Download MBBS Surgery Presentations 61 Tuberculosis of Urinary Tract Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 61 Tuberculosis of Urinary Tract PPT-Powerpoint Presentations and lecture notes

Tuberculosis of Urinary tract

Dept Of Surgery

Etiology

? Peak incidence in 20-40 age group worldwide
? Male-female ratio 2:1
? Virulence of mycobacterium strain

? Cord factor - inhibits granuloma formation
? Sulphatides - impairs macrophage phagocytosis
? Lipoarabinomannan ? inhibits macrophage killing

? Host factors - immunocompromise
Microbiology

Mycobacteria
? 2.4 um long x 0.5um wide
? Non-motile, non-flagel ated
? Strict aerobes
? Thick cel wal containing 4 complex layers of approx 50%

lipids

? Very difficult to stain (hot carbolfuschin)
? Stain is `fast' to acid or alcohol
? Very slow growing ? doubling time 16-20 hrs

4 mycobacteria strains cause human tuberculous disease

? M. tuberculosis
? M. bovis
? M. leprae
? M. africanum

Mycobacteria tuberculosis accounts for most of the

disease

Humans are the only reservoir of the disease


Pathogenesis

Clinical presentation

? Frequent painless micturition
? LUTS
? Sterile pyuria, 20% without pyuria
? Gross hematuria 10%, microscopic hematuria 50%
? Renal or suprapubic pain


Renal TB

? Renal TB is caused by the activation of a prior blood

borne renal infection

? Healing process results in fibrous tissue and calcium

salts being deposited

? Papillary necrosis and strictures in the calyceal stem

KUB radiographic view in a patient with left renal tuberculosis with associated calcifications


Ureter TB

? Tuberculous ureteritis is always an extension of the

disease from the kidney

? Leads to fibrosis and stricture formation

? Site most commonly affected is the ureterovesical

junction (UVJ)

Stricture at the distal left ureter
Bladder TB

? Earliest forms of infection start around one or

another ureteral orifice

? Healed mucosal lesions have a stellate appearance

Diagnosis

Urine Examination
? Urine culture (3-5 specimen)

? Tuberculin Test




? Radiography

? Plain Radiographs
? Intravenous Urography
? Computed Tomography (gold standard tool )

? Cystoscopy and Biopsy (rarely indicated )
? Retrograde Pyelography

? stricture at the lower end of the ureter
? ureteral catheterization

? Percutaneous Antegrade Pyelography
? Arteriography, Radioisotope Investigation and MRI

CT after oral contrast medium with bilateral tuberculosis
Management

Antitubercular drugs:
? Multidrug treatment
? 6 to 9 months ( Iseman, 2000 )
? Rifampicin, INH, pyrazinamide, and ethambutol

Surgery
? Current focus is on organ preservation and

reconstruction

? Delayed until medical therapy has been administered

for at least 4 to 6 weeks
Nephrectomy
? Indications

? nonfunctioning kidney with or without calcification

? extensive disease involving the whole kidney, together

with hypertension and UPJ obstruction

? coexisting renal carcinoma

Partial Nephrectomy
? Localized polar lesion containing calcification that

has failed to respond after 6 weeks of intensive

chemotherapy

? Area of calcification slowly increasing in size and may

gradually destroy the whole kidney
Reconstructive Surgery
? Ureteral Strictures: entire stricture should be excised
? Augmentation Cystoplasty
? Urinary Conduit Diversion
? Orthotopic Neobladder