Genital urinary system

Genital urinary system's disease overview

Mycobacterium tuberculosis is inhaled into the lungs to the alveoli, where they are destroyed by polygon leukemia and great macrophages. Although most of the tuberculosis bacilli is destroyed, some still exist and are taken to regional lymph nodes. According to the bacillus pipe, it plunges into venous blood and sowing in different organs, including the kidneys that cause genital urinary tract .

Although both kidneys may be infected with tuberculosis, clinical disease usually only develops in one kidney. The hyperactive environment of the kidney marrow weakens the phagocytic function that facilitates tuberculosis bacilli to develop. 

The development of tuberculosis tumor can be eroded into the kidney system; The bacilli spreads to the renal pelvis, ureter, bladder and other genitalia. Depending on the patient's resistance, fibrosis and narrowing of the urinary tract may develop with the formation of chronic abscess. The spread of lesions can lead to function loss.

complications of genital urinary system

  • Urine stenosis
  • Urine congestion

    • Common bacterial superinfection

  • abscess
  • Hypertension kidney disease
  • Scarring of renal parenchyma, loss of kidney function, and, final, the end stage of kidney disease
  • narrow and obstructing ejaculation pipes or vas deferens can cause infertility due to infertility and similarity, tuberculosis in the fallopian or endometrial tube can be conducted. to infertility, popular in developing countries.

    • Causes of Genital urinary system's disease

    The cause of the urinary tract is caused by tuberculial bacteria (Mycobacterium tuberculosis). Tuberculosis can be seen in all parts of the body, of which tuberculosis is the most common tuberculosis (accounting for 80-85% of the total number of cases) and is the main source of infection to people around. 

    Symptoms of Genital urinary system's disease

  • Expression of the disease is often vague. The doctor must think of the disease and do diagnostic tests. Symptoms are often chronic, continuous and non -specific progress. Genital urinary system is often manifested as a repeated urinary tract infection that does not respond to conventional antibiotics. People with genital urinary system rarely have typical symptoms of tuberculosis. 
  • The common symptoms of the genital urinary system, the order of gradual decrease in the frequency of occurrence including increasing the number of urination (the first stage of the disease is urination many times. The day, when the disease progresses, urinates many times day and night), difficulty urinating, lumbar pain, lower sores, blood or pus, fever. 

    • Urinary urgency is relatively rare unless the bladder is seriously damaged. 

  • Patients may have painful testicles, holes of biomedo, or genital ulcers. Many cases of patients have absolutely no symptoms. Infertility, the cause is not determined in both men and women sometimes due to the urinary tract labor system
  • While the signs of the mulfuria is sterile pyuria, up to 20% of patients with secondary infection with coliform bacteria. P>
  • General blood is occurring in 10% of cases and usually yards and painlessness. Microscopic blood occurs in 50% of cases.  
    • testicular or epididymis.

    Transmission route of Genital urinary system's diseaseGenital urinary system

  • The ureter is a consequence of the kidney, often spreading to the ureter connection into the bladder, rarely limiting the ureter 1/3 above. The ureter often causes narrowing of the ureter and kidney water stasis. Sometimes severe cases can cause the entire ureter. 50% of patients with tuberculosis will have ureter. 
  • The same, the bladder tuberculosis is secondary after the kidneys and usually starts from the ureter. The initial manifestation was the inflammation of the bladder mucosa and creating granuloma lesions. The fibrosis of the ureter can lead to damage to the kidney or anti -reflux valve of the damaged ureter (the image of the hole) as a result of the ureter reflux. In severe cases related to the entire wall of the bladder, the deep muscle layer is gradually replaced by fibrous tissue, creating a thick bladder. The tubercles are very rare in the bladder, if any, they often appear in the ureter. At that time, it is necessary to distinguish it from the bladder tumor. 

    • Solar testicular tuberculosis is common in children, the possibility is due to blood sugar spread. Meanwhile, in adults, the epididymis is thought to be directly spread from the diuretic tuberculosis. The testicular tuberculosis is usually caused by the spread directly from the urinary tract and the consequence is infertility due to the obstruction of the vasectomy on both sides.

  • Prostate tuberculosis also spreads bloody, but very rare. When the prostate is tuberculosis, rectal visits detect nodules and gland lesions. Eighty -five percent of patients with TLT tuberculosis also suffered from kidney tuberculosis. In case of heavy tuberculosis, it may ulcer to the perineum area, although this progress is very rare. Reducing semen amounts may show that tuberculosis has spread to the prostate or clogged vasectomy.
  • Patients with genital and urethraic tuberculosis manifestations of tuberculosis on the penis or female genitals in contact with tuberculosis when intercourse. The penis ulcer can extend to the urethra. In women can spread to the fallopian tubes and uterus, causing narrow.

    • People at risk for Genital urinary system's disease

  • About 10% throughout the lives of healthy people with normal immune systems infected with tuberculosis from childhood will turn into tuberculosis. For immunodeficiency people such as HIV -infected, the risk of transitioning from tuberculosis to labor will increase very high, about 10% /year.

    • The concentration of air -in -air particles dominated by the number of bacteria coughed by patients coughing and ventilation in the exposure area. time exposed to tuberculosis bacteria.

    The state is close to the source of tuberculosis bacteria.

    Improved immune system: HIV, diabetes, and malnutrition ...

    Tobacco and alcohol users can increase the risk of tuberculosis and tuberculosis. 

    Environmental factors: Narrow space, full ventilation, air circulation containing air bacteria containing tuberculosis bacteria.

    Prevention of Genital urinary system's disease

  • Reduce the intensity of infections in the air with good ventilation. Doors and windows of examination chambers, waiting areas and disease rooms should be opened for natural ventilation or using electric fans in the right direction to dilute bacterial particles and push bacteria out, under the sun will be easily destroyed.
  • Use a mask or at least with a towel to cover the mouth when contacting and talking to others (health workers), when sneezing, cough.

    • Pick up phlegm on paper or cup, leave at the prescribed place, wash soap regularly.

  • Get sputum tested in the right place, preferably outdoors, ventilated environment. If not, it is necessary to have a good ventilation, less exposed by medical staff and others. Do not place the sputum in small rooms or toilets.
  • Normal masks have little effect on protecting tuberculosis bacteria. Places with high risk of infection to wear a standard respiratory protection mask such as N95 or equivalent or higher.

    • Isolate: There should be a place to care for treatment for people with AFB (+) tuberculosis, especially for people with multiple drug resistance.

  • In special establishments such as prison, detoxification establishments, educational institutions, reformatory schools, social protection facilities that are very highly infected, need ways A satisfactory reason for new treatment to avoid serious fluids.
  • To protect HIV -infected people to visit: It is necessary to identify those who suspect (cough) to guide them to use masks, paper covers, transfer to their own waiting areas or rooms Isolation (if any) and priority for examination to reduce contact time.
  • BCG vaccine (Bacille Calmette-guérin): Due to the open vaccination program, to help the body form the immune system against tuberculosis when working
  • Patients must comply with tuberculosis treatment in accordance with the instructions of the physician to achieve effective treatment, avoid the risk of infection (especially when coughing up tuberculosis, There is a positive AFB sputum test).

    • avoid tuberculosis to people around:

  • Use a mask or at least with a turban when contacting and talking to others, when sneezing, coughing.
  • Do not spit indiscriminately, spit phlegm into paper towels and burn, wash the soap regularly.
  • Ensuring the environmental sanitation of the patient: Natural ventilation (DOORS
  • in, windows, open umbrellas), sunlight.
  • Regularly expose the sun, mat, blanket, screen

    • Diagnostic measures for Genital urinary system's disease

  • Test tuberculin skin (IDR): positive in about 90% of patients, but only indicates that patients are infected with tuberculosis bacteria rather than acting.
  • CTM, blood sedimentation speed (VSS), blood biochemistry, CRP are useful to assess the severity of the disease, kidney function, and respond to the body's treatment.
  • Consecutive urine implants are still considered as a standard test for evidence of active disease, with 65% sensitivity and 100% specificity. Must be processed for urine samples immediately after taking the disease. Implantation before starting resistance treatment and adjustment of treatment sensitivity according to results. 
  • Polymerase Chain Reaction, PCR) has been studied and proven to be highly sensitive and fast. In different studies, data shows that the sensitivity is from 87 - 100% (usually> 90%) and the specificity is 92 - 99.8% (usually> 95%). Comparison of PCR with urine implant (37%), bladder biopsy (47%), and venous ureter (IVP) (88%).

    • Along with meticulous clinical examination, PCR is the best tool to avoid the delay in treatment because the results are available in just 6 hours. Diagnostic imaging

  • chest and spine can show old or active lesions. Of the 50% of patients, the chest X -ray results are negative.
  • The urinary system is not prepared (Kub) may indicate calcification in the kidneys and ureter in about 50% of patients. Calcification in the bladder is not common.
  • Venous ureter (IVP) and contrast blades: These are standard visual tests for diagnosis of kidney disease and have a sensitivity of 88 - 95%. They also help determine the widespread scope and severity of the disease.

    • Ultrasound can detect follicles or tuberculosis lesions, kidney scars, kidney stasis, and abscess in the kidney, very sensitive ultrasound in the testicular tuberculosis. In recent years, high -resolution rectal ultrasound (Trus) has become a non -invasive technique that is very helpful in evaluating in infertile men due to low sperm (oligospermia) or non -sperm ( Azoopermia) is accompanied by low semen.  Trus can indicate abnormalities in seminal vesicles and vas deferens, helping to assess the condition of the prostate. It may show the expansion or fibrosis of the epididymis, atrophy, thickening or calcification of the seminal vesicles, or prostatitis.

  • Reverse renal pelvis is rarely indicated except in patients with renal impairment or to assess narrow in the upper urinary tract. It also helps to sample urine from the kidneys to implant urine.
  • CT scan: This is a useful support method for IVP and in the case of late patients, or need to further assess the level of disease and indirect function of the function of The kidneys are affected by normal opposite kidneys. The method has high sensitivity in calcification and thickness of the ureter and bladder.
  • Non -specific renal radiography but can be used to assess kidney function and monitor treatment.

    • Genital urinary system's disease treatments

    Genital labor treatment regimen includes 2 components:

    Medicine treatment

    The urinary tract system meets well with the shorter treatment process than the pulmonary tuberculosis because the genital urinary tract has a low number of tuberculosis bacilli. Treatment drugs are indicated and closely monitored by the doctor. The main objective of treatment is to protect renal parenchyma and kidney function, avoid spreading to the community, and to manage the attached diseases.

    Surgical treatment

    Although the use of the drug is the main method in the treatment of urinary tuberculosis, some cases require surgical intervention during the treatment of genital urinary tract. In general, drug treatment is needed 4 to 6 weeks before surgical intervention. In a recent European study, the frequency of surgical intervention in the genital urinary system in the past 20 years is 0.5% of the total urinary surgery. Indications for cases such as:

  • Hydronephrosis
  • Renal failure due to progression of urinary tract
  • Kidney decreased or lost function
  • Narrow of the fallopian tubes or vas deferens causing infertility

    • Persistent pain

  • Uterine bleeding relapses
  • Recurrence of endometrial tuberculosis

    • with surgical methods such as:

  • Partial or whole kidney cutting
  • Salpingectomy
  • Surgery to regenerate

    • ureter or urethra

  • Stent ureter (JJ)
  • Augmentation Cystoplasty (Augmentation Cystoplasty)

    • See also:

  • How many types of tuberculosis have?
  • What is the testicular crested? Structure and function
  • Structure, testicular weight & spermatic mechanism

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