尿路結核の臨床的観察

Abstract

A clinical observation was made on 29 cases of urinary tuberculosis newly found at the urological department of Aichi Medical College Hospital and that of Tosei Hospital during six-year period, 1973 to 1978. 1. Urinary tuberculosis constituted 0.34% of new patients who visited the outpatient department of both hospitals. There was no striking difference by year. 2. Male to female ratio was 1.9. The age distribution showed the peak at the fifth decade. 3. Affected side was predominant on the left (65.5%) 4. 48.3% of the patients had history of tuberculosis. Pulmonary tuberculosis was most frequent (27.6%). 5. Chief complaint most frequently noted was pain in the prostatic region in male and bladder symptom in female. 6. Urinalysis showed albuminuria and pyuria with many WBC in most of the cases. 7. Cystoscopy found many cases with normal vesical mucosa and normal vesical capacity. 8. 41.4% of the patients showed accelerated blood sedimentation rate more than 31 mm/hour. 9. Mycobacterium in urine could be detected in 38% by smear and stain, and 72.4% by culture. 10. Primary drug resistance of Mycobacterium was seen in 38.5% against streptomycin, 38.5% against INH and 15.4% against PAS. 11. Pyelographic changes were either slight or remarkable in many cases. Ureteral structure was often found. 12. 79.3% of the patients were treated by chemotherapy alone and 20.3% by nephrectomy with chemotherapy. Chemotherapy was carried out by combination of SM, INH and PAS in 86.2% of the cases and its duration was 2 years for sole chemotherapy and one year for post-nephrectomy. 13. So far, 72.4% of the cases received all of the scheduled treatment and none of them has shown recurrence of tuberculosis.