Tuberculosis of the bladder: symptoms, treatment
One of the most common secondary diseases of patients suffering from TB is tuberculosis of the bladder, as one of the manifestations of lesions of the tubercle Bacillus of the genitourinary system. The spread of tuberculosis infection on the urinary organs is diagnosed in 20% of cases.
Description of pathology
The distribution of tuberculosis is Mycobacterium tubercle Bacillus. This kind of microorganisms are resistant to acids, enters the body during respiration and is able to stay a long time in «sleep» state. In addition, pathogenic microorganisms enter the body through food bodies during pregnancy, the mother infected the child, if contact with patients with tuberculosis infection occurs through the mucous membranes and the skin of the body. Under favourable conditions bacteria aktiviziruyutsya and infects the body.
Often the infection is localized in the respiratory organs but infection of other systems of the body by hematogenous, with the movement of blood. Kidney and urinary tract is the second most common pathology of tuberculosis. Positive conditions for the development of infection are created with the weakening of the body, what are the stress, and other diseases that undermine the immune system.
The causes of the disease
Lose bladder tuberculosis is due to primary infection of the kidneys and infection in the urethra. In some cases, the root cause is tuberculosis of the genital organs, but this phenomenon happens rarely. It is worth noting that to a greater extent to the risk of pathogenic exposure to TB bacteria are susceptible people with chronic inflammatory diseases in the anamnesis.
Often it’s a bladder infection occurs through ureters, through which pathogenic microorganisms carry out promotion of the affected kidney. But there is another option of developing the disease is active multiplication of mycobacteria in the urine, on the walls of the bladder.
In the initial phase of destruction at the mouth of the ureters arise granulomatous lesions, may cause tubercul (tubercular nodules). Further, the inflammatory process extends to the bladder and around the urethra, there are ulcerative lesions (fistulas, fistulas and other) and swelling that leads to strictures and narrowing of the urinary tract. Tissue of the bladder is largely affected ulcerative lesions and deformed, there are fibrous scars, and the volume of the bladder decreases.
With deep lesions of the muscular tissue is likely a violation of the integrity of the bladder wall, formation of through holes, the spreading of the pathological process in the direction of nearby organs. In severe cases and if neglected the disease occurs the flow of urine from the bladder back into the ureter and kidney (urinary reflux) is a dangerous pathology that reduce renal function and subsequent destruction of the kidneys.
The symptoms and course of tuberculosis of the bladder
The symptoms of the initial phase of the pathology development
At the initial stage of the development of the disease can occur without obvious symptoms or manifestation of some attributes of a General nature. Probable loss of appetite leading to a weight reduction, weakness, fatigue and intense sweating (especially at night). The symptoms of each patient individually and is different, the signs occur together or single, or not expressed at all in the early stages of formation of pathology. In women is often diagnosed tuberculosis of the bladder during the examination of patients with suspected infertility. Consequently, infertility is an indirect sign of the disease.
TB infection in the absence of adequate therapy can provoke serious complications and even death. The consequence of nephrotuberculosis is the occurrence of further frequent infectious-inflammatory processes of the urinary system, poorly amenable to traditional antibiotic therapy. Any disease can be cured easier at an early stage, so detection of even the slightest signs should be cause for medical examination.
The symptoms of progressive tuberculosis infection
With the further development of infection occur pronounced signs of lesions of the organs of the urinary system:
- Disorders of the process of urination (dysuria). Increased frequency to urinate (up to 20 times per day, exceeding the rate of four times), regardless of the time of day. Possible pain in the form of a burning sensation in the urethra and the suprapubic region. In severe cases, manifested by enuresis.
- Blood admixtures in the urine (hematuria). Occurs at the end of the process of urination. If during the procedure of urination is observed blood of impurities, this symptom indicates serious lesions of the bladder and kidney damage.
- Purulent impurities in the urine (pyuria). Laboratory analyses of the urine is determined by high content of leukocytes. Visually it can be noted clouding of urine.
- Pain in the lumbar region. Perhaps the appearance of renal colic.
Methods of diagnosis of tuberculosis of the bladder
The most simple method of identifying the presence of bacilli in the body tuberculin skin test is. However, the Mantoux test indicates the presence of infection and uninformative regarding the differentiation of the type of disease. Laboratory tests of blood and urine with the use of cultural methods of inoculation of bacteria determine the presence and concentration of mycobacteria in the body. Also it is not possible determine which organs are affected and how critical damage. With this purpose, instrumental methods of examination.
The most commonly used for the detection of tuberculosis of the bladder instrumental methods:
- Roentgenography of organs of the retroperitoneal space allows to determine the presence of calcium deposits (calcifications) in the tissues of the renal parenchyma and the walls of majevica and swollen lymph nodes. Enlarged nodes the lymphatic system and the presence of calcifications indicate inflammation. Chest x-ray revealing upon detection of primary foci of tuberculous infection and destruction of its lungs, kidneys and bladder.
- Cystoscopy allows to explore the surface of majevica and the mucous membrane of the ureters, to determine the degree of damage to the external tissues, the presence of the contour deformation. In addition, when cystography fistula visible and it is possible to identify vesicoureteral reflux. If necessary, using the cystoscope to biopsy the tissue of the bladder.
- Computed tomography with the use of contrast enables a clear visualization of the state of organs of the urinary system and identify the smallest structural abnormalities.
- Magnetic resonance imaging is a reliable method to determine the severity and extensiveness of the lesions of tuberculous infection majevica and adjacent organs. This method is indispensable for determining the fistula.
Treatment of tuberculous infection of the bladder
Tuberculosis of the bladder requires a long and laborious therapy. Is inpatient, in a special tuberculosis dispensaries orientation. Traditionally, tuberculosis of the bladder treated by medical therapy, need for surgical intervention depends on the severity of the disease. For the treatment combines several drugs antibacterial action, active against Bacillus. Perhaps the use of drugs anti-inflammatory effect to promote healing of damaged tissues.
The duration of drug therapy of tuberculosis of the bladder is at least 4 months, and in complicated cases the administration of drugs be extended until. Treatment difficult for patients to tolerate, there is the risk of side effects. When kidney damage and the presence of renal insufficiency the dose of drugs reduce reduce toxicity.
Surgical therapy is indicated when significant structural changes of the bladder. Surgical intervention is aimed primarily at restoring the normal volume of the body to normalize its functioning and elimination of urinary disorders. Type applied of reconstructive plastic surgery is determined individually, taking into account patient characteristics and diseases. The most frequently used different types of cystoplasty, intestinal augmentation. These operations give high-quality and long-lasting results.
When tuberculous infections of the body is exhausted, so these patients need high-calorie food. But keep in mind renal damage, with decline of kidney function better to refrain from eating fried, smoked, salty and sour foods, strong drinks and strong tea and coffee. Recommended consumption of white bread, meat, boiled potatoes and cereals, sweet. Useful to drink cranberry juice, have a positive influence on renal function.
Antibacterial therapy prolonged use adversely affects the microflora of the gastrointestinal tract, so it is advisable to use probiotics to recreate the normal microbocenosis. It is useful to introduce in the diet of the patient fermented milk products containing beneficial bacteria.
Prevention of tuberculosis infection and tuberculosis of the bladder is to strengthen the immune system, caution in the contact with tubercular patients, timely vaccinations and annual medical checkup. When working with cattle, among which seen cases of TB must be examined, since bovine mycobacteria survive in the human body. Since tuberculosis of the genitourinary system is a social phenomenon, people leading a normal life, have a lower risk of the disease. You must refrain from excessive Smoking and alcohol, unprotected sex and prolonged stress. Essential for the prevention of tuberculosis has the quality of living conditions (satisfactory nutrition and adequate material and social background).