Sharp cystitis – the inflammation of an internal cover of a bladder of infectious genesis which is usually not complicated by structurally functional changes from an urinary system. Sharp cystitis is shown by the speeded-up painful urination, presence at urine of pus and blood, subfebrilitety. Sharp cystitis is diagnosed on the clinical manifestations given the general analysis of urine and ultrasonography. In the course of therapy of sharp cystitis observance of the guarding mode, application antibacterial and sedatives, travolecheny, local thermal influences, performing physiotherapy is shown.
Sharp cystitis – the display of an infection of urinary tract, widespread in urology, which is found at children's and adult age mainly at patients is a female. Infectious agents most often get into a bladder from an urethra (the ascending way), from kidneys and mochetochnik (the descending way), and also other centers of an inflammation: through a bubble wall (kontaktno), through a lymph or blood.
Sharp cystitis can be shown by catarrhal and hemorrhagic changes of an internal cover of a bladder. At catarrhal sharp cystitis of uroteliya it is edematous and hyperemic, blood vessels of a wall of a bubble are expanded. Increase in permeability of vessels leads to sweating in the center of an inflammation of a large number of erythrocytes and to development of hemorrhagic cystitis. Distribution of an inflammation on a submucous layer is characteristic of a severe form of sharp cystitis. Sharp cystitis can be primary (without the previous bladder pathology) or secondary; focal (cervical cystitis, trigonit) or to diffusion (total).
Reasons of sharp cystitis
Development of sharp cystitis requires presence of pathogenic microflora at a bladder and existence of certain factors. In most cases sharp cystitis is caused by gramotritsatelny activators (in 80% of cases - colibacillus, and also proteas, a klebsiyell), grampolozhitelny (enterokokk, staphylococcus), and also microbic associations.
In developing of sharp hemorrhagic cystitis a role of the contributing factor is played by the adenoviral, herpetic, parainfluenzal infections causing violation of microcirculation and an innervation of a bladder with development further of a bacterial inflammation. In some cases sharp cystitis is caused by a combination of a chlamydial, mikoplazmenny or ureaplazmenny infection and bacterial microflora. Allocate specific sharp cystitis of a gonorrheal, trikhomonadny, tubercular etiology.
At the healthy person uric ways are cleared due to regular outflow of urine, besides, the internal cover of a bladder is very steady against an infection thanks to development of a special mukopolisakharidny secret. Forming on the surface of a bladder a thin protective layer (), it interferes with adhesion and penetration of pathogenic microorganisms into a bubble wall, promotes an inactivation and their elimination at an urination. Hormones estrogen and progesterone participate in regulation of development of a protective layer.
Various changes of a mutsinovy layer of a bladder lead to loss of its protective function against the background of which development of sharp cystitis is possible. So, violation of an urodinamika at a neurogenetic bladder promotes its insufficient clarification and stagnation of urine. Sharp cystitis can be connected with injuries of an internal cover of a bladder when carrying out tool and surgeries (a kateterization of a bladder, a tsistoskopiya, an ureteroskopiya); decrease in local immune protection at avitaminosis, frequent SARS; influence of radiation, toxic and chemicals.
At girls primary sharp cystitis is usually caused by insufficient observance of rules of hygiene, vagina dysbacteriosis. At boys against the background of anatomo-functional pathology of a puzyrno-urethral segment (a stenosis of an urethra, a sclerosis of a neck or a diverticulum of a bladder, a fimoz, neurogenetic dysfunction) secondary sharp cystitis quite often develops. Important value in developing of sharp cystitis has the stagnation of blood in a small basin leading to violation of blood circulation in a bladder wall; exchange violations (kristalluriya).
Rather high percent of cases of sharp cystitis at women is connected with the features of a structure of a female urethra, hormonal violations, frequent genital inflammations (vulvita, vulvovaginita) promoting hit of microflora in a gleam of an urethra and a bladder. Sharp cystitis at men almost always arises against the background of prostatitis, an uretrit and an orkhiepididimit. Active sex life provides a high probability of hit of an infection in a bladder.
Symptoms of sharp cystitis
For sharp cystitis frequent imperative desires to an urination, a miktion in the small portions with gripes and pain at the end, emergence of a terminal gematuriya are characteristic; a pain syndrome in a bladder, a crotch and an anus; change of transparency and color of urine (muddy or colors of "meat slops").
Strong and frequent desires to an urination at sharp cystitis arise even at accumulation of small volume of urine that is caused by the increased reflex excitability of a bladder provoking reductions of a detruzor. Frequency of miktion depends on weight of sharp cystitis (sometimes they occur each 20–30 min.).
Involvement in inflammatory process of a neck of a bladder at sharp cystitis is followed by the constant intensive pain giving to a crotch, back pass and a head of a penis at men. The reflex delay of an urination because of sharp pain and a spasm of an external sphincter of an urethra and muscles of a pelvic bottom can be observed.
The cervical form of sharp cystitis with involvement of a sphincter of a bladder can be followed by urine incontience episodes. At distribution of infectious process to the top uric ways to dizurichesky frustration the subfebrilny temperature and an indisposition joins that indicates development of the sharp ascending pyelonephritis.
Diagnosis of sharp cystitis
Diagnosis of sharp cystitis is rather simple in connection with its specific symptomatology. Results of the general analysis of urine in which are observed the leykotsituriya having neytrofilny character, an eritrotsituriya, a bakteriuriya, a large number of cages of a flat epithelium and slime help to confirm sharp cystitis. Makrogematuriya points to heavy hemorrhagic sharp cystitis and is an adverse predictive sign concerning a further recurrence. For identification of the activator of an inflammation and its sensitivity to antibiotics the cultural research of urine is carried out.
In clinical blood test at uncomplicated sharp cystitis criteria of ostrovospalitelny process seldom come to light. According to ultrasonography of the bladder which is carried out against the background of it "physiological filling" the thickening of an internal wall of a bubble and existence in his cavity of enough a "ekhonegativny" suspension comes to light.
Tsistoskopiya and tsistografiya in the period of sharp cystitis are not shown, their carrying out is possible after subsiding of an inflammation.
At patients with the complicated sharp cystitis expediently further inspection for detection of neurogenetic dysfunction of a bladder (urodinamichesky inspection), gynecologic problems at women (dab microscopy, crops separated on STD, PTsR-researches), prostate gland diseases at men ( dab from an urethra, a prostate secret research).
Treatment of sharp cystitis
At sharp cystitis rest (if necessary – a bed rest), plentiful drink (in days - to 2, 5 l of liquid) and the sparing dairy and vegetable diet is shown. It is necessary to monitor regular depletion of intestines, to exclude sex life and to avoid overcooling.
Facilitate a condition of the patient with sharp cystitis the general and local thermal procedures (warming, dry heat on area of a bladder, grass sedentary bathtubs of t = +37,5 °C). Instillations of a bladder and hot bathtubs at sharp cystitis are contraindicated.
Medicamentous therapy of sharp cystitis consists in reception of anesthetics, spazmolitichesky, antihistaminic, uroseptichesky and antibacterial medicines. At the expressed pain syndrome are shown a papaverine, , sodium metamizol, , diclofenac, paracetamol (orally or rektalno). Antimicrobic therapy of sharp cystitis is carried out taking into account an antibiotikogramma to which results apply nitrofurans, antibiotics of a broad spectrum of activity (with oral administration and primary removal with urine).
At sharp uncomplicated cystitis at adults treatment of a ftorkhinolonama (norfloksatsiny, Yotsiyoproyofloksatsiny) or monuraly is preferable. In therapy of sharp uncomplicated cystitis at children urologists generally apply amoxicillin, tsefalosporina (a tsefuroksima aksetit, a tsefaklor, ), nalidiksovy acid. Course treatment of sharp cystitis makes not less than 7 days.
Treatment of sharp cystitis is supplemented with phytotherapy with application of collecting the herbs possessing the diuretic, antimicrobic, anti-inflammatory and tanning action (bearberries, a cowberry leaf, renal tea, a sporysh). After subsiding of a sharp stage of cystitis physiotherapy is appointed (magnetotherapy, magnetolaser therapy, an electrophoresis, UVCh, an induktotermiya, etc.).
Forecast and prevention of sharp cystitis
The forecast at sharp cystitis, as a rule, favorable, in case of the complicated form a disease can get a chronic current.
The regular urination and full depletion of a bladder, respect for personal hygiene, timely treatment of a SARS and sexually transmitted infections, increase in immune protection of an organism, preservation of anatomic and functional integrity an uroteliya and a detruzor is important for prevention of sharp cystitis when carrying out urological manipulations and operations.