Tuberculosis of urinary system

Pathological anatomy. When miliary form of renal tuberculosis in the cortical layer, as a rule, both kidneys bumps appear gray, the surface of the kidney becomes this dark red, she seemed to be strewn with semolina.
Histological examination showed typical lymphoid or epithelioid cell bumps with characteristic laganovskis giant cells.
In the chronic form of the disease tuberculosis bumps in the early stages are also predominantly in the cortical layer. Because of the relative resistance of the bark, buds to TB infection, they are scarring. In cerebral layer bumps, located mainly in the field of renal papillae, do not tend to reverse development. Merging with each other and being cheesy decay, they form one or more of TB cheesy sites from 0.5 to 1 cm in diameter.
Most often cheesy hearth melts, forming separate caverns with ragged, moth-eaten walls lined purulent film (membrana Ruedas). Gradually specific inflammation from the edge of the cavern spreads to adjacent areas renal parenchyma, which also occurs destructive process. In most cases, the contents of the cavity through a thin fistulous progress crop up in a urine-diverting way.
Isolated or merged among themselves caverns often occupy the most part of the renal parenchyma (Fig. 79). Progressive tuberculosis destruction can lead to the total destruction of the kidneys (TB Pioneros).

Fig. 79. Tuberculosis kidney and ureter. In the renal parenchyma along with caverns and caseous lesions of the collapse of the rich miliary rash bumps. The ureter is expanded, mucous dotted with tuberculosis bumps and sores.

In recent years under the impact of treatment on the place of cavities often detected smooth cavity with clear content.
Tuberculosis can spread to the membrane of the kidney. Fibrous capsule thickens and tightly fused with the kidney. If you are involved in the process of fat capsules developing fibrotic-sclerosing parametric.
Cup-pelvis system involved in the tuberculosis process downward path. On the mucous membrane formed small tubercles yellowish color, surrounded by a zone of hyperemia. In the future, there is the growth of granulation tissue and pitting on the place of caseous reborn bumps. Infiltrative the process captures submucosal and muscular layers of the pelvis, which thickens, becomes swollen, proboscidalis. Often the expansion of cups, pelvis and ureter.
Specific changes in the ureter similar to those in the pelvis. Can cause narrowing of the lumen of the ureter at the expense of developed infiltration and granulation or scar tissue.
In the bladder is the first centers of tuberculosis usually develop in the field ureter mouth and only occasionally in the bottom of the bubble.
Miliary bumps on the mucous membrane of the bubble " nekrotizirutee and, together, form ulcers elongated, irregular in shape, with dirty yellowish bottom and rash bumps on the periphery. The edges of the ulcer giperemiei and swollen.
Ulcers bubble in advanced cases affect significant portions of the gallbladder wall and, being partially scarring, cause wrinkling and rigidity. The capacity of the bladder is reduced, sometimes up to 20-30 ml (Microcystis). Cicatrices in the area of the mouth of the ureter in some cases cause a gaping crater mouth, in other stricture or obliteration. Tuberculosis bubble sometimes leads to the formation of the gallbladder-rectal or gallbladder-vaginal fistula.