointestinal tract, urolithiasis, nonspecific pyelonephritis, etc. Because of this, tuberculosis of the urinary system is not always detected. His symptoms masquerade as signs of the aforementioned diseases.

Features of the disease in women and men

From the floor depends on how the tuberculosis of the genitourinary system manifests itself. In women, the symptoms include less severe pain. In men, they are stronger. They still more often develop tuberculosis of the genital organs. Statistics show that such progression in women is observed only in 7% of cases, and in men - in 31%.

Considering tuberculosis of the urogenital system in men, the symptoms of this ailment, it is worth noting that first Koch sticks strike the prostate (prostate gland). The pathological process then involves other organs and structures of the reproductive system: the seminal vesicle, the testicle, the epididymis. In rare cases, the penis is affected. It causes ulcers, the ailment affects the peripheral lymph nodes. Similar signs, observed on the penis, require differential diagnosis with cancer.

Tuberculosis of the genitourinary system: diagnosis

When making a diagnosis, clinical methods are first used. They do not allow to determine reliably whether a person has tuberculosis or not. However, thanks to them, experts find suspicious signs. Clinical methods of research include interviewing a sick person, conducting an examination, palpation of painful areas.

An important role in diagnostics is played by laboratory methods of research:

1. Patients take a blood test. It does not reveal any specific signs inherent in tuberculosis of the urinary system, but it can show leukocytosis and an increase in the rate of erythrocyte sedimentation. This will indicate the presence of an inflammatory process in the body.
2. Assign urine tests. This is the main laboratory method for diagnosing tuberculosis. In urine, with the disease, Koch's rods, other infections (if they are present or develop complications) are found. Analyzes can show proteinuria, leukocyturia, erythrocyturia.

Experts note the importance of using all possible research methods, their combination and repeated use.

Diagnostic methods include tuberculin diagnostics. Its essence lies in the subcutaneous administration of a special condensed culture liquid. It is called tuberculin. Tuberculodiagnosis has indications and contraindications. The testimony includes: suspicion of tuberculosis of the genitourinary system, evaluation of the effectiveness of specific treatment, control of the activity of the process. Contraindications are individual intolerance.

When diagnosing tuberculosis, endoscopic research methods may be used:

1. One of them is cystoscopy. In this method, the endoscope, which is a catheter with lighting and optical systems, is inserted through the urethra into the bladder. Nonspecific signs of tuberculosis are diffuse or focal hyperemia of the mucous membrane of the internal organ under consideration. Specific symptoms revealed by cystoscopy are tuberculous tubercles, scars formed on the site of ulcers.
2. In some cases, when it is impossible to make an accurate diagnosis and there are some doubts, endovezical biopsy is performed. With her, the material for research is collected. The result can confirm the presence of tuberculosis or a tumor of the bladder. If the result is negative, tuberculosis is not excluded.

As an auxiliary research methods, review radiography and tomography are used. Thanks to these methods of research, specialists learn about the parameters of the kidneys, the condition of the pericardial cellulose, identify the centers of calcifications and ossifications in the organs of the urinary system, in the lymph nodes of the retroperitoneal space. Applicable for tuberculosis renal angiography. With it, destructive changes in the kidneys are established, the architectonics of renal vessels are studied, the possibility of performing an organ-preserving operation and the volume of renal tissue subject to resection are determined.

Sometimes an ultrasound scan is prescribed. This is a non-invasive method of investigation. Ultrasound can evaluate the cup-and-pelvis system, detect kidney stones, sclerotic changes, pockets of calcifications, caverns, cystic lesions in a timely manner. At the same time, it is impossible to provide an accurate diagnosis of the echostructure of the lesions. Having evaluated the results of ultrasound, one can only assume the presence of tuberculosis.

Treatment regimens for the disease

Treatment of tuberculosis of the genitourinary system is prescribed depending on the stage:

• At the initial stages, medicamentous treatment is used. Patients are prescribed tuberculostatic drugs in combination with macrolides and fluoroquinolones, immunocorrectors, proteolytic enzymes. The choice of medicines is made by the doctor taking into account the sensitivity of the detected mycobacteria of tuberculosis and the effectiveness of the therapy used.
• At the III stage of the disease, medication is combined with an organ-preserving operation. The patient can be assigned a kidney resection or a cavernotomy (opening the cavity).
• At the last stage of the disease, drug treatment and nephrectomy are performed (removal of the affected kidney).

Nephrectomy among patients with urinary tract tuberculosis is quite often. This is due to the late appeal to specialists for medical help, uncontrolled standard treatment. After nephrectomy, postoperative complications are possible, but they are extremely rare. These include hematomas, suppuration of subcutaneous fat, purulent and long-lasting healing fistula, hernia.

Tuberculosis of the genitourinary system in men, namely genitals, is more complicated in treatment. He is less susceptible to conservative therapy. For treatment, specific antituberculosis drugs are prescribed in the same dosage as with tuberculosis of the urinary system. In addition, with this disease shows immobilization of the scrotum with tightly fitting meltings, the use of novocaine blockages of the spermatic cord (in combination with streptomycin). Tuberculosis of the male genitourinary system is treated within 2 or 3 months. If the results are unsatisfactory, then resection of the epididymis or epididymectomy is performed. With total defeat of the testicle, an operation is performed to remove it. If tuberculosis affects the prostate gland and seminal vesicles, then a conservative treatment is prescribed.

In conclusion, it should be noted that tuberculosis of the genitourinary system develops approximately 10-15 years after the onset of pulmonary or osteoarticular tuberculosis. If symptoms occur, it is recommended that you seek help from specialists and do not delay the visit, because because of the progression of the disease in the future, you may need to remove the kidney. In the early stages, such an outcome can be prevented.