Núcleo Interdisciplinar de Pesquisa em Urologia and Department of Surgery/Urology, Federal University of Juiz de Fora, Minas Gerais-Brazil.
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Microbiol Spectr. 2017 Jan;5(1). doi: 10.1128/microbiolspec.TNMI7-0015-2016.
Urogenital tuberculosis is the second most frequent form of extrapulmonary tuberculosis. Starting with a pulmonary focus, 2 to 20% of patients develop urogenital tuberculosis through hematogenous spread to the kidneys, prostate, and epididymis; through the descending collecting system to the ureters, bladder, and urethra; and through the ejaculatory ducts to the genital organs. Urogenital tuberculosis occurs at all age ranges, but it is predominant in males in their fourth and fifth decades. It is a serious, insidious disease, generally developing symptoms only at a late stage, which leads to a diagnostic delay with consequent urogenital organ destruction; there are reports of patients with renal failure as their initial clinical presentation. Although the condition has been long recognized by nephrologists, urologists, and infectious disease specialists, urogenital tuberculosis is still largely unknown. Even when suggestive findings such as hematuria, sterile pyuria, and recurrent urinary infections are present, we rarely remember this diagnostic possibility. Greater knowledge of the features of urogenital tuberculosis then becomes relevant and should emphasize the importance of an early diagnosis.
泌尿生殖系统结核是仅次于肺部的第二大肺外结核形式。有 2%~20%的患者开始时肺部有结核病灶，通过血行播散至肾脏、前列腺和附睾；通过下行收集系统至输尿管、膀胱和尿道；通过射精管至生殖器官，会发展为泌尿生殖系统结核。泌尿生殖系统结核可发生于所有年龄段，但主要见于 40 岁至 50 岁的男性。这是一种严重且隐匿的疾病，通常仅在晚期出现症状，导致诊断延迟，继而泌尿生殖器官遭到破坏；有报道称，肾衰竭是患者的首发临床表现。尽管肾病学家、泌尿科医生和传染病专家早已认识到这种情况，但泌尿生殖系统结核仍知之甚少。即使存在血尿、无菌性脓尿和反复尿路感染等提示性发现，我们也很少会想到这种诊断可能。因此，更深入地了解泌尿生殖系统结核的特征变得尤为重要，这有助于强调早期诊断的重要性。
