外科泌尿生殖系统结核课件.pptVIP

* (2a) dilated calices and thinning of the renal cortex (2b) mural enhancement and thickening of the proximal ureter (3a) dilated calices and narrowing of the infundibula (3b) circumferential ureteral wall thickening, left ureter is normal * globular calcific areas of increased opacity in the medial upper pole of the right kidney (arrowheads). The calices are markedly enlarged with ill-defined margins (white arrows). Small, irregular collections of extracaliceal contrast material are also present (black arrows). (b) mucosal irregularities and erosions Figure 1.bladder reduced capacity. * Genitourinary Tuberculosis TB - introduction A disease observed in humans for over 7000 years ( Myers, 1952 ) A common disease in Egypt around 1000 BC ( Morse et al, 1964 ) TB - introduction Almost one fourth of the deaths in England in 1700s were caused by TB ( Colby, 1954 ) Globally, TB is the most common opportunistic infection in AIDS patients ( Pape et al, 1983 ; WHO, 1997 ; Perlman et al, 1999 ). From TB to GxUinary TB Genitourinary TB is “metastatic from” rather than “secondary to ” primary lung TB infection. ( Medlar, 1926 ) Primary site of bloodstream dissemination Urinary system: kidney Genital system: epididymis Genitourinary TB - introduction 10 million/y new TB cases 10% of the new cases are extrapulmonary TB, 20% of these are Gxurinary TB 200,000 new cases of Gxurinary TB Serious urological problem Nonspecific irritative voiding symptoms, insidious onset ?diagnosed late remains a major health problem in developing countries (Scand J Infect Dis. 2002) (Renal Failure. 2005) Development of Gxuinary TB The initial infection occurs in the renal cortex where the bacilli can remain dormant ( lying asleep ) within granulomas for decades. This dormant infection then becomes activated due to failure of the local immune response. Development of Gxuinary TB The primary site for infection of the genital tract is often the epididymis in men and the fallopian tubes