Wise Gilbert J, Shteynshlyuger Alex
Division of Urology, Maimonides Medical Center, 48-02 Tenth Avenue, Brooklyn, NY 11219, USA.
Curr Urol Rep. 2008 Jul;9(4):305-13. doi: 10.1007/s11934-008-0053-9.
Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.
泌尿生殖道结核表现为非典型症状。泌尿生殖道结核患者中仅有20%至30%有肺部感染史。结核常累及泌尿生殖系统下部而非肾脏。泌尿生殖系统下部结核最常累及附睾和睾丸，其次为膀胱、输尿管、前列腺和阴茎。使用卡介苗治疗膀胱癌可导致泌尿生殖系统下部出现有症状的结核感染。泌尿生殖系统下部结核可表现为刺激性排尿症状、血尿、附睾睾丸炎、前列腺炎和瘘管。精囊、输精管、输卵管和子宫结核可导致不孕。尿液分析可能显示无菌性脓尿、血尿或蛋白尿。通过培养、组织检查或聚合酶链反应研究鉴定出抗酸杆菌即可确诊。药物治疗可能无法缓解症状。通常需要进行手术干预和尿路重建。
