Fillion A, Koutlidis N, Froissart A, Fantin B
Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
Service d'urologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
Rev Med Interne. 2014 Dec;35(12):808-14. doi: 10.1016/j.revmed.2014.07.006. Epub 2014 Sep 17.
Genito-urinary tuberculosis is the fourth most common manifestation of the disease, but it is often underestimated by clinicians because of few and non-specific symptoms and insidious disease course. The most common urinary findings are multiple ureteral stenosis. The most common genital involvement is an epididymal nodule for men and a chronic salpingitis for women. The definite diagnosis of genito-urinary tuberculosis is obtained on the basis of culture studies. Due to the paucibacillary nature of the disease, especially of genital location in woman, a probable or presumptive diagnosis is frequently considered with several parameters including radiological imaging (abdominal CT-scan, pelvic ultrasound, pelvic MRI). Endoscopic and surgical procedures are frequently required to obtain specimens for histopathologic and bacteriological studies. Medical treatment is the method of choice, with a combination of four drugs, namely isoniazid, rifampicin, ethambutol and pyrazinamide, followed by a two-drug regimen, for a total of six month duration. Surgery might be indicated in complicated genito-urinary tuberculosis (decreased renal function, infertility, urologic complaints).
泌尿生殖系统结核是该疾病第四常见的表现形式，但由于症状较少且不具特异性，病程隐匿，临床医生常常对其估计不足。最常见的泌尿系统表现是多发性输尿管狭窄。最常见的生殖器受累情况，男性为附睾结节，女性为慢性输卵管炎。泌尿生殖系统结核的确切诊断基于培养研究得出。由于该疾病菌量少的特性，尤其是女性生殖器部位的感染，常需综合包括放射影像学检查（腹部CT扫描、盆腔超声、盆腔MRI）在内的多项参数来做出可能或推定诊断。经常需要通过内镜和外科手术获取标本进行组织病理学和细菌学研究。药物治疗是首选方法，采用异烟肼、利福平、乙胺丁醇和吡嗪酰胺四种药物联合，随后采用两药方案，疗程共六个月。对于复杂的泌尿生殖系统结核（肾功能减退、不孕、泌尿系统不适），可能需要进行手术治疗。
