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Tuberculosis of Urinary Tract PowerPoint Presentation

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Description : Tuberculosis of the Urinary tract.

Tags : Tuberculosis, Urinary tract, mycobacteria strains, human tuberculous disease, M. tuberculosis, M. bovis, M. leprae and M. africanum. Mycobacteria tuberculosis accounts for most of the disease, Renal TB, Papillary necrosis, calyceal stem

Published on : Dec 29, 2020 | Views : 2885 | Downloads : 4

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Slide 1-

Tuberculosis of Urinary tract
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5000 BC Observed in humans 375 BC Hippocrates described ‘phthisis’ 1696 Wiseman described ‘scrofula & King’s Evil’ 1882 Koch’s postulates organism in disease growth outwith body disease following infection History
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1882 Ehrlich discovered acid-fastness 1925 Calmette & Guerin generate BCG 1929 Medlar reported asymptomatic renal tubercles in pulmonary TB 1937 Wildbolz coined term ‘genitourinary tuberculosis’ 1943 Streptomicin discovered 1952 Isoniazid discovered 1966 Rifampicin discovered History………………..
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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 Etiology
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Mycobacteria 2.4 um long x 0.5um wide Non-motile, non-flagellated Strict aerobes Thick cell wall 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 Microbiology
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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
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Pathogenesis
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Frequent painless micturition LUTS Sterile pyuria, 20% without pyuria Gross hematuria 10%, microscopic hematuria 50% Renal or suprapubic pain Clinical presentation
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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 Renal TB
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KUB radiographic view in a patient with left renal tuberculosis with associated calcifications
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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) Ureter TB
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Stricture at the distal left ureter
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Earliest forms of infection start around one or another ureteral orifice Healed mucosal lesions have a stellate appearance Bladder TB
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Urine Examination Urine culture (3-5 specimen) Tuberculin Test Diagnosis
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Criteria for Tuberculin Positivity, by Risk Group
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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
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CT after oral contrast medium with bilateral tuberculosis
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Antitubercular drugs: Multidrug treatment 6 to 9 months ( Iseman, 2000 ) Rifampicin, INH, pyrazinamide, and ethambutol Management
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Surgery Current focus is on organ preservation and reconstruction Delayed until medical therapy has been administered for at least 4 to 6 weeks
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Nephrectomy Indications nonfunctioning kidney with or without calcification extensive disease involving the whole kidney, together with hypertension and UPJ obstruction coexisting renal carcinoma
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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
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Reconstructive Surgery Ureteral Strictures: entire stricture should be excised Augmentation Cystoplasty Urinary Conduit Diversion Orthotopic Neobladder