Urethral and penile tuberculosis

　　Can be caused by the spread of bladder tuberculosis or by the formation of cavities in the prostate seminal vesicle tuberculosis, which destroys the prostate urethra. Tuberculosis is a rare disease in urogenital tuberculosis, with an incidence rate of less than 1%.

　　Can cause perineal inflammation, perineal abscess, or secondary infection, and ulcers form after rupture. Urethral tuberculosis often occurs secondary to severe urogenital tuberculosis and is difficult to treat. If urogenital tuberculosis is treated actively in the early stage and the range of urethral stricture is small, the prognosis is better. The only effective treatment for penile tuberculosis in the past was penile amputation. Due to the progress of anti-tuberculosis drugs, it is possible to cure the disease with the active cooperation of doctors and the use of anti-tuberculosis drugs alone, and the integrity of the penis can be preserved.

　　1. Urethral tuberculosis:Urethral discharge, frequent urination, dysuria, urethral bleeding or hematuria, difficulty urinating when urethral stricture occurs, urinary stream becomes thin, urinary range shortens, urination becomes weak, palpation of the perineum feels rough, hard, and fibrous urethra, which can cause urethritis, perineal abscess, or secondary infection, and ulcers form after rupture.

　　2. Penile tuberculosis:Hard nodules on the glans penis, painless,溃破后呈潜行性溃疡，其底部有干酪坏死组织及肉芽组织，溃疡长期不愈。

　　1. Early diagnosis and treatment:If tuberculosis is present, it should be treated early to avoid deterioration of the condition and to prevent the spread of the bacteria; tuberculosis patients can receive treatment at any chest and lung clinic.

　　2. Examination for those who have had close contact with tuberculosis patients:This mainly involves checking the family members of the patient, including tuberculosis skin test needles and/or lung X-rays for children, and lung X-rays for older children and adults.

　　3. Healthy Lifestyle:Tuberculosis bacteria invade and cause disease when the body's resistance is low, therefore, it is important to maintain a healthy lifestyle to reduce the chance of disease, which includes: moderate exercise, adequate sleep, balanced diet, avoiding smoking and alcohol, breathing fresh air, keeping indoor air circulation, and personal hygiene (for example: avoid coughing or sneezing towards others).

　　4. BCG Vaccination:The Department of Chest and Lung of the Health Bureau provides BCG vaccination services for all newborns in Hong Kong; for children under 15 living in Hong Kong who have never been vaccinated with BCG, it is also recommended that they receive this vaccine injection.

　　First, urethral tuberculosis

　　1. Urethral secretion, frequent urination, dysuria, urethral bleeding, or hematuria.

　　2. Difficulty in urination, thinning of the urinary stream, shortening of the urinary range, and weak urination.

　　3. Palpation of the perineum reveals thick, hard, cord-like urethra or urethral sinus.

　　4. Urethrogram shows urethral stricture.

　　5. Direct smear of urethral secretion finding tuberculosis bacteria is helpful for diagnosis.

　　6. Transurethral biopsy can make a definitive diagnosis.

　　Second, penile tuberculosis

　　1. Hard nodules and chronic ulcers on the glans penis.

　　2. Direct smear or culture of Mycobacterium tuberculosis can distinguish soft chancre, hard chancre, penile amebiasis, and penile cancer.

　　3. Pathological biopsy can make a definitive diagnosis.

　　Generally, the nutritional supply of patients with urethral and penile tuberculosis should be slightly higher than that of ordinary people, including heat sources, proteins, and vitamins, to meet the nutritional needs during tuberculosis treatment.

　　1. First treat renal tuberculosis, prostatic tuberculosis, and epididymal tuberculosis;

　　2. Anti-tuberculosis drug treatment;

　　3. Urethral dilation should be performed for patients with urethral stricture;

　　4. Bladder fistula should be performed for patients who cannot undergo urethral dilation or whose dilation effect is poor;

　　5. When anti-tuberculosis drug treatment is ineffective for penile tuberculosis, local resection of the lesion can be performed;

　　6. In cases where urethral stricture is localized, the stricture scar can be excised and anastomosed or urethral incision can be performed under urethroscope;

　　7. In difficult cases of urethral stricture treatment, sometimes it is necessary to perform urinary diversion surgery;

　　8. In case of renal failure, treatment can be carried out according to the routine treatment for chronic renal failure, mainly dialysis therapy or kidney transplantation.