Ureteral tuberculosis

　　Ureteral tuberculosis is secondary to renal tuberculosis. Mycobacterium tuberculosis first invades the mucosa of the ureter, develops to the submucosa and muscular layer, and finally leads to fibrosis, causing ureteral stricture, hardening, thickening, and rigidity, even complete obstruction.

　　Urogenital tuberculosis infection occurs first in the kidneys, and the lesions are mainly in the renal medulla and renal papilla, showing progressive development, causing tissue destruction, and forming cavities. The cavities then become larger and communicate with the renal pelvis. Mycobacterium tuberculosis and its tuberculous substances are excreted into the bladder with urine, and the bacteria descend to the ureter, causing tuberculous lesions. Ureteral stricture is most common in the bladder wall segment of the ureterovesical junction, followed by the renal pelvis ureteral junction, and can also occur in other parts, showing segmental stricture.

　　In addition to general symptoms, ureteral tuberculosis can also cause other diseases. The main complications of this disease are upper urinary tract obstruction and renal积水, leading to renal failure in the late stage. Therefore, once detected, active treatment is needed, and preventive measures should also be taken in daily life.

　　Patients with ureteral tuberculosis often have a history of pulmonary tuberculosis or renal tuberculosis. In the early stage, there are symptoms such as frequent urination, urgency, dysuria, and hematuria. In the late stage, ureteral obstruction can cause back pain, even skin sinus tracts, accompanied by low fever, fatigue, and other consumptive symptoms. When there is severe renal积水, the enlarged kidneys can be palpated, and there is tenderness in the renal area.

　　The fundamental measure to prevent urogenital tuberculosis is to prevent pulmonary tuberculosis. Due to the progress of molecular biology in recent years, the Centers for Disease Control and Prevention in the United States (1989) proposed a strategic plan to eliminate tuberculosis within 20 years. Humans may use new preventive, diagnostic, and therapeutic methods to eliminate tuberculosis. Antituberculosis chemotherapy plays a decisive role in controlling tuberculosis. Rational chemotherapy can eliminate bacteria within the focus, ultimately leading to recovery.

　　The various examinations for ureteral tuberculosis are as follows:

　　1. Cystoscopy

　　The examination can show congestion of the bladder mucosa or tuberculous nodules, which are more obvious around the ureteral orifice.

　　2. Intra-venous Urography (IVU)

　　Early ureteral tuberculosis is mainly manifested as ureteral dilatation, uneven thickness, irregular edges, loss of natural shape, sometimes showing bead-like appearance. In the late stage, it presents as contraction and rigidity, with possible fibrous calcification. Severe ureteral stenosis can cause the kidney and ureter on the affected side to be unshadowed, and retrograde contrast can display the condition of ureteral lesions.

　　3. CT Examination

　　Only through large-area continuous scanning can the narrowing in the middle and distal parts of the ureter be displayed. Otherwise, only the dilatation of the pelvis and ureter can be displayed. For the narrowing of the proximal ureter, CT can often display the thickening of the ureteral wall and the narrowing of the lumen at the same time as showing renal tuberculosis. CT can also display the calcification of the ureteral wall and differentiate it from ureteral calculi.

　　4. MRI Examination

　　MRI can well display the dilated ureter and the stenotic part of the ureter, and can partially replace the traditional IVU. In terms of renal tuberculosis, MRI has no obvious advantages over CT.

　　The symptoms of ureteral tuberculosis patients are different, and their dietary requirements are also different. Please consult a doctor for specific dietary standards according to specific diseases. The diet of patients should be light, easy to digest, with a high intake of vegetables and fruits, and a reasonable diet arrangement. Pay attention to adequate nutrition. In addition, patients should also pay attention to avoid spicy, greasy, and cold foods.

　　The treatment of ureteral tuberculosis first uses antituberculosis drugs, and the surgical treatment method depends on the location, length, and renal function of the ureteral lesion. Adhering to combined drug use and sufficient long-term treatment is the key to thorough treatment.

　　Antituberculosis drug treatment is the main measure, and the specific method is the same as that for renal tuberculosis drug treatment.

　　Antituberculosis drugs should be used before and after surgery for surgical treatment, the principle is the same as that for renal tuberculosis, and the specific surgical method is as follows:

　　1. Excision of the lesion segment, ureterovesical or ureterovesical anastomosis.

　　2. In patients with long-segment ureteral stenosis and good renal function, a total ureterectomy plus ileal ureterostomy can be performed.

　　3. In patients with long-segment ureteral stenosis, if the renal function is poor or has been auto-amputated, a total nephroureterectomy should be performed.