Tuberculosis of urinary system

Tuberculous process in the urinary system always starts with tuberculosis of the kidneys.
There are two forms of tuberculosis renal: acute (miliary) and chronic (cheesy). In the acute form miliary eruption of tuberculosis bumps observed in both kidneys, mainly in the cortical layer them, and reflects the General generalization of a tuberculous process, when a similar rash available in other parenchymatous organs. Therefore, this form of tuberculosis kidney has no independent clinical picture and is not related to the activity of the urologist.
At second, a chronic form of a tuberculous process in kidney develops slowly. TB bumps in the renal parenchyma undergo necrosis with the formation of ulcers, lesions of caseosa and caverns. Chronic form manifests expressed clinical picture, and that's it mean, speaking of tuberculosis of kidneys and urinary system.
Tuberculosis of the kidneys occurs in 1 % of all autopsies. Against all surgical diseases of the kidneys, taken together, it is 15%. This disease occurs mostly between the ages of 20 to 40 years, with equal frequency in men and women. Clinically tuberculosis in 80-85% of cases it develops in one kidney, equally often left or right.
Tuberculosis kidney - secondary disease arising from hematogenous metastasis of TB infection from the primary complex in the lung or the intestine. In rare cases it is possible initial infection of the kidneys simultaneously with light.
The occurrence and course of tuberculosis are determined not only by the condition of the urinary system, but the General properties of the organism - its resistance (immunity) and reactivity against tuberculosis infection, living conditions, which is ill, and biological properties of the agent of tuberculosis.
TB infection may occur in the kidneys in four ways: 1) per continuitatem, 2) the ascending or urinogenny, 3) lymphogenous and 4) haematogenous.
The development of tuberculous lesions of the kidneys per continuitatem, i.e. in the transition process from the nearby organs, such as tuberculosis adrenal gland, spine, are very rare.
Ascending path tuberculosis infection of the bladder gap in the ureter is possible only in that case when the bladder and, therefore, one kidney is affected by tuberculosis. When spasmodic contraction of the bladder Mycobacterium tuberculosis can be abandoned in the renal pelvis opposite, healthy kidneys. Ulcerative and cicatricial changes in the field of cystic triangle are a violation of the switching ability ureter mouth, which facilitates retrograde flow of urine.
Possible and the upward path of tuberculosis infection of the bladder through the lymphatic vessels of the ureter, but this is rare.
With rare exceptions, infection of the kidneys tuberculosis from already existing in the body of the hearth is hematogenous route. The aggravation of process in such a focus and mass invasion into the blood highly virulent Mycobacterium tuberculosis in low resistance lead to miliary TB. If the blood is a small amount weakened bacteria, they can settle in various organs, including the kidney (the so-called organ tuberculosis).
This requires a certain allergic status of the renal parenchyma. So Mycobacterium tuberculosis in some cases cause the development of TB disease in kidney, other nonspecific reaction type banal chronic nephritis, in the third - die without causing any reaction.
In the modern view, in most cases, TB affects both kidneys, but later one of them the process dies down, and the other is progressing.
The spread of tuberculosis in the kidney is in the blood, lymphatic vessels and urinary channels.
Following the kidney in most cases, affected the ureter, bladder, often sexual organs of men (prostate, epididymis and testicles) and rarely urethra.
The ureter and urinary bladder are infected with tuberculosis current urine and lymphogenous way. On the first route of infection shows regression of changes in the bladder after obliteration of the lumen of the ureter, the second - thickening and infiltration of its walls.
In the urinary bladder of a tuberculous process applies not only per continuitatem, but also through the lymph system.