male germline tuberculosis
Introduction
Introduction to male reproductive tuberculosis The most common form of urinary male reproductive tuberculosis is kidney tuberculosis. Most male genital tuberculosis is secondary to kidney tuberculosis, mainly in the prostate, seminal vesicle, epididymis, and occasionally in the testis and penis. The more severe the disease of renal tuberculosis, the higher the possibility of male tuberculosis. Because epididymal tuberculosis often has clinical manifestations, it is easy to be discovered by patients or doctors at an early stage, while prostate and seminal vesicle tuberculosis are more concealed and difficult to find. basic knowledge The proportion of illness: 2%, more common in patients with renal tuberculosis and tuberculosis Susceptible people: male Mode of infection: respiratory transmission Complications: tuberculosis, kidney tuberculosis, bone tuberculosis
Cause
Male reproductive tuberculosis
Cause:
Urinary tuberculosis is closely related to male germline tuberculosis. Both sides of the ejaculatory duct and the prostatic tube are open to the posterior urethra. When the infected urine passes through the prostatic urethra, it can enter the prostate and seminal vesicles, causing infection, so the common urinary tuberculosis is common in the clinic. Male reproductive tuberculosis.
However, whether male genital tuberculosis is caused by kidney tuberculosis or mainly by primary infection and blood circulation, there is still controversy. It is now considered that the common pulmonary tuberculosis, bone tuberculosis, kidney tuberculosis, tuberculous meningitis, etc. In the original infection, tuberculosis spreads to the place through the blood line, so it is believed that the male germ line tuberculosis may also spread the blood of the primary infection, the tuberculosis in the tail of the epididymis, has always been considered to be through the prostate, the vas deferens to the epididymis The author of the tail, and supporting blood line dissemination, through the epididymal angiography Macmillan (1954) found that the blood vessels of the epididymis tail are richer than the blood vessels of other epididymis, Gow (1986) has performed prostate on 20 patients with confirmed epididymal tuberculosis Biopsy, only one patient was diagnosed with prostate tuberculosis. Although there were not many biopsy materials, the lesions may have been missed. However, only one of the 20 cases was tuberculosis. It is also quite likely that the tuberculosis of the epididymis is from the blood. Epididymal tuberculosis is the only symptom of patients, urinary angiography and urinary tuberculosis culture are negative, and epididymal lesions and sinus can be cultured in tuberculosis, above It is said that both of them can cause male reproductive system infection, but which is the main one, further research is needed. Testicular tuberculosis is mostly the direct spread of epididymal tuberculosis, and can also be caused by blood infection. Testicular tuberculosis without epididymis is rare. Can not be identified with the tumor, such as anti-tuberculosis treatment is invalid, should be explored early.
Pathogenesis
1. prostate and seminal vesicle
Early tuberculosis forms tuberculous nodules in the glandular duct or seminal vesicles, and then gradually spreads into the seminal vesicle or prostate parenchyma. Prostatic tuberculosis forms tuberculous granuloma, which can be fused to form a cheese-like transformation, forming a cavity, fiber After the contraction, a non-smooth and hard knot-like mass is formed. If calcification occurs, the prostate is harder. The seminal vesicles and fibroblasts proliferate to form a hard mass. It is rare to have a cheese-like change and form a cavity. The seminal vesicle scar sometimes causes ureteral obstruction behind the bladder. Occasionally, tuberculosis lesions rupture to the periphery of the prostate, and even wear the perineum or scrotal skin to form the sinus. Can also lead to urethral stricture, dysuria, blood infection, first in the prostate capsule or prostate parenchyma formation of lesions, severe cases of cold abscess, can form a sinus in the perineal rupture, fibrosis caused by posterior urethral stricture.
Multiple tuberculous nodules can be seen under the microscope, with macrophage infiltration, prostate progenitor cells, ductal epithelial cells destroyed, disappeared, and partially replaced by fibrous tissue, in which case cheese-like abscess and granuloma-like changes can be seen.
2. Epididymis and testicles
The main lesions are caseous and fibrotic. When the tuberculosis invades the vas deferens, the wall of the vas deferens thickens. The vas deferens becomes hard and thick and beaded. The lesion can spread along the vas deferens to the epididymis, and then spreads throughout the epididymis and testis. The epididymal tubule contains exfoliated epithelial cells, white blood cells and a large number of tubercle bacilli, followed by tubule necrosis, granuloma formation, cheese-like transformation and fibrosis, and even sperm granuloma can be seen in the epididymis. First located in the epididymis interstitial, visible most miliary microscopic granuloma, and then invaded the epididymis tube, the vas deferens did not change significantly, the epididymis cheese-like changes quickly spread to the epididymis, adhesion to the scrotum, forming a cold abscess, broken Suspension pus, long-term unhealed, epididymal tuberculosis can spread directly to the testis, causing testicular tuberculosis, testicular intrinsic sheath involvement, there may be a small amount of exudate, testicular inherent sheath can prevent tuberculosis from invading the testis, often seen epididymis is completely Destroyed, and the testicles are still intact.
Prevention
Male reproductive tuberculosis prevention
1. Strengthen health education so that young people understand the harms and ways of infection of tuberculosis. Develop good health habits that don't spit. The TB patients are burned or disinfected.
2. Regular physical examination of adolescents should be carried out to achieve early detection, early isolation and early treatment. In addition, BCG vaccine should be given to infants and young children on time to make the body immune and reduce the occurrence of tuberculosis.
3. Found that there are symptoms such as low fever, night sweats, and blood clots in dry cough, so go to the hospital for examination. After the diagnosis of tuberculosis, it should be treated immediately with streptomycin, remi-salt, and ethambutol. At the same time, we must also pay attention to increase nutrition to enhance physical fitness. As long as it is found to be timely and completely treated, tuberculosis can be completely cured.
4. Tuberculosis is a disease transmitted by the tubercle bacillus through the respiratory tract. It is mainly transmitted by the patient's cough, sneezing and flying droplets when speaking loudly. Therefore, in order to avoid infection, it is necessary to develop good hygiene habits. When sneezing, use a handkerchief to cover your mouth and avoid facing others; the room should be ventilated frequently, and people in densely populated areas should pay more attention; more exercise should be done to improve immunity.
Complication
Male reproductive tuberculosis complications Complications tuberculosis, kidney tuberculosis, tuberculosis
Prostate tuberculosis often occurs with seminal vesicle tuberculosis and epididymal tuberculosis. The seminal vesicle and epididymis play an important role in male fertility, especially epididymis. If the tuberculosis forms scar contracture and deformation, it can affect sperm passage and impair sperm function. Therefore, male reproductive system Tuberculosis can affect male fertility and should be treated early. Secondly, complications such as tuberculosis, renal tuberculosis, peritoneal tuberculosis, and bone tuberculosis can be complicated.
Symptom
Male reproductive tuberculosis symptoms common symptoms skin adhesion semen less blood fine nodules
1. Have a history of tuberculosis in the urinary system or other areas.
2. Prostatic and seminal vesicle tuberculosis can be reduced in blood and semen, rectal examination in the prostate and seminal vesicle can touch induration.
3. Epididymal tuberculosis can touch the tail of the epididymis, the quality is hard, no pain or slight pain, adhesion to the skin, can form a long-term unhealed sinus.
4. The vas deferens tuberculosis can be licked and beaded nodules.
5. Infertility is caused by obstruction of the spermatic tract caused by double vas deferens or epididymal tuberculosis. Semen routinely shows no sperm and the amount of semen is reduced.
Examine
Examination of male reproductive tuberculosis
Detection of tuberculosis in prostatic fluid and semen is helpful for diagnosis. Negative patients cannot rule out the disease. Urine, semen or prostatic fluid can be found in proteins, red blood cells and white blood cells.
1. Urethroscopy can be seen in the expansion of the prostate orifice and tuberculous nodules.
2. When the nature of the prostate induration is not easy to identify, prostate biopsy can also be performed through the perineum or rectum.
3. X-ray examination of IVU can understand the urinary tract tuberculosis, calcification in the prostate area, plaque plaque can be seen in the plaque-like ambiguity or cheese-like abscess formation, the vas deferens occlusion can not be seen in the late stage.
Diagnosis
Diagnosis and identification of male reproductive tuberculosis
Diagnostic criteria
Any male kidney tuberculosis patients should be carefully examined for germline tuberculosis. The diagnosis of epididymal tuberculosis is generally difficult. If there is a typical epididymal induration, skin adhesion, sinus and bead-like vas deferens, the diagnosis can be determined if If you have symptoms of kidney tuberculosis, the diagnosis is more obvious.
The normal epididymis is sometimes misdiagnosed as epididymal tuberculosis. It is normal for the epididymis head and tail to be slightly enlarged or slightly hard. If there is no infiltration or induration, the diagnosis cannot be confirmed and should be followed up.
Simple prostate tuberculosis, when the epididymal tuberculosis is not complicated, the diagnosis is difficult, the induration in the prostate, can be touched in non-specific chronic prostatitis, especially granulomatous prostatitis, early prostate cancer, should be comprehensive analysis and examination, diagnosis has When it is difficult, it can be done for biopsy. Generally, when the prostate tuberculosis is diagnosed by rectal examination, it is hard and has nodules, which is smaller than normal prostate.
Differential diagnosis
1. Prostatic stones have frequent urination, difficulty in urinating, pain in the lumbosacral or perineal area, sexual dysfunction, such as erectile dysfunction, premature ejaculation, blood essence, ejaculation pain, rectal examination and calculus or stone friction Sense, X-ray film can be seen in the shadow of the prostate area, B-ultrasound can be found with strong light spots behind the sound.
2. In the advanced stage of prostate cancer, dysuria and urinary tract irritation may occur. The rectal examination of the prostate surface is uneven, the texture is hard, sometimes it can touch the induration and tenderness, and can be identified by PSA examination, CT and prostate biopsy.
3. Chronic prostatitis lower abdomen, lumbosacral or perineal area pain and bulging discomfort are common symptoms, some patients have urinary disorders, but no history of tuberculosis, rectal referral prostate shape is normal or swollen, texture is normal or slightly hard Urine routine can be normal, prostatic fluid and semen are acid-resistant staining, and smear or tuberculosis culture is negative.
4. Non-specific granulomatous prostatitis is the genital tissue of the prostate, its prostatic fluid, the foreign body reaction of the bacterial product or the autoimmune reaction, causing tissue damage, necrosis, and granuloma formation. Change, may also be secondary to systemic immune response, with urinary tract irritation, perineal, lumbosacral pain, discomfort and ejaculation pain, prostate enlargement, induration, more common in elderly patients, prostate induration and rapid growth, mountain peak Protrusion, irregular elasticity, uneven texture, often occurs between or after urinary tract symptoms, rapid obstruction symptoms occur and urinary retention, blood, urine routine can be found in the number of eosinophils increased, no abnormalities in prostatic fluid routine.
5. Non-specific epididymitis includes acute and chronic epididymitis, the former often accompanied by high fever, scrotal skin congestion and redness, hydrocele, pain and tenderness, the latter may or may not have a history of acute epididymitis, mostly located in the tail of the epididymis, A few are located in the head of the epididymis, pain and tenderness, and the vas deferens have no beaded induration.
6. Filariasis has a history of filariasis endemic areas and a history of filaria infection. The induration is mostly in the epididymis head and spermatic cord. The size is about 1cm2. When the time is large, the texture is not as good as the nodules of tuberculosis, and there is pain during the attack. Blood routine eosinophils increase, and sometimes microfilariae can be found in the blood.
7. Semen cysts have epididymal nodules, mostly located near the head of the epididymis, the capsule is sexy, the edges are neat and smooth, the epididymis is normal, and the diagnostic puncture can extract the milky white sperm-containing liquid.
8. The benign tumor of the epididymis is mostly a round mass of about 1cm2, which is slightly hard and has a smooth surface.
9. Epididymal deposition has a history of vas deferens ligation, epididymis tail swelling, 1 ~ 2cm, the surface is not smooth (swollen epididymis tube), the texture is slightly harder than chronic epididymitis but slightly softer than the epididymal tuberculosis.
10. Gonorrhea epididymitis has a history of gonorrhea, an acute process, local redness and pain, purulent discharge in the urethra, which may be found Gram-negative diplococcus, no epididymis induration.
11. Epididymal sperm granuloma is about 1cm2 round and small lumps, the surface is smooth, medium hardness, often tenderness, B-ultrasound can be identified.
12. Non-specific epididymal orchitis Scrotum scrotum pain and discomfort, often have a history of posterior urethritis, prostatitis and seminal vesiculitis, or may have a history of equipment used in the urethra.
13. Testicular tumors Testicular masses are large, growing rapidly, hard and heavy, and the epididymis is generally normal.
14. gonococcal epididymal orchitis scrotal swelling and pain, 1 to 2 days after acute onset, testicular epididymis increased significantly, urethral redness and swelling, more secretions, penis often painful erection, urethral secretion can be detected Gram-negative double Cocci.
