1例单纯后尿道结核报道并文献复习  

A case of isolated posteriorurethra tuberculosis and literature review

作　　者：张小马[1] 方军[1] 龚强[1] 张勋初[1] 

机构地区：[1]安徽省铜陵市人民医院泌尿外科,安徽铜陵244000

出　　处：《安徽医药》2010年第2期194-195,共2页Anhui Medical and Pharmaceutical Journal

摘　　要：目的提高对单纯后尿道结核的早期不典型泌尿系结核的认识。方法回顾性分析该院2007年收治的1例单纯后尿道结核合并前列腺增生患者的临床资料,结合文献探讨其发病机理、临床特征及诊疗措施。结果入院后泌尿系B超检查示前列腺增生,回声欠佳,膀胱充盈良好,内壁毛糙,三角区可见32 mm×11 mm中等回声灶。血前列腺特异性抗原(PSA)正常。生殖系彩超及静脉尿路造影(IVU)检查未见明显异常。膀胱镜检查示膀胱三角区黏膜充血、水肿,有一陈旧性血凝块约30 mm×10 mm,后尿道精阜后方有一息肉样赘生物约20 mm×15 mm,蒂较宽,灰白色,壁尚光滑,表面无明显溃烂及活动性出血。取活组织病理检查示后尿道结核。经抗结核治疗9个月,随访至今无血尿复发。结论尿常规异常和IVU检查是诊断泌尿系结核的主要线索,对影像学检查未发现明显血尿原因,应警惕泌尿系结核的可能。膀胱镜检查既可直接看到病灶又可取活组织病理检查明确诊断。男性单纯后尿道结核可能与结核菌株特性及患者免疫力有关,另与患者前列腺增生,精阜拉长抬高导致精阜后方尿流动力学改变有关。治疗主要是规则抗结核治疗至少半年并定期随访。Aim To improve the understanding of isolated posteriorurethra tuberculosis of the early atypical urinary tuberculosis. Methods Retrospective study was made of one case of isolated posteriorurethra tuberculosis combined with benign prostatic hyperplasia. The pathogenesis, clinical features, diagnosis and treatment of this disease were reviewed and discussed with relevant literature. Results The prostatic hyperplasia, uneven ultrasonic echo of prostate,well filled bladder having rough interior wall and middling ultrasonic echo of focus （32 mm × 11 mm） in vesical trigonum were revealed by ultrasonography. Prostate - specific antigen of blood was normal. Genital color doppler ultrasonography and intravenous urography examination were not abnormal. Cystoscopy revealed vesical trigonum mucosa which a stale gore（30 mm × 10 mm） was situated in was inflammatory hyperemia and edema and a neoplasm（20 mm × 15 mm） was situated in posteriorurethra of the back of verumotanum, offwhite and had a wide pedicel, smooth wall which the surface of was not cankered and bleeding. Histopathological examination confirmed tuberculous granuloma of the urethra. Follow - up of 9 months showed no recurrence of hematuria by anti-tuberculous treatment. Conclusion Abnormal urine routine and intravenous urography examination were the main clue for diagnosing as urinary tuberculosis. It was possible to doubt urinary tuberculosis that no evident reasons of hematuria were found on imaging examination. Cystoscopy can direct find local lesion also bite diseased tissue for precisely diagnosis by biopsy. Isolated male posteriorurethra tuberculosis may be relation with the speciality of tubercle bacillus and the immune state of patient, else with prostatic hyperplasia complicated by changes of urinary flow dynamics. Treatment consisted of at least a half- year course of regulation anti - tuberculous drugs and periodic follow-up.

关 键 词：尿道结核 诊断 治疗 

分 类 号：R527[医药卫生—内科学]