Tuberculosis of urinary system

Palpation. To probe the tuberculosis kidney is not more than 20% of the cases; often is palpated not sick, and compensatory increased opposite the kidney. Sometimes it is possible to probe through the vagina sklerozirovanie the ureter. Men often detected by palpation TB changes in the epididymis, prostate, which is extremely facilitates the treatment of cystitis, pyuria or hematuria unclear etiology.
Treatment. To streptomycin has been recognized that TB kidneys can only be cured by nephrectomy. Currently, the indications for removal of a tubercular kidney sharply limited, and the results of this operation has improved considerably. Before nephrectomy at a tuberculosis of kidneys was accompanied by 12-15% by death of patients from miliary TB or TB meningitis. Currently, thanks to the specific antibiotic therapy before and after surgery nephrectomy for tuberculosis was safe in the same way as the kidney and other diseases. Destruction of tubercular kidney without such therapy is now invalid.
Preoperative preparation TB drugs improves the General condition of the patient, the temperature drops to normal, increased appetite, dysuria stops. Patient operate in the phase of remission process. During the operation should strive to ensure that the contents of the caverns had been wound. However, contamination of the wound urine or pus from a tubercular kidney now is not as threatening as it was before the application of streptomycin.
After surgery, chemotherapy lasts for all time of stay of the patient in the hospital and after discharge him from the hospital to the full normalization of urine, but not less than 2 months (preferably in the health conditions).
Indications for the removal of a tubercular kidney unilaterally process should be considered as tuberculosis Pioneros, policewoman poorly functioning kidney, tuberculosis kidney with large pockets of caseous necrosis or melatonine.
With bilateral tuberculosis nephrectomy is shown only when deep destruction of single and limited damage to the second kidney.
At the location of the caverns in one of the poles of the kidneys and in the absence of destructive process in the rest can be limited resection of the affected Department. When localization caverns simultaneously in the upper and lower pole of the kidney can be repetirovali both poles. Separate knobs that can remain in the kidney undergoing resection, under the influence of chemotherapy are fibrous degeneration or dissolve.
The technique of resection of the kidney. After the exposure of the kidneys and its launch into the wound perform a careful selection of vascular legs. Additional blood vessels leading to the pole, subject resection, tied up. On 1.5-2 cm distal to the intended line resection netscout and prepare the chin fibrous capsule kidneys. Renal stem squeeze your fingers or soft clip or squeeze kidney hand and produce a wedge or ploskostei resection of poles in healthy tissues. Release the pressure on the vessel or on the renal parenchyma, define a bleeding artery and cut away their catgut with flashing environmental parenchyma. Venous bleeding stop imposing on the cut plane of the piece of muscle, which is fixed kedgotoline seams made through the parenchyma and fibrous capsule (Fig. 86). In wound enter 1 gram streptomycin and leave 1 or 2 drainage.
Using only one chemotherapy, can be more or less stable cure minor lesions of the kidneys without signs of destruction on pyelogram or ulcerative-cavernous lesions of small and average values.
Chemotherapy must be prolonged up to 1-2 years. During the treatment and after it is necessary to control with the use of crops, vaccination urine and contrast radiography of the kidneys.
Under the influence of chemotherapy epithelioid cells turn into fibroblasts and fibroblasts, giant cells disappear. Bumps vibratsiya and encapsulated. There is also, though to a lesser extent, collagenase caseous lesions. The inner surface of cavities cleared from caseous masses, which acquires smooth appearance.
Signs of recovery are considered proof disappearance from the urine of leukocytes and tubercle bacilli, confirmed multiple vaccinations urine, and reverse development or stabilization foci of destruction on pyelogram. Specific chemotherapy with known successfully used for bilateral tuberculosis of kidneys, if nephrectomy or resection of the kidney is contraindicated. To expect a recovery in the extensive damage both kidneys it is not necessary, but some of seriously ill General condition improved considerably, the number of leukocytes in urine is reduced, or they disappear altogether. The same happens with Mycobacterium tuberculosis.
Conservative treatment without surgery is shown.
1) in patients with tuberculosis of the kidneys without the effects of decomposition on pyelogram;
2) in patients with small and medium size centers, including with small single caverns in the kidney;
3) with bilateral tuberculosis of kidneys, excluding the possibility of surgical intervention.
Treatment effectiveness is reduced in the development of resistance of tubercle bacilli to chemotherapy, especially to streptomycin. The best means of combating resistance is the use of streptomycin in combination with PASK, tibon, ftivazide or salyuzid. When cavernous TB preferable to appoint ftivazid or salyuzid as the drugs isonicotinic acid better streptomycin stimulate processes of fibrocisti. Streptomycin quickly leads to resorption or hardening of tuberculous lesions. When mixed flora urine correct to assign streptomycin with broader antibacterial effect than ftivazid or salyuzid.
Patients with liver disease, and suffering from epilepsy, should not appoint ftivazid, as it has a toxic effect on the liver and, nameplease in the blood that causes seizures.
The most rational is to combine streptomycin with PAS and ftivazide. The latter can be replaced by other derivatives isonicotinic acid - salyuzid, metazid. To avoid habituation of Mycobacterium tuberculosis to ftivazide and its analogs recommended to replace them periodically by tibon or vitamin D2. The treatment is carried out in the following dosage: streptomycin 1 g per day; ftivazid, salyuzid or metazid for 0.2-0.5 g 3 times daily. Tibon appointed by 0,02-0,03 g 3 times, vitamin D2 - from 20 000 to 25 000 units 3 times a day. PAS should be taken in ascending doses ranging from 2 g / day and gradually increasing the daily dose of up to 10,
In the postoperative period and in case of worsening of the tuberculosis process streptomycin is assigned daily 1 g per day.
Anti-TB drugs, positively acting on a specific process in the urinary bladder, causing remission dysuria and the healing of ulcers.
Tuberculosis bladder applies adrenocorticotropic hormone dose of 10 units 4 times a day for 3-4 weeks under the control blood pressure.
In the case of developing resistance of Mycobacterium tuberculosis to one of the three components of chemotherapy renal tuberculosis, as well as with intolerance to one or another drug, it should be replaced by another.
Streptomycin is best to replace cycloserine. This low-toxic drug is readily soluble and is rapidly absorbed and especially works well on a virulent form of tuberculosis bacilli. Its concentration in urine is 10 times higher than in the blood; this makes it especially suitable for the treatment of tuberculosis urinary system. It is devoid of negative properties of streptomycin can cause abnormally fast scarring TB tricks that sometimes lead to the obliteration of diverting ways (ureters, cervical cups). Therapeutic effect cycloserine does not exceed streptomycin, but a pronounced effect in cases where developed an intolerance or resistance to streptomycin. Cycloserine administered in a dose of 0.25 g 2-4 times a day, preferably in combination with vitamin B6 0.05 g 2 times a day. The side effects caused by cycloserine in the form of involuntary muscle contractions and light cramps, while the appointment of vitamin B6 are not observed. Intolerance to PAS is expressed more often in the gastro-intestinal disorders, vomiting, diarrhea. To combat them need to reduce the dose, and assign 0.3 g burnt magnesia or half a glass of milk 3 times a day.
Drugs isonicotinic acid - ftivazid, metazid, salyuzid - cause sometimes side disorders in the form of dizziness, muscle spasms, increased reflexes, transient difficult urination. The best antidote is barbiturates.
Not only medicines and climatotherapy, but good nutrition, good housing conditions, work without fatigue determine the success of treatment. You dispensary observation of patients.