Benchekroun A, Lachkar A, Soumana A, Farih M H, Belahnech Z, Marzouk M, Faik M
Clinique Urologique A, CHU Ibn Sina, Rabat, Maroc.
Ann Urol (Paris). 1998;32(2):89-94.
Urogenital tuberculosis raises major diagnostic problems due to the frequently atypical and misleading clinical features. It is a serious disease as the lesions are often multifocal and extensive, requiring major surgical resection and urinary tract reconstruction. Prevention of this disease is based on generalization of BCG immunization and adequate treatment of pulmonary tuberculosis. Between 1985 and 1995, 80 patients with urogenital tuberculosis were treated in our department. These patients consisted of 50 males (62.5%) and 30 females (37.5%) with a mean age of 38 years (range: 20 to 50 years). IVU revealed silent kidney in 26% of cases, ureterohydronephrosis in 36% of cases, small bladder in 17% of cases, and was normal in only 5% of cases. Renal function was impaired in 32% of patients. The diagnosis was confirmed by a positive test for AFB in the urine in 64% of cases, bladder biopsy in 20% of cases and pathological examination of the operative specimen in 20% of cases. Treatment consisted of temporary urinary diversion (32%), antituberculous chemotherapy in all patients, and corticosteroid therapy in 8.7% of patients. Surgical treatment was required in 95% of patients: partial nephrectomy (2.5%), nephrectomy (50%), enterocystoplasty (18%), ileoureteroplasty (5%), ureteric reimplantation (12.5%), ureterocaliceal anastomosis (1.2%).
由于泌尿生殖系统结核的临床特征常常不典型且具有误导性，因此引发了重大的诊断难题。这是一种严重的疾病，因为病变往往是多灶性且广泛的，需要进行大型手术切除和尿路重建。该病的预防基于卡介苗免疫接种的普及以及对肺结核的充分治疗。1985年至1995年间，我科共治疗了80例泌尿生殖系统结核患者。这些患者包括50名男性（62.5%）和30名女性（37.5%），平均年龄为38岁（范围：20至50岁）。静脉肾盂造影显示，26%的病例存在静息肾，36%的病例有输尿管肾积水，17%的病例膀胱较小，只有5%的病例正常。32%的患者肾功能受损。64%的病例通过尿液抗酸杆菌检测阳性确诊，20%的病例通过膀胱活检确诊，20%的病例通过手术标本病理检查确诊。治疗包括临时尿路改道（32%），所有患者均接受抗结核化疗，8.7%的患者接受皮质类固醇治疗。95%的患者需要手术治疗：部分肾切除术（2.5%）、肾切除术（50%）、肠膀胱扩大术（18%）、回肠输尿管成形术（5%）、输尿管再植术（12.5%）、输尿管肾盂吻合术（1.2%）。
