[Multislice computed tomography in the diagnosis of nephrotuberculosis].

The sensitivity of the conventional radiotherapy involving excretory urography and ultrasound scanning is 80.3%. The clinical and X-ray form of new-onset nephrotuberculosis is being specified and revised during a follow-up and, in some cases, intraoperatively or at autopsy. The main reason for discrepancy between preoperative and postoperative diagnoses is inadequate visualization of the upper urinary tract when standard radiation diagnosis is used. Multislice computed tomography makes it possible to visualize the renal parenchyma, its vessels and urinary tract and yields a real three-dimensional image of urinary organs, to ascertain the pattern of urinary tract abnormalities, the preservation of the renal vasculature, and the functional reserves of the diseased and contralateral kidneys, and to define the only correct management tactics for patients with nephrotuberculosis in 93.3% of cases.

[Disability in patients with urogenital tuberculosis].

The timely diagnosis of urogenital tuberculosis and the early initiation of specific therapy are an essential prerequisite to the maximum maintenance of function of an affected organ and to a good prognosis of the disease. Analysis of 205 history cases in patients with new-onset urogenital tuberculosis who were examined and treated at our hospital in 1999-2003 has revealed advanced destructive urogenital tuberculosis in 56.1% of cases. The able-bodied patients were 58.05%. Medical examination determined disability group II in 27.8%. The able-bodied patients who were recognized to be disabled were 57.89%. Since the highest disability rates (34.15%) among the patients with new-onset urogenital tuberculosis were observed in the group of the most able-bodied age (41-50 years), this condition inflicts a great economic loss. The true disability rates are higher than those observed by us since some patients undergo medical examination in their local tuberculosis dispensaries and fail to be statistically registered at our hospital.

[Urogenital tuberculosis: problems of present-day diagnosis and treatment]. / Problemy svoeveremennoi diagnostiki i lecheniia urogenital'nogo tuberkuleza.

The analysis of 4904 cases with tuberculosis admitted to the urological department of Moscow tuberculosis hospital N 7 in 1996-2002 showed increased incidence of new-onset and recurrent urogenital tuberculosis--the share has risen from 2.1 to 7.8%. Of 267 new cases, 49.4% had severe destructive forms. The disease manifested with chronic cystitis in 35 (13.11%), subacute orchoepidydimitis in 35 (13.11%), anatomofunctional alterations of the kidneys (hydronephrotic transformation, non-functioning kidney, ureteritis, etc.) in 76 (28.46%) patients. Bacterial discharge occurred in 52% of new cases. The diagnosis was based on clinical and x-ray data in 48%. Isolated genital tuberculosis, isolated nephrotuberculosis and their combination were revealed in 14.23, 59.57 and 26.2% patients, respectively. Among the patients with advanced destructive forms 75% got disabled completely. This fact indicates the importance of early diagnosis and adequate etiotropic therapy. Active urogenital tuberculosis was treated surgically in 51% patients, most of the operations were made for marked destructive processes in the kidneys. The organ-removing operations were conducted in 73% of them. Preoperative tuberculostatic therapy reduced frequency of postoperative complications. In early diagnosis, the organ was saved in operations in 9.38%. It is recommended to refer patients to the phthisiourologist to be examined for urogenital tuberculosis if they have long-standing urogenital infection, destructive lesions of the upper urinary tracts, calculous prostatitis.