肾结核延迟诊断12例分析

目的探讨肾结核延迟诊断的原因和早期诊断方法。方法回顾分析12例肾结核病史特点及治疗过程。结果12例患者患肾切除，病理报告提示肾结核，早期延迟诊断。结论早期诊断有利于挽救患者的肾脏和避免手术治疗。延迟诊断的原因：（1）满足于膀胱炎或肾盂肾炎的诊断，长期使用一般抗感染药物治疗，未认真地进一步追查膀胱炎的原因或肾盂肾炎的鉴别诊断。（2）发现膀胱结核，而忽视肾结核的病变。（3）发现男性生殖系结核，而忽视生殖系结核与肾结核的密切关系。（4）明确泌尿生殖系疾病的诊断而忽视肾结核同时存在的可能性。（5）实验室不准确的抗酸杆菌报告。     

附睾结核的诊治分析(附31例报告)

目的:探讨附睾结核的特殊临床表现及诊治方法。方法:对本组31例附睾结核患者长期随诊,每次均常规行附睾睾丸体格检查、双肾及阴囊彩超检查,尿及精液查抗酸杆菌,合并阴囊破溃者行分泌物涂片查抗酸杆菌并取破溃的组织进行病理检查,双肾彩超如提示肾结核可能的患者均行泌尿系CT检查。所有患者均予药物抗结核治疗。结果:20例药物治疗者均治愈;11例术前考虑附睾结核的均得到术后的病理证实,其中4例术后随诊期间结核复发,继续予以抗结核药物治疗后治愈。阴囊破溃流脓者经抗结核后自行闭合痊愈。结论:附睾结核通过药物抗结核治疗可痊愈,部分脓肿在抗结核的同时行手术引流,破溃的窦道在抗结核治疗后可达到临床治愈。     

单纯性附睾结核的诊治分析

目的:提高对单纯性附睾结核的诊治水平。方法:在35例附睾结核患者中通过尿路影像学检查无肾结核及尿抗酸杆菌检测阴性者,定义为单纯性附睾结核20例进行回顾性分析,均行强化抗结核治疗,即异烟肼(INH)、利福平(RFP)、链霉素(SM)或乙胺丁醇(EB)联合用药,2周后行病灶切除术,术中均行附睾结核病灶清除,术后继续常规抗结核治疗6～9个月。结果:随访6个月～5年,16例无异常情况,3例分别于术后3、3.5、5年出现泌尿系结核感染,1例于术后3.5年出现对侧附睾结核。结论:单纯性附睾结核可能为唯一或早期泌尿生殖系结核首发的表现,及时手术治疗,预后较好。     

西藏地区44例男性附睾结核回顾性分析

目的:总结西藏地区附睾结核的发病情况及临床诊治过程,以提高附睾结核的诊治能力。方法:回顾性分析2014年10月～2019年10月西藏自治区人民医院收治44例附睾患者的临床资料。结果:附睾结核住院患者占同期住院人数的1.3%,均为藏族,发病年龄高峰为40～60岁。临床体征主要为阴囊疼痛伴触痛(65.9%)、无痛性阴囊肿大(34.1%)、串珠样输精管(22.7%)及阴囊窦道(15.9%)。17例(38.6%)患者有肺结核史;35例病理检查确诊结核病,12例睾丸受累;7例行脓液涂片抗酸杆菌镜检,阳性率57.1%;4例行脓液结核分枝杆菌和利福平耐药基因(GeneXpert MTB/RIF)检测,阳性率100%。单纯抗结核药物治疗9例,35例在抗结核药物治疗同时给予手术干预。所有患者出院后随访4周～2年,非手术患者药物治疗效果良好;手术患者无复发。阴囊结核无复发。结论:本地区附睾结核患者仍以中老年患者为主,大多数患者缺乏特异性临床表现而易早期误诊,延误治疗。使用抗结核药物联合手术是附睾结核的有效治疗方法。     

睾丸结核11例临床分析

目的：分析睾丸结核误诊误治的相关因素,探讨临床睾丸结核诊断及治疗方法。方法：回顾性分析2008～2011年收治11例睾丸结核患者的临床资料。结果：睾丸结核患者病史3～18个月。11例睾丸结核中合并附睾结核10例,合并肺结核6例。5例曾被误诊为附睾睾丸炎。误诊主要原因是早期临床表现不典型,缺乏影像学检查。11例中,7例通过术后病理检查结果确诊,4例经睾丸穿刺活检确诊。误诊时间平均4个月。3例经6个月抗结核治疗后痊愈,8例经抗结核及手术治疗后痊愈,随访6个月未见复发。结论：睾丸结核临床少见,漏误诊率较高。B超、CT、MRI和睾丸穿刺细胞学检查有助于睾丸结核诊断。对于局部于酪样坏死严重,病变较大且有脓肿形成或抗结核治疗效果不明显的患者可以考虑手术治疗。     

老年男性睾丸及附睾肿块27例报告(附文献复习)

目的提高老年男性睾丸及附睾肿块的诊治水平。方法对27例老年男性睾丸及附睾肿块临床资料进行分析。结果经手术和病理诊断,结核及炎症21例,睾丸肿瘤4例,附睾肿瘤2例。5例恶性肿瘤术后接受综合治疗(化疗、放疗)。术后随访7个月～3年,22例良性病变者预后好:恶性肿瘤患者1例死于术后8个月,余4例经综合治疗已无瘤生存13～20个月。结论老年患者睾丸及附睾肿物中附睾结核常见。术前彩色B超、CT有助于明确诊断。对恶性肿瘤患者应尽早根治性切除术,并积极采取术后综合治疗。     

原发性附睾肿瘤

目的提高对原发性附睾肿瘤的诊治水平。方法报告原发性附睾肿瘤２３例,良性２２例（９５．７％）,其中附睾腺样瘤１４例,平滑肌瘤６例,附睾多发纤维假瘤１例,硬化性血管瘤１例。恶性１例,为附睾腺癌。良性肿瘤作单纯肿瘤或患侧附睾切除。结果预后良好,１９例获随访,术后无复发。恶性肿瘤预后差,处理方法与睾丸恶性肿瘤相同。附睾肿瘤极易误诊为附睾结核、慢性附睾炎、精液囊肿等。结论良性肿瘤除具有一定良性表现特征外,采用Ｂ超及针吸细胞学检查,有助于术前对该病的诊断。恶性肿瘤生长迅速,往往侵及睾丸精索。     

肾结核540例诊治分析

目的 提高临床肾结核的诊断及治疗水平.方法 总结1980年至2005年540例肾结核患者的临床资料.男 303例,女237例.发病年龄10～69岁,其中20～40岁364例(67.4%).病程6周～18年.主要症状为尿频、尿急、尿痛、脓尿和血尿,男性患者中症状不典型12例.尿抗酸杆菌检查276例、尿TB-PCR检查56例、IVU检查384例、B超检查379例、CT检查389例、膀胱镜检查158例.结核发生于左肾251例,右肾262例,双肾结核27例.合并男生殖系结核132例,继发男性结核性尿道狭窄18例,女性同时有结核性膀胱阴道瘘11例.一侧肾结核并发对侧肾积水74例.长程药物治疗84例,包括一侧肾结核57例和双肾结核27例;短程药物治疗后行患侧肾及部分输尿管切除456例,就诊时一侧肾结核对侧肾积水伴肾功能不全44例先行积水侧肾造瘘,肾功能改善后行结核肾切除,患侧肾切除术后发生肾功能不全4例,二次手术行肾造瘘.11例行狭窄段输尿管切除后膀胱再植术,挛缩性小膀胱致肾积水38例中行回肠膀胱扩大术27例、乙状结肠膀胱扩大术9例、膀胱再生术2例.其中7例患者拒绝再次手术,长期留置肾造瘘管.结果 尿抗酸杆菌阳性24.6%(68/276)、尿TB-PCR阳性57.1%(32/56);IVU诊断肾结核141例(36.7%)、患侧肾脏未显影227例(59.1%)、显示肾自截16例(4.2%);B超诊断肾结核156例(41.2%)、肾积水166例(43.8%)、多囊肾或肾囊肿21例(5.5%)、肾脏无明显异常36例(9.5%);CT诊断肾结核344例(88.4%).随访6个月～25年.药物治疗组12例一侧肾结核患者(19.1%)在6～12个月后无效或恶化,改行患肾切除,其余45例药物治疗后18～24个月尿液检查正常,IVU显示病灶稳定或消失.双肾结核患者27例死于肾功能衰竭4例,12例改行一侧肾切除(其中5例加行对侧肾部分切除),余11例随访结核病灶稳定或缩小,肾功能正常.结论 临床肾结核的发生率无明显下降,而肾结核的并发症明显降低,非手术治愈率显著增加.尿TB-PCR和IVU为早期肾结核的诊断方法.     

附睾结核的MRI 诊断价值

目的 分析附睾结核的MRI 表现,总结其MRI 的诊断要点.方法 对8 例经病理确诊为附睾结核的MRI 进行回顾性分析,重点分析其部位、形态、MRI 信号、强化方式及泌尿生殖系其他部位的情况.结果 8 例患者中2 例为局限于附睾附睾头的单发实性圆形小结节灶,6 例累及整个附睾弥漫性或多发形态不规则结节灶;4 例为实性病灶,2 例为囊实性病灶;8 例病灶实性部分T1WI 均呈等信号,T2WI 均呈低信号,囊性部分T1WI 呈低信号,T2WI 呈高信号.增强扫描8 例病灶中T2WI 呈低信号实性部分均明显强化.8 例患者中伴有泌尿系、睾丸、前列腺、精囊腺、肺结核分别为4 例、4 例、2 例、1 例及1 例.结论 附睾结核常伴发其他泌尿生殖系结核,典型的附睾结核多累及整个附睾,表现为在T2WI 呈低信号的实性病灶,且增强扫描明显强化,此MRI 特异性表现可以对附睾结核进行准确定位和早期诊断.     

西藏地区泌尿生殖系结核临床资料分析（附179例报告）

目的探讨西藏地区泌尿、生殖系（男性）结核的临床表现特点和诊治经验。方法回顾性分析从2000年～2008年西藏自治区人民医院收治的179例泌尿、生殖系结核患者的临床资料。结果本组179例患者中因结核脓肾、肾自截、附睾睾丸结核皮肤破溃行手术＋抗痨治疗者102例（56.8%）,因肝功、肾功不全放弃治疗者24例（13.5%）,其余患者行抗痨治疗（29.7%）。本组接受治疗的155例患者中随访到128例,失访率17.4%。随访时间6个月～7年,平均随访时间3.4年。其中单纯抗结核药物治疗者42例（79.2%）,行手术＋抗结核药物治疗者86例（67.2%）。结论西藏地区结核病患者就诊时多数病情已较为严重,手术切除器官的比例高,部分患者因结核引起肾功能不全。     

男性不育症患者精浆锌与血清生殖激素测定及意义

目的评价精浆锌及血清生殖激素水平测定在不育症诊断及判定睾丸功能损害程度的意义。方法对200例男性不育症患者进行了精浆锌、血清生殖激素(FSH、LH、T、PRL)检测,并结合精液常规检查、睾丸容积测定以及睾丸病理活检进行分析。结果不育症患者精浆锌含量下降、血清生殖激素异常与睾丸间质细胞功能受损、生精上皮不同程度的破坏有明显的关系。结论精浆锌及血清生殖激素的检测,对判定男性不育症患者睾丸损害程度及鉴别睾丸原发性与梗阻性无精子症具有重要的作用。     

Assessment of Chlamydia trachomatis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, and Mycoplasma genitalium in semen and first void urine specimens of asymptomatic male partners of infertile couples

The purpose of this study was threefold: to compare semen and first void urine (FVU) specimens from asymptomatic infertile men for the detection of Chlamydia trachomatis, genital ureaplasma, and genital mycoplasma infections using in-house inhibitor-controlled polymerase chain reaction (PCR)-microtiter plate hybridization assay; to determine the prevalence of those organisms in infertile men in Tunisia; and to study the relationship between these bacteria and male infertility. Paired urine and semen specimens from 104 patients were examined by in-house PCR for the presence of DNA of Chlamydia trachomatis, genital ureaplasmas (Ureaplasma urealyticum and Ureaplasma parvum) and genital mycoplasmas (Mycoplasma hominis and Mycoplasma genitalium). Semen analysis was assessed according to the guidelines of the World Health Organization. Nominal scale variables, the Mann-Whitney test, and the Kruskal-Wallis nonparametric analysis of variance test were used for statistical analysis. There was a very high concordance (>95%) and a very good agreement (kappa > 0.9) between the detection of Chlamydia trachomatis, genital ureaplasmas, and Mycoplasma hominis in semen and corresponding FVU specimens. Our findings also show a high concordance (81.1%) and a good agreement (kappa = 0.79) between the detection of Mycoplasma genitalium in both specimens. C trachomatis, genital mycoplasmas, and genital ureaplasmas were found to be widespread among infertile male patients in Tunisia, as shown by their respective prevalences of 43.3%, 18.3%, and 14.4%. The mean values of seminal volume, sperm concentration, sperm viability, sperm motility, sperm morphology, and leukocyte count were not significantly related either to the detection of C trachomatis DNA or to that of genital ureaplasma or mycoplasma DNA in semen specimens. Using our in-house PCR, both semen and FVU were found to be sensitive diagnostic specimens for the detection of C trachomatis, ureaplasmas, and mycoplasmas. The FVU, a less invasive and self-collected specimen, can serve as a marker for the presence of these organisms in the genital tract and can be used as a reliable way of detecting asymptomatic carriers of infection.     

泌尿生殖系罕见病3例报告并文献复习

目的：探讨泌尿男生殖系罕见病的诊断与治疗方法。方法：回顾性分析3例精阜纤维上皮性息肉、先天性膀胱颈挛缩以及阴囊皮样囊肿患者的临床资料，术前采用排尿性膀胱尿道造影、膀胱尿道镜、尿动力学检查诊断；手术采用经尿道电切、钦激光内切开以及开放手术。结果：3例患者均于术前获得正确诊断，经手术治疗均得到满意疗效。结论：提高泌尿外科医生对罕见病的诊断及治疗水平十分重要。     

Urogenital Tuberculosis: Classification,Diagnosis, and Treatment

Urogenital tuberculosis (TB) is one of the most common forms of extrapulmonary TB. There are many controversies concerning the epidemiology, definition, classification, treatment, and management of patients with urogenital TB, which includes kidney TB, urinary tract TB that is a complication of kidney TB, and genital TB, both male and female. In this paper, we discuss the risk factors and a detailed classification for urogenital TB and the clinical features of each form of the disease. Special attention is paid to urogenital TB induced by bacillus Calmette-Guérin. Modern approaches to the diagnostic work-up and chemotherapy of urogenital TB are described.Patient summaryUrogenital tuberculosis (TB) seems to be a rare disease, but it is mostly overlooked. Urogenital TB is contagious and is a cause of infertility. Modern techniques allow diagnosis of this infection in time, and optimal management may save organs.     

Do Ureaplasma urealyticum infections in the genital tract affect semen quality？

Aim:To investigate the relationship between Ureaplasma urealyticum(UU)infection and semen quality.Methods:From 2001 to 2003,346 eligible patients aged 20-45 years were invited from two hospitals in Shanghai,China,toparticipate in an investigation which included questionnaires about general and reproductive health,an external genitaltract examination,UU culture and semen analysis.Multiple linear regression models were used to examine whetherUU had a significant effect on semen quality after adjustment for confounding factors.Results:Findings suggestedthat UU infection was associated with higher semen viscosity and lower semen pH value.Sperm concentration waslower in UU positive subjects than that in UU negative subjects(54.04×10~6/mL vs.70.58×10~6/mL).However,UUdid not significantly affect other semen quality indexes.Conclusion:UU infection of the male genital tract couldnegatively influence semen quality.(Asian J Androl 2006 Sep,8:562-568)     

Contribution of investigations to the diagnosis of bilateral vas aplasia

BACKGROUND: Bilaterally absent vas deferens is a surgically uncorrectable cause of male infertility. It is usually diagnosed clinically. We evaluate the role of semen analysis and radiological imaging in providing objective evidence of vas aplasia. METHODS: Twenty consecutive patients with clinically suspected bilateral vas aplasia were enrolled for this prospective study. They were investigated on the basis of an algorithm till corroborative evidence for vas aplasia was obtained. This successively included a semen analysis on at least two occasions, transrectal ultrasonogram (TRUS), pelvic magnetic resonance imaging (MRI) and scrotal exploration. The contribution of each investigation to confirming the diagnosis was evaluated. RESULTS: Seventeen patients (85%) had a low volume ejaculate while all 20 had azoospermia and semen fructose levels below normal. Semen pH was non-acidic in 75% of cases and thus was not contributory to the diagnosis. TRUS and MRI were non-contributory in 30% and 50% of evaluations, respectively. The clinical diagnosis was found to be correct in all patients. CONCLUSIONS: Vas aplasia is a clinical diagnosis. Low volume ejaculate with azoospermia and low or absent semen fructose is sufficient corroborative evidence and no further investigations are required for this diagnosis.     

男性生殖系统肉瘤8例诊治报告并文献复习

目的分析男性生殖系统肉瘤的临床特点,提高其诊治水平。方法对武汉协和医院2016-2019年收治的8例男性生殖系统肉瘤患者的病史、临床表现、影像学资料、病理诊断和随访结果进行回顾性分析,并复习近年国内外相关文献。结果8例患者均行扩大切除术,术后病理结果为:横纹肌肉瘤3例(其中会阴部泡状横纹肌肉瘤、睾丸附睾横纹肌肉瘤及阴囊胚胎性横纹肌肉瘤各1例)、阴囊高分化脂肪肉瘤2例、阴囊上皮样肉瘤1例、阴囊中度恶性黏液纤维肉瘤1例、阴茎包皮系带多形性皮肤肉瘤1例。随访时间13~47个月,1例出现全身多发转移,于术后1年死亡,1例失访,其余6例随访期内未见复发。结论男性生殖系统肉瘤极为罕见,有局部复发倾向,远处转移少见,主要采取以手术切除为基础的综合治疗手段。     

Coccidioidomycosis of the male genital tract

PURPOSE: Symptomatic genital tract infection is a rare manifestation of disseminated coccidioidomycosis. We characterized the clinical presentation, diagnosis, management and outcome in male patients with genitourinary coccidioidomycosis. MATERIALS AND METHODS: We reviewed all cases of genital tract coccidioidomycosis involving testes, epididymis or prostate at our institution between 1990 and 2000, and searched the medical literature for all reports since the first reported case in 1943. RESULTS: A total of 30 male patients with a median age of 58 years who had coccidioidomycosis of the genital tract were identified, including 6 at our institution. Four patients (13%) had a simultaneous pulmonary infection and 63% (19) had a remote history of primary pulmonary coccidioidomycosis. The most commonly involved genital tract sites were the epididymis in 18 cases, prostate in 14 and testes in 6. Patients with prostatitis presented with urinary obstruction, prostatic enlargement, tenderness and palpable nodules. Most patients with epididymal infection presented with scrotal swelling, tenderness and induration. All 30 patients (100%) had histopathological evidence of granulomatous inflammation with fungal spherules. Urine fungal cultures were positive in 19 cases (63%). A total of 12 patients received combined medical and surgical treatment, and 18 underwent surgical excision only. Most immunocompetent patients with isolated genital coccidioidomycosis did well with surgical resection alone. Six deaths occurred in patients with multifocal, extragenital, disseminated disease. CONCLUSIONS: Male genitourinary coccidioidomycosis is rare but it should be considered in the differential diagnosis of patients with exposure to the endemic area who present with prostatitis or epididymitis.     

Infection and pyospermia in male infertility

Summary Infections of the male genitourinary tract may contribute to infertility by adversely affecting sperm function, causing anatomical obstruction or initiating a leukocyte response. The majority of infertile males are asymptomatic, and the significance and the criteria for the diagnosis of a genital tract infection are controversial. The evaluation for a genital tract infection focuses on urine and semen cultures as well as on the accurate quantitation of seminal leukocytes. An elevated seminal leukocyte count, pyospermia, can be associated with male infertility and may reflect an infectious or inflammatory disorder. In addition, the role of specific genital tract infections such as chlamydiosis, gonorrhea, ureaplasma and trichomoniasis and their possible association with male infertility is addressed.