Urologic tuberculosis is a foci of tuberculosis secondary to other parts of the body, the most important of which is renal tuberculosis, tuberculosis of the kidney, which is the most common and first to occur in the urinary tract and later spreads from the kidney to the entire urinary system. Therefore, renal tuberculosis actually represents the significance of urologic tuberculosis. I. Diagnosis The disease process of renal tuberculosis is very slow, and the clinical manifestations are dominated by bladder irritation symptoms. Therefore, the diagnosis of renal tuberculosis is guided by the symptoms of cystitis (urinary frequency, urinary urgency, and urinary pain). In addition to the obvious causes of cystitis, the possibility of renal tuberculosis should be considered and further systematic examination is necessary. (A) History analysis and physical examination: The presence of renal tuberculosis lesions should be considered for long-term chronic urinary frequency, urgency, painful urination and hematuria, or cystitis that does not heal with general anti-inflammatory treatment. In particular, urinary tract infections in young and middle-aged men with no general bacterial growth in urine culture should be examined for urological tuberculosis. During the physical examination, attention should be paid to TB lesions throughout the body, especially in the male genital tract to check for nodules in the prostate, vas deferens, and epididymis. The urinary tract should be examined for masses in the kidney area and percussion pain in the cribriform angle. (B) Laboratory tests: 1. Routine urine examination The urine is often acidic, contains a small amount of protein, and a small or moderate amount of red blood cells and white blood cells can be seen under the microscope in most patients. However, in the case of mixed urinary tract infection, the urine may be alkaline, and a large number of white blood cells or pus balls can be seen microscopically. 2, urinary common bacterial culture Kidney tuberculosis is a specific infection of the urinary tract. Urine culture of common bacteria should be negative. However, a significant proportion of patients with renal tuberculosis have mixed urinary tract infections, and urine culture of common bacteria can be positive. 3. Urine tuberculosis bacillus test (1) 24-hour urine antacid bacillus test Mycobacterium tuberculosis is one of the antacid bacilli. 24-hour urine is concentrated for direct smear antacid staining for antacid bacillus test. The method is simple, the result is rapid, and the positive rate can reach 50-70%. However, the bacillus of foreskin and the bacillus of grass are also acid-resistant bacilli that often exist in urine, so the acid-resistant bacillus in urine is not equal to the bacillus of tuberculosis. However, repeatedly and repeatedly this test can find the same acid-resistant bacilli, and combined with the clinical history and characteristics of the reference, it still has some reference significance for the diagnosis of renal tuberculosis. (2) Urinary tuberculosis culture Urinary tuberculosis culture is decisive for the diagnosis of renal tuberculosis. A positive urine culture for tubercle bacilli can confirm the diagnosis of renal tuberculosis. However, the culture time is long, and it takes 1 to 2 months to get the result, and the positive rate can be as high as 90%. (3) Urinary tuberculosis animal inoculation The results of urinary tuberculosis animal inoculation are of high value for the diagnosis of renal tuberculosis and can be used as a basis for the diagnosis of renal tuberculosis, with a positive rate of more than 90%. However, it is time-consuming and takes up to 2 months to obtain the results. 4, urine tuberculosis IgG antibody determination Nassau et al. found a certain amount of specific antibodies in active tuberculosis patients, and Grauge et al. proved that the specific antibodies were IgG class. The First Affiliated Hospital of Hubei Medical College reported that the enzyme-linked immunosorbent assay was used to determine TB IgG antibodies in urine using polymeric OT as antigen, and the positive rate was up to 89.1% in the urine of patients with renal tuberculosis who had TB IgG antibodies. This test proved to be specific and sensitive, and has considerable clinical significance for the diagnosis of renal tuberculosis. However, in case of advanced renal tuberculosis and the kidney function is severely impaired and cannot secrete urine, or renal tuberculosis is complicated by ureteral obstruction, the urine on the diseased side cannot be discharged and the urine tested comes from the healthy kidney, false negative may occur. 5, tuberculin test Tuberculin test is a test to check whether the human body is infected with Mycobacterium tuberculosis, most often used in pulmonary tuberculosis, but also has reference value for tuberculosis lesions in other organs of the body. (1) Tuberculin has the following types: ① old tuberculin; ② pure tuberculin; ③ pure protein derivatives made from atypical mycobacteria; ④ four types of kaja mycobacteria. Generally, old tuberculin is used for the test. (2) old tuberculin (OT) is made: human type tuberculosis bacteria culture for 2 months, heat inactivation, filter out the dead bacteria, evaporation and concentration to the original amount of 1/10, that is, the original tuberculin solution. Later, according to the 1952 World Health Organization, each ml contains 10 tuberculin units (TU), equivalent to 1000 mg. (3) Test method: Using the old tuberculin standardized solution, the first time with 1/1000 or 1/2000 (each 0.1 ml contains 10.5 TU) dilution 0.1 ml injected into the left forearm in the middle 1/3 of the skin. After 48 to 72 hours, observe the reaction, and if negative, repeat the test with 1/100 (100 TU per 0.1 ml) dilution and judge the reaction result. (4) Positive criteria for tuberculin test (5) Significance of positive tuberculin reaction: (1) Have been vaccinated with BCG and artificially immunized. (2) Has been infected with Mycobacterium tuberculosis, but further confirmation or exclusion of active tuberculosis is required. (3) Significance of positive children: under 8 years old, active TB may be greater than 50%. under 4 years old, almost all have the possibility of active TB. under 3 years old, not only have active TB, if not treated, the prognosis may not be good. under 1 year old, all have active TB, if not treated, the prognosis is definitely not good. ④ If the tuberculin test is strongly positive, there is active tuberculosis and must be examined. 6, blood sedimentation test: renal tuberculosis is a chronic long-term lesion and a wasting disease, so blood sedimentation test can be increased. Li Zhe reported that 255 of 300 cases of renal tuberculosis had increased blood sedimentation. However, the blood sedimentation test is not specific for renal tuberculosis disease, but it can often indicate the possibility of renal tuberculosis in patients with cystitis with increased blood sedimentation, so it can be used as a reference test. Renal function tests (1) urea nitrogen, creatinine, uric acid measurement: one side of the kidney tuberculosis renal function test does not affect, if one side of the serious renal tuberculosis, and the involvement of the opposite side of the kidney or cause hydronephrosis and cause functional effects, the above renal function tests may show an increase. Although renal function test is not a direct diagnostic indicator of renal tuberculosis, it has a very important reference value for the management of renal tuberculosis patients, so it must be performed routinely. (2) Radionuclide nephrographic examination: If the renal lesion is limited and does not interfere with the secretory function of the whole kidney, the nephrograph shows normal. If there is considerable destruction of the renal parenchyma, the nephrogram shows insufficient blood supply or prolonged secretion and excretion time. In cases of severe destruction of the affected kidney, a non-functional horizontal line nephrogram is shown. If the kidney tuberculosis causes hydronephrosis on the opposite side, the nephrogram may show hydronephrosis and obstruction curves. Although this test has no specific diagnostic value, it is simple and painless for the patient, so it is also included as a routine test in clinical practice. (C) Cystoscopy: Cystoscopy is an important diagnostic tool for renal tuberculosis, which can establish the diagnosis by directly seeing the typical tuberculosis changes in the bladder. Early bladder tuberculosis can be seen as congestion and edema of the bladder mucosa and tuberculous nodules, with the lesions mostly surrounding the ipsilateral ureteral orifice of the renal lesion and later spreading to the bladder triangle and other areas. More severe bladder tuberculosis is seen with extensive mucosal congestion and edema, tuberculous nodules and ulcers, and cave-like changes with upward retraction of the ureteral orifice. The blue time of discharge from the ureteral orifice on both sides was observed by intravenous injection of indigo carmine to understand the renal function of both sides separately. Retrograde intubation on both sides was also possible at the same time of cystoscopy, and ureteral catheters were inserted into the renal pelvis on both sides respectively to collect urine from the renal pelvis on both sides for microscopic examination and TB culture and animal inoculation of TB bacilli. Since these are the data of the fractional kidney examination, their diagnostic value is more meaningful. Retrograde pyelogram can also be performed after retrograde cannulation by injecting a contrast agent (12.5% sodium iodide or pantothenic glucosamine) into the bilateral ureteral catheters to understand the condition of both kidneys. In most patients, the nature of the lesion, its location and severity can be clarified. If the bladder tuberculosis is severe, the bladder is contracted, and the volume is less than 100 ml, it is difficult to see the situation in the bladder, so this test is not recommended. （X-ray examination: X-ray examination is the main diagnostic method of renal tuberculosis. The diagnosis of renal tuberculosis can be established by showing typical images of tuberculosis on X-ray. The following X-ray examinations are routinely performed: 1. Plain radiographs of the urinary tract can show an enlarged or lobulated kidney shape. 4.5 to 31% of them can show lamellar, cloudy or plaque-like calcified foci of renal tuberculosis. The distribution is irregular and variable, often limited to one kidney. If the calcification spreads to all of the tuberculous kidney or even the ureter, it forms the so-called “self-cut kidney”. 2.Intravenous pyelogram Intravenous pyelogram is also called excretory or downstream urography. After the contrast agent is injected intravenously, it is secreted and excreted by the kidney, and the X-ray film is taken when the contrast agent fills the renal calyces and pelvis. The commonly used contrast agents are Urografin, Hypaque, Diodrast, etc. Currently, non-ionic contrast agents such as Iopamiro, Omipaque, Ulfravist, etc. have been developed and applied, which can greatly reduce the toxicity and side effects of iodine agents. Since the contrast agent is secreted from the kidney and then shows the urinary system, this imaging method can clarify renal lesions in addition to understanding renal function. The typical manifestation of tuberculosis is seen as destruction of the renal parenchyma. Lesions limited to the renal papillae and calyces are grossly marginal and uneven, like worm-like lesions, or their funicular parts are deformed, shrunken or lost due to inflammatory lesions or scarring. If the lesion is widespread, complete destruction of the calyces can be seen, and the caseous necrosis presents a “cotton peach-like” tuberculous cavity with uneven margins. If the whole kidney is destroyed, forming an abscessed kidney and losing renal function, the kidney will not be visualized on intravenous nephrography. Ureteral tuberculosis may show irregular wall, uneven lumen thickness, loss of normal softness and curvature, and a stiff, cord-like tube on X-ray imaging. 3, high-dose intravenous pyelogram: If the patient’s total renal function is poor and general intravenous pyelogram cannot show the kidney well, the amount of contrast agent can be increased for high-dose intravenous pyelogram. It may make the original lesions that are not well shown to be clearly visualized. The usual method is to use 2 ml of 50% pantothenic glucosamine contrast agent per kg of body weight, add the equivalent amount of 5% glucose water or saline, and drip rapidly intravenously within 5 to 8 minutes. It is not necessary to abstain from water before contrast, and it is not necessary to pressurize the ureter during contrast. However, the total amount of contrast agent should not exceed 140 ml. Retrograde pyelogram After inserting a ureteral catheter into the renal pelvis through cystoscopy, retrograde injection of contrast agent from the catheter into the renal pelvis to take an X-ray film is called retrograde pyelogram. Generally, 12.5% iodine contrast agent is used; if there is an allergy to iodine, 12.5-25% sodium bromide is used. Since the concentration and amount of contrast agent injected can be adjusted as needed to show the intrarenal lesions more clearly, the diagnostic rate can be improved. 5.Pelvic puncture with retrograde contrast For lesions that cannot be performed by intravenous or retrograde pyelography and are difficult to define, and the nature of the lesion cannot be confirmed, direct pyel puncture can be performed followed by injection of contrast, which can also show typical X-ray manifestations of renal tuberculosis or other lesions and play a role in determining the diagnosis. After pelvic puncture, the contents of the punctured kidney can also be subjected to various laboratory tests and tuberculosis tests. Currently, thanks to the improvement of ultrasonography, the pelvic puncture can be guided, which is safer and more accurate.