Diseases of the urinary system are quite common. They can affect the kidneys, urinary tract, and bladder. Of all the existing diseases, it is worth highlighting and considering the genitourinary tuberculosis. Every person needs to know about this disease, because no one is safe from an ailment.
More information on tuberculosis affecting the urinary system
Probably there is no such person who would not hear about tuberculosis. This is a common disease in which bacteria called Koch sticks infect the lungs. However, not only in these organs can these microorganisms live. Extrapulmonary forms of the disease are known to specialists. The first place among them is tuberculosis of the genitourinary system.
How is this ailment transmitted? Koch sticks enter the urinary system through the hematogenous route. Based on this, we can conclude that at first a person becomes infected with ordinary tuberculosis from a patient who releases pathogens into the environment. In the future, Koch's sticks can enter the urinary system with a blood stream. Thus, the infection route is first airborne, and then hematogenous.
Genitourinary tuberculosis in women and men begins with kidney damage. Of these, the infectious process spreads through the renal tubules, vessels into 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 in only one of these paired internal organs.
How does the disease develop? Koch's sticks, when it enters the kidneys, affect the cortical and medulla. In the organ, tubercles arise. They gradually ulcerate, caseous decay occurs. As a result, caverns are formed. Inflammatory processes develop around them, tubercles arise. All this can lead to complete destruction of the kidney with the formation of pyonephrosis.
With further development, genitourinary tuberculosis in women and men affects the fibrous and fatty capsule of the internal organ. Tubercles and ulcers appear on the renal pelvis, ureter. Because of this, the walls thicken, become infiltrated, swollen. Ulcers subsequently heal, structures form 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. Tuberculous tubercles appear on the mucous membrane of the internal organ. They undergo further decay. In their place, ulcers, scars form. In the future, the bladder becomes wrinkled due to the fact that the affected walls of the internal organ are replaced by sclerotic tissue.
Genitourinary tuberculosis: a brief classification of the disease
Experts in practice apply a classification that distinguishes several stages in an ailment:
- For the first stage of the disease, infiltrative tuberculosis of the kidneys is characteristic, i.e. non-destructive.
- At the second stage, an initial destruction is observed, i.e., single small caverns appear. In diameter, they do not exceed 1 centimeter.
- In the third stage, there is limited destruction. A large cavity or polycavernous tuberculosis appears in one of the segments of the kidney.
- The fourth stage is characterized by total or subtotal destruction.
The clinical picture of the disease
Genitourinary tuberculosis can manifest itself in different ways. No wonder this ailment in the medical literature is called one of the most common "hoaxes" among diseases of the bladder, kidneys and urinary tract. The manifestations of tuberculosis are often affected by the joined complications. 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, which, in turn, are divided into subjective (those that the patient feels) and objective (detected by specialists during the examination).
Common signs of urinary tuberculosis
With a disease in 20-30% of people, body temperature rises. Basically, it ranges from 37–38 degrees. In some patients, in the presence of additional diseases, complications, a temperature of 38–39 degrees is noted, chills appear.
About 5–18% of sick people have hypertension (high blood pressure). Previously, experts believed that this symptom is a consequence of joined pyelonephritis. It has now been proven that hypertension is a symptom that may indicate kidney tuberculosis. It should be noted that the frequency of detection of this symptom depends on the nature of the ailment. For instance:
- with tuberculosis of the kidney parenchyma, about 1.1% of sick people suffer from hypertension;
- with tuberculosis of the renal papilla - 3.2%;
- with tuberculous pyonephrosis and polycavernous tuberculosis - 18.3%.
Local subjective symptoms of the disease
Often people ask the question: "Symptoms, if there is tuberculosis of the genitourinary system, what?" The sensation that may occur is painful and rapid urination. Specialists in the 50-60s of the last century revealed this sign in all people. Then a tendency toward a decrease in the frequency of symptom manifestation began to be observed. In the 60-70s, only 48% of people complained of impaired urination, and in the 80s - only 43% of patients. In recent years, the symptom has been observed less frequently. This is due to a decrease in the frequency of damage to the mucous membrane of the bladder.
Quite often found signs are pain in the lumbar region that occurs when tuberculosis of the genitourinary system begins to develop. These symptoms are noted in about half of sick people. Pain is usually one-sided. Only 15–20% of sick people report unpleasant sensations localized on both sides.
The nature of the pain is acute, similar to renal colic. It occurs due to a violation of excretory function as a result of blockage of the ureters with blood clots, purulent plug, swelling of the mucous membrane. Renal colic is a symptom that is observed not only with tuberculosis of the urinary system. It is also characteristic of other diseases. One of them is urolithiasis. To make an accurate diagnosis, a urological examination is performed.
Local objective signs
The above symptoms that have tuberculosis of the genitourinary system are symptoms that are subjective. Objective signs include leukocyturia. This term refers to an increased number of white blood cells in the urine. Leukocyturia is the earliest sign of a disease. However, it is not required. If leukocytes are not detected during urinalysis, this is not considered confirmation of the absence of the disease.
Signs of genitourinary tuberculosis include erythrocyturia. In medicine, this term refers to an increased level of red blood cells in the urine. In recent years, this symptom has been detected quite often - in about 70–75% of sick people. The incidence of erythrocyturia is associated with the development of a destructive process in the kidney.
An early objective symptom of tuberculosis is proteinuria (detection of protein in a urinalysis). It is detected in 85–95% of sick people. There are several opinions on the occurrence of proteinuria:
- 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.
- Other researchers claim that protoinuria is caused by dystrophic changes occurring in the tubules and glomeruli of the kidneys.
Every year, doctors are increasingly finding another sign of tuberculosis. This is a non-specific bacteriuria. Infection can be detected at all stages of the disease. Most often it is found in cavernous forms. The causative agents of nonspecific urinary infection are different. Escherichia coli, and staphylococci, and streptococci, and sticks of blue-green pus are detected. Mixed flora is not uncommon.
The most reliable symptom of the disease is the detection of Koch sticks in the urine. However, specialists are not always able to find the main causative agent of the disease. Even modern methods of bacteriological research do not help. The fact is that some people take antibiotics as prescribed by a doctor for existing ailments or drink these drugs while self-medicating. As a result, tuberculosis mycobacteria lose their ability to reproduce and grow. After sowing, they, of course, for this reason are not detected. This makes it difficult to identify the pathogen in the body of a sick person.
Features of urinary tuberculosis in children and the elderly
This disease is mainly affected by adults. In children, genitourinary tuberculosis is much less often diagnosed. A frequent and early symptom that occurs in them is polyuria, i.e., an increase in the volume of urine excreted. There are other signs, but they are often associated with other diseases. Another important feature of tuberculosis in children is that in girls more often it is not a destructive form of the disease, but in boys it is a destructive form.
Urinary tuberculosis affects many elderly people. This is due to a decrease in immune defense, the appearance of various ailments. The symptoms of tuberculosis are affected by concomitant and urological diseases. These include: hypertension, diseases of the gastrointestinal tract, urolithiasis, non-specific pyelonephritis, etc. Because of this, tuberculosis of the urinary system is not always detected. Its symptoms are disguised as signs of the above diseases.
Features of the course of the disease in women and men
Gender depends on how the genitourinary tuberculosis manifests itself. In women, symptoms include less severe pain. In men, they are stronger. They are even more likely to develop genital tuberculosis. Statistics show that such progression in women is noted only in 7% of cases, and in men - in 31%.
Considering the genitourinary tuberculosis in men, the symptoms of this disease, it is worth noting that at first the Koch sticks affect the prostate (prostate gland). Other organs and structures of the reproductive system are then involved in the pathological process: seminal vesicle, testicle, epididymis. In rare cases, the penis is affected. Ulcers appear on it, the ailment affects the peripheral lymph nodes. Similar signs observed on the penis require differential diagnosis with cancer.
Genitourinary tuberculosis: diagnosis
When making a diagnosis, clinical methods are first used. They do not allow to reliably determine whether a person has tuberculosis or not. However, thanks to them, experts detect suspicious signs. Clinical research methods include interviewing a sick person, conducting an examination, palpation of painful places.
An important role in the diagnosis is played by laboratory research methods:
- 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 erythrocyte sedimentation rate. This will indicate the presence of an inflammatory process in the body.
- Urine tests are prescribed. This is the main laboratory method for diagnosing tuberculosis. In the urine with the disease, Koch's sticks, other infections (if they are present or the development of complications are found) are detected. Tests can show proteinuria, leukocyturia, erythrocyturia.
Experts note the importance of using all possible research methods, their combination and repeated use.
The list of diagnostic methods includes tuberculin diagnostics. Its essence lies in the subcutaneous administration of a special thickened culture fluid. It is called tuberculin. Tuberculin diagnostics have indications and contraindications. Indications include: suspicion of tuberculosis of the genitourinary system, assessment of the effectiveness of specific treatment, monitoring the activity of the process. Contraindications are individual intolerance.
In the diagnosis of tuberculosis, the use of endoscopic research methods is possible:
- One of them is cystoscopy. With this method, an endoscope, which is a catheter with lighting and optical systems, is inserted through the urethra into the bladder. Non-specific signs of tuberculosis are diffuse or focal hyperemia of the mucous membrane of the considered internal organ. Specific symptoms detected by cystoscopy are tuberculous tubercles, scars formed at the site of ulcers.
- In some cases, when it is impossible to make an accurate diagnosis and there are some doubts, an endovascular biopsy is performed. When it is sampling material for research. The result can confirm the presence of tuberculosis or a tumor of the bladder. With a negative result, tuberculosis is not excluded.
As auxiliary research methods, panoramic x-ray and tomography are used. Thanks to these research methods, experts will learn about the parameters of the kidneys, the state of the perinephric fiber, identify foci of calcification and ossification in the organs of the urinary system, in the lymph nodes of the retroperitoneal space. Applicable for tuberculosis renal angiography. With the help of it, destructive changes in the kidneys are established, the architectonics of the renal vessels is studied, the possibility of performing organ-preserving surgery and the volume of the renal tissue to be resected are determined.
Ultrasound scanning is sometimes prescribed. This is a non-invasive research method. Ultrasound allows you to evaluate the pyelocaliceal system, timely detect kidney stones, sclerotic changes, foci of calcification, caverns, cystic formations. In this case, the echostructure of the lesions is impossible to make an accurate diagnosis. Having estimated the results of ultrasound, we can only assume the presence of tuberculosis.
Disease treatment regimens
Treatment of tuberculosis of the genitourinary system is prescribed depending on the stage:
- In the initial stages, medication is used. Patients are prescribed tuberculostatic drugs in combination with macrolides and fluoroquinolones, immunocorrectors, proteolytic enzymes. The choice of drugs is carried out by the doctor, taking into account the sensitivity of the detected mycobacterium tuberculosis and the effectiveness of the therapy used.
- At stage III of the disease, drug treatment is combined with organ-preserving surgery. The patient may be assigned a resection of the kidney or 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 tuberculosis is carried out quite often. This is due to the late appeal to specialists for medical care, uncontrolled standard treatment. After nephrectomy, postoperative complications are possible, but they are extremely rare. These include hematomas, suppuration of subcutaneous fatty tissue, purulent and long-healing fistulas, hernias.
Genitourinary tuberculosis in men, namely the genitals, is more difficult to treat. It is less amenable to conservative therapy. For treatment, specific anti-TB drugs are prescribed in the same dosage as for tuberculosis of the urinary system. In addition, with this disease, immobilization of the scrotum using tight-fitting swimming trunks, the use of procaine blockade of the spermatic cord (in combination with streptomycin) is indicated. Tuberculosis of the male genitourinary system is treated for 2 or 3 months. If the results are unsatisfactory, then resection of the epididymis or epididyectomy is performed. With total damage to the testicle, an operation is performed to remove it. If tuberculosis affects the prostate gland and seminal vesicles, then conservative treatment is prescribed.
In conclusion, it is worth noting that genitourinary tuberculosis develops approximately 10-15 years after the onset of pulmonary or osteoarticular tuberculosis. If symptoms occur, it is recommended to seek help from specialists and not to delay a visit, because due to the progression of the disease, kidney removal may be required in the future. In the early stages, such an outcome can be prevented.