TB bacteria enter the body through the airways and penetrate into the lungs and, in most cases, there are. But sometimes they can get into the lymph nodes and venous blood, and then - spread to other organs. Tuberculosis of the bladder is rare and is not an independent disease - he begins to develop in the kidneys, and then spreads to the genitourinary system, including on the bladder.

This kind of TB developed in about half of patients suffering from renal tuberculosis. In patients with a weakened immune system, genitourinary tuberculosis can lead to kidney damage, and a number of other complications. For example, patients with this type of TB hypertension occurs twice as often as the average.

Tuberculosis of the bladder usually begins with inflammation in the mouth of the ureter, urinary channel narrowing, and development of vesicoureteral reflux - disorder in which urine from the bladder flows back into the ureters. In severe cases, TB affects the entire bladder wall where the deeper layers of muscle tissue is gradually replaced by fibrous tissue. Tubercles (nodules that can form in the tissues affected by TB bacteria) in the urinary bladder are rare; more often they appear in the mouth of the ureter. Upon detection of isolated tubercles at a considerable distance from the mouth of the ureter doctor may prescribe screening for malignant diseases as tuberculosis of the urogenital system such tumors are rare.

It is estimated that tuberculosis Tuberculosis - a full recovery is not guaranteed   urogenital system accounts for 6% of all cases of extrapulmonary tuberculosis Extrapulmonary tuberculosis - many forms ; in developing countries the figure reaches 15-20%. In addition, extensive research conducted in the second half of the twentieth century, have identified a variety of prostatic lesions in 10-12% of men who died from tuberculosis. However, autopsy results have not always been enough to determine whether changes in prostate tissues have been associated with tuberculosis.

Before the advent of anti-TB treatment, most patients with urogenital tuberculosis belonged to the age group of 16 to 40 years; in the early 20th century, doctors described the disease as "a disease of young adults." Today, more than 70% of patients with the condition are over 35 years old, 15-20% - over 65 years.

Causes

In most cases, tuberculosis urinary organs is caused by tuberculosis bacteria (Mycobacterium tuberculosis). These bacteria proliferate slowly fall once in 24 hours, and can survive in immune cells after phagocytosis. Much more rare tuberculosis pathogens kidneys and bladder may be bacteria such as M kansasii, M fortuitum, M bovis, M avium-intracellulare, M xenopi, M celatum. Men, like women, the development of varieties of tuberculosis usually occurs after infection with TB bacteria through airborne droplets. The probability of infection through sexual contact is very small, but there are cases where tuberculosis infecting mochevopolovuyu system transmitted through homosexual sex among men. Previously it was assumed that genitourinary tuberculosis can be transmitted through urine, but studies confirm it failed.

HIV infection, prolonged use of steroids or immunosuppressive drugs increases the likelihood of contracting tuberculosis as the urinary organs, and the reactivation of previously cured of tuberculosis.

Symptoms of tuberculosis of the bladder

Patients with this disease are rarely seen classic symptoms of tuberculosis; Tuberculosis is often asymptomatic urinary system.

The most common symptoms of TB of the genitourinary system: an unusually frequent urination (first - in the afternoon, in the late stages of the disease - at night), dysuria, pain during urination, blood or pus in the urine, fever. Tuberculosis of the genitourinary system often leads to frequent infections of urinary tract, which are difficult to treat with antibiotics. Men with this disease often complain of swelling and pain in the testicles. Infertility in men and women, in some cases also a sign of tuberculosis of the urinary system.

Diagnostics

Because the symptoms of TB Symptoms of TB - how to recognize the disease   genitourinary system are often poorly expressed, for extended periods of time can ignore both patients and doctors. In the differential diagnosis is necessary to exclude violations such as renal cell carcinoma Carcinoma - how to prevent disaster? , Epididymitis, hydrocele, spermatoceles, testicular tumors, pelvic inflammatory disease, benign prostatic hyperplasia, urethritis.

In 90% of patients with tuberculosis of the urinary system has a positive Mantoux test, but it only indicates that the human body has the TB bacteria, but does not establish what kind of TB ill patients. To diagnose tuberculosis of the bladder, is also required to conduct a general analysis of blood, urine, sputum analysis secretion of gamma interferon.

It is also used X-ray, computed tomography or magnetic resonance imaging, and in some cases carried ultrasound. If you suspect a malignancy may require biopsy.

Treatment

In tuberculosis of the urinary system is usually an effective course of treatment shorter than in pulmonary tuberculosis - is associated with a lower bacterial load. Standard treatment of pulmonary tuberculosis lasts six months, with genitourinary tuberculosis - four months. HIV-positive patients may be advised to take medication for nine months.

Used in the treatment of isoniazid, rifampicin, ethambutol, pyrazinamide, streptomycin. Severe cases may also be assigned high doses of prednisone for several weeks. If TB leads to serious disturbances in the urogenital system, you may need surgery.

Direct inguinal hernia usually is acquired, and is a consequence of the imperfection of the connective tissue of the inguinal ring or significant physical activity. Treatment of direct inguinal hernia surgery, no conservative methods to get rid of the direct inguinal hernia can not.

What is the direct inguinal hernia

Inguinal hernia - a protrusion of any organ in the abdomen, pelvis, or part of it through the various openings of the inguinal canal under the skin, in the intermuscular space or any space.

Inguinal channel - this anatomical formation that starts inside the abdominal cavity, the inner surface of the abdominal wall, and falls down inside and opens slightly above the scrotum in males and above the labia majora in women. The walls of the inguinal canal formed by muscles and ligaments between which men pass the spermatic cord, and the women - round ligament of the uterus.

Inguinal hernia can be oblique or direct. Oblique inguinal hernias are congenital and acquired, they develop during the passage of the internal organs through the spermatic cord. The spermatic cord is a complex of vas deferens, blood and lymph vessels, surrounded by a single membrane.

There are also combined inguinal hernias - a combination of two or three separate hernia sac on one side, not communicating with each other and represents a straight, oblique hernia, or a combination thereof.

Direct hernia can be vpravimymi (patient can straighten them yourself) and nevpravimymi when this is not possible because of adhesions separated viscera from hernia sac.

Direct inguinal hernia - Causes of

Direct inguinal hernias are only acquired. They appear, usually with a combination of two factors: the inherent characteristics of the connective tissue, which leads to relaxation and an increase in the amount of the inguinal ring, and high physical activity (most weight lifting), accompanied by a sharp increase in intra-abdominal pressure.

During exercise in the inguinal canal fall into the abdominal organs or pelvic covered with a thin serous membrane - peritoneum. Direct inguinal hernia in men is accompanied by a hit in the hernial sac bowel loops, omentum, and sometimes the bladder Urinary bladder - structure and function .

Initially, the hernia occurs only during exercise, and then reduce a self, but eventually it can be to reduce a stop due to the presence of adhesions in the hernial sac.

Signs direct inguinal hernia

It starts right inguinal hernia with the fact that the patient finds himself in a tight groin oblong protrusion. In the initial stage, it appears only on exertion and fades independently. Then diverticulum becomes a permanent standing and sitting and disappear when lying down. But even with the disappearance of the outer protrusion in this place can be felt a little tight cord, which indicates the presence of a hernia.

Pain may occur when the power, and may be permanent aching in nature. Appearing in the groin and abdomen, they are distributed on the lower back and sacrum, sometimes give the inner surface of the thigh. Direct inguinal hernia in men Inguinal hernia in men - at any age   often accompanied by digestive disorders such as constipation, flatulence, nausea, sometimes - vomiting.

In some cases, the hernia sac enter the bladder, uterus ovaries. This leads to a violation of urination and menstruation. Such women have painful periods.

Sometimes inguinal ring is compressed and pinched blood vessels, causing sudden severe pain caused by blood circulation. This is called a strangulated hernia. Danger prejudice that poor circulation in tissue necrosis can occur and spread of infection to the entire abdominal cavity (peritonitis). Infringement may occur in the background, even a short-term increase in abdominal pressure, such as coughing or sneezing background.

Direct inguinal hernia - Treatment

For direct inguinal hernia patient required surgery. At the same time, the sooner it is done, the more effective treatment and less risk of disease recurrence.

The operation is to remove the hernia sac and the strengthening of the inguinal canal in the region by the closure of the hernial ring, plastic local tissues or sew a mesh graft, made of polypropylene. The operation can be carried out by laparotomy (incision with conventional fabrics) or laparoscopic (by puncture of the skin in several places and introducing endoscopic instruments) access. Each of these methods has its advantages and disadvantages. But recently, surgeons are inclined to believe that the traditional laparotomy access is preferable as it causes fewer complications and recurrences.

Direct inguinal hernia requires timely detection and surgical treatment.

Galina Romanenko