阴茎结核

　　阴茎结核主要通过阴茎与结核分枝杆菌直接接触感染，少数为血行感染，严重的尿道结核也可波及阴茎。

　　主要通过阴茎与结核杆菌直接接触发生感染。Lewis（1946）统计的65％的原发阴茎结核皆因宗教割礼包皮环切时，用口吸吮阴茎止血所引起，这种方法已弃用。阴茎头与有病变的子宫颈接触，亦可引起阴茎结核。血行感染则可直接侵犯阴茎海绵体，引起结核性海绵体炎。另一种传染方式为严重的尿道结核发展成尿道周围炎，最后侵及阴茎海绵体及阴茎头。直接接触感染病变多发生在阴茎头、阴茎系带或外尿道口，最初为结核结节，以后成为溃疡，溃疡境界清楚，周边硬，基底部有干酪样坏死或肉芽组织。溃疡逐渐扩大可侵及阴茎头全部，腹股沟淋巴结亦常有继发结核性感染。海绵体结核多表现为结节性增生，纤维组织可使阴茎变形弯曲，有时可形成瘘管。

　　阴茎海绵体受累时，阴茎勃起弯曲和疼痛，有时可形成瘘管。结核杆菌可以经尿道上行性感染影响膀胱、输尿管、肾脏，导致膀胱结核、输尿管结核、肾结核，可以出现血尿、脓性尿以及尿频等改变，同时可并发输尿管堵塞（称作肾自截）、膀胱挛缩，使膀胱容积减小，并发严重的尿频。

　　临床表现有继发于泌尿生殖系结核的尿频、血尿病史。病变开始于阴茎头、系带、冠状沟等处。初期为绿豆大小的硬结，周围肿胀变硬，无疼痛，逐渐形成溃疡，形状不规则，边缘呈潜入性，溃疡表面有脓苔，不易剥除，无触痛。血沉快。华康氏反应阴性。

　　预防泌尿生殖系结核的根本措施是预防肺结核，由于近年来分子生物学的进展，人类可能运用新的预防、诊断及治疗方法来消灭结核病。

　　1. Eradicate the source of infection:Establish a tuberculosis monitoring network, discover patients in a timely manner, and treat them thoroughly to quickly control the source of infection. Effective chemotherapy can reduce the infectivity of patients to almost disappear within two weeks, although it takes several months to make the sputum bacilli negative.

　　2. Protect susceptible populations:Vaccination with BCG vaccine is the most effective way to prevent tuberculosis. It is vaccinated at birth and supplemented every 5 years until the age of 15. There are two methods of vaccination with BCG vaccine: scarification method and intradermal injection method. For those who are positive for the tuberculin test in adolescents, INH chemical prophylaxis can be adopted, 300mg per day, lasting for half a year to one year.

　　3. Cut off the transmission route:Patients in the active stage should wear masks, not spit on the ground, prevent laughing and emotional exuberant speaking: keep the room ventilated, air clean, and ultraviolet ray disinfection are all effective means to cut off the transmission route.

　　When diagnosing penile tuberculosis, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. There are no special related examinations for penile tuberculosis. Direct smearing of ulcer secretions or tuberculosis culture can find tuberculosis bacilli, or perform local biopsy, and pathological examination can make a diagnosis.

　　What kind of diet should penile tuberculosis patients have? Good dietary methods can help patients with treatment and recovery. The following diets can be useful for regulating and supplementing the nutrients lacking in the patient's body.

　　1. Anti-infection foods should be added to the diet, such as walnuts, loofah, black bean paste, olives, almonds, loofah, crucian carp, and others.

　　2. To enhance the immune function, you can choose turtle, shrimp, sandworm, crucian carp, sandfish, and others.

　　3. Select ant-ulcer foods according to symptoms, such as shepherd's purse, screw, jujube, seagull fish, rapeseed, taro, mung bean, adzuki bean, wheat flour, malan head, eel, and crucian carp.

　　The common western medical treatments for penile tuberculosis are as follows:

　　1. Look for other tuberculosis foci in the body, and first deal with renal tuberculosis, prostate tuberculosis, and epididymis tuberculosis.

　　2. Antituberculosis drug treatment.

　　When the antituberculosis drug treatment for penile tuberculosis is ineffective, local resection of the lesion can be performed.