Balanit — a penis head inflammation against the background of an infection or other causes. Symptoms include local hyperaemia, a raid on a head, hypostasis, pain, emergence of cracks and erosion, difficulty of an urination. At inadequate therapy a number of complications can join. Methods of diagnostics mean definition of the diseases and factors influencing development of a state, identification of the activator if balanit is caused by the infectious agent. Treatment individually also depends on the reason; can include hygienic procedures, local use of ointments, antibacterial and antifungal therapy, in the presence of indications – carrying out .
With balanity 3-11% of men of any age face, but more often pathology is diagnosed for age patients. During the summer period incidence is higher, prevalence of a balanit correlates with the standard of living, hygienic culture, religious and ethnic traditions. It is proved that the penis head inflammation practically does not occur at men with the cut-off extreme flesh. At not cut off men in a preputsialny bag the smegma creating conditions for reproduction of microflora accumulates. Practically in 100% of cases balanit proceeds in a combination with an inflammation of an internal leaf of extreme flesh - postity (balanopostit). Relevance of a perspective in urology and andrology is connected with the frequent recidivous course of a disease and emergence of a number of the complications reducing quality of life (including intimate).
Reasons of a balanit
Etiology of an inflammation of a head of a penis of a multifaktorn. The disease can have infectious genesis or arise against the background of local and system pathological processes. Infectious balanita are caused fungal (Candida), virus (VPCh), bacterial agents (a pale treponema, a hemolytic streptococcus, Neicer's gonokokk), protozoa (trichomonad), etc. Noninfectious forms quite often arise against the background of allergodermatoz, diabetes, scleroatrophic depriving, puzyrchatka, diseases of an urinogenital path and urological operations. Act as the contributing factors for development of inflammatory process in the field of a head:
- Wrong hygiene. Unsatisfactory or excessive hygiene of genitals reduces factors of local protection. The infection easily gets into the formed microcracks against the background of dryness mucous. Existence of a short bridle and fimoz promotes a skaplivaniye of the smegma causing mechanical and chemical irritation of a head. Besides, in such conditions growth of the pathogenic microflora causing inflammatory reaction begins.
- Mestnorazdrazhayushchy factors. Means of local contraception, antiseptics, consider the chlorinated water, some medicines as provocative balanit factors. Aggressive substances not only corrode skin, but also allergization promote. Rare replacement of pampers at children and lying adult patients, carrying an uroprezervativ quite often are complicated by an inflammation of genitals.
- Immunosupressivny states. Patients with the reduced immune responsiveness (after organ transplantation, himioluchevy therapy, against the background of reception of hormones, antibiotics, at some diseases) suffer from a balanit more often. In these cases usually allocate the fungal activator — Candida .
- Diseases of an urogenital path. Recidivous IMVP, , a short bridle, , urological operations and medical manipulations — the frequent reasons of a balanit. The combination of a mechanical travmatization, easing of immunity and activation of a secondary infection are characteristic of patients after surgical intervention. The urine containing salts provokes an inflammation in an urethra and a head of a penis.
The pathogenesis is presented by a dynamic complex of the cytologic and chemical processes happening in the fabrics in response to a trauma or influence of the physical, chemical or biological agent including local reactions and the resulting morphological changes. The aseptic inflammation, its transition in infectious and consolidation of a smegma strengthen the general reaction. At children up to 5 years at compulsory moving of extreme flesh sinekhialny membranes are damaged, through a wound surface pathogenic bacteria get owing to what develops balanit. At elderly patients urine changes the physical and chemical properties, often its density is higher, there are salts, and sometimes and sugar. Accompanying and the congestion of urine leads to mechanical, and then and to chemical irritation of skin. Secondary accession of microbic flora aggravates an inflammation.
On character of a current allocate sharp and chronic inflammatory process. Pathology can be primary or accompany any disease. By the form a pathogen distinguish virus, fungal, bacterial balanit; on the emergence mechanism ‒ post-traumatic, allergic, medicamentous (chemical) and so forth. For sharp infectious process, considering expressiveness of an inflammation and feature of a current, the following forms are characteristic:
- Simple (catarrhal). Most often balanit it is found in the form of a catarrhal inflammation. Hyperaemia and puffiness are expressed moderately, the general health suffers slightly. There are a slight itch and burning. At the timely and correctly picked up treatment recovery occurs quickly and without formation of cicatricial fabric.
- Erosive (ulcer). Inflammatory process progresses, and on skin erosive defects, with a clear boundary and moknutiy are formed. Gradually erosion occupy the increasing area, the internal leaf of extreme flesh is practically always involved. Completely it is impossible to bare a head because of a pain syndrome and the created fimoz. Inguinal lymph nodes can be increased.
- Gangrenous. Further development of an inflammation, deepening and merge of the erosion covered with a purulent raid leads to a fabric nekrotization. Health of the patient heavy that is caused by intoxication, a pain syndrome and increase in temperature reaction. Pakhovy lymphadenitis and is registered practically at all men with a gangrenous form of a balanit.
Symptoms of a balanit
Symptoms of a balanit depend on degree of expressiveness of an inflammation and a stage of a disease: at sharp process clinical manifestations are brighter. Reddening and hypostasis of a head, a raid with an unpleasant smell, ulcerations (it is frequent with release of blood) and plaques, an urination zatrudnennost, narrowing of an external opening of an urethra, an itch and pain, violation of erectile function is characteristic of a disease. The sharp delay of urine at a balanita meets less often.
If joined , during the act of urination urine accumulates under extreme flesh and inflates it. At some patients register reaction of regionarny lymph nodes — pakhovy lymphadenitis or a limfadenopatiya. At the chronic course of a disease symptoms are expressed moderately, typical a recurrence against the background of easing of immunity of any genesis: reception of antibiotics, overcooling, an error in food, changes of a climatic zone and so forth.
Further progressing of an infectious inflammation can lead to an uretrit, cellulitis (a bacterial infection of deeper layers of skin) and penis gangrene. The result of recidivous inflammatory process can be (including, cicatricial) and , and urethra striktura. Emergence of a delay of urine, a puzyrno-mochetochnikovy reflux, erectile dysfunction is possible. At the timely address to the urologist or the dermatovenerologist of many undesirable consequences it is possible to avoid. Men with balanity and fimozy have the increased risk of development of cancer of penis: because of impossibility to open a head diagnostics is complicated, and the existing tumor at initial stages has no painful manifestations.
The presumable diagnosis is established after survey of the urologist. Consultations of the dermatovenerologist, the endocrinologist, the rheumatologist, the oncologist can be necessary for specification of the reason. Diagnostic actions include testing for diabetes, crops of biomaterial from affected areas on flora and sensitivity to medicines, serological researches on syphilis, analyses on HIV and STD, the test with potassium hydroxide at suspicion of genital candidiasis. At a severe form of a balanit performing ultrasonography of a bladder with control of residual urine is proved that allows to establish obstructive violations.
If the reason of a balanit remains not clear, the disease carries a recidivous current, or there is no effect of the carried-out therapy, the biopsy of suspicious sites with the subsequent morphological research is carried out. Differential diagnostics is carried out with psoriasis, a soft and firm shankr, a gerpesvirusny infection, a malignant new growth.
Treatment of a balanit
At the confirmed venereal disease medicines are appointed taking into account the activator. In addition include immunomodulators, polyvitamins, processing of a head in the scheme antiseptic solutions. Treatment is received by both partners. Recommend to patients with a nonspecific balanit without fimoz:
- Careful care of genitals. A daily retraktion of extreme flesh and elimination of a smegma — the basic rule of hygienic leaving. The naked head of a penis is washed warm water without use of the irritating detergents. Trays with broths of the herbs possessing anti-inflammatory action (a camomile, a calendula, a sage), irrigations by solution of baking soda, a lotion with antiseptics (, and so forth) relieve pain and reduce an inflammation.
- Application of corticosteroids. At patients (irrespective of age) with soft symptoms of a balanit of noninfectious genesis perhaps local use of hormones. At boys is more senior than 3 years extreme flesh carefully delay. Success from treatment with lack of a recurrence makes 65-95%. Hormonal medicines cannot be applied more than 14 days as it can lead to thinning of skin. For patients with a xerotic balanit the tsirkumtsiziya as at them more likely develops cicatricial is more proved.
- Dermatotropny means with immunosuppressive action. At a frequent recurrence instead of corticosteroids purpose of means on the basis of a macrolactam of an askomitsin which has immunosuppressive, anti-inflammatory, dermatotropny effect is more preferable. Effect of therapy - 64%. In the absence of positive dynamics resort to surgery.
- Antibacterial therapy. If the secondary bacterial infection joined, local and system application of antibiotics is proved. At the expressed clinical manifestations and complications (for example, penis cellulitis) oral administration of antibacterial medicines of a broad spectrum of activity initially empirically is shown. After obtaining results of a bakposev carry out correction of the scheme of therapy if it is necessary.
- Antifungal medicines. Balanit a kandidozny etiology means use of antifungal medicines of local and system action, a diet with refusal of sweet, drozhzhesoderzhashchy products and alcohol. The repeating attacks of an infection of fungal genesis can demonstrate serious violations in work of immune system. At background diabetes it is important to try to obtain the target level of glucose.
Fimoz with a frequent recurrence of a balanit — the main indication to trimming that considerably facilitates a state and allows to conduct full-fledged sexual life. At erectile dysfunction consultation of the andrologist or sexologist is recommended to the patient.
Prevention and forecast
In the majority of observations, when following to all recommendations of the doctor, unpleasant symptoms decrease in 3-5 days. The forecast for life favorable. Preventive actions include use of hypoallergenic condoms at casual sexual communications, refusal of local contraceptives, wearing cotton linen of the corresponding size, regular sex life. When carrying an uroprezervativ or pampers timely replacement of products and special means for leaving with the moistening and antiseptic properties is recommended.
Special attention is paid to hygiene of genitals: the penis needs to be washed with warm water with soap or gel with the neutral environment without irritant action. It is obligatory to shift extreme flesh. You should not apply detergents more often than 1 time a day since it is destroyed by lizotsy - the antibacterial enzyme protecting from infectious microorganisms and allocations of sebaceous glands which humidify grease and preserve mucous urethras and skin against infection. At all symptoms of trouble it is necessary to see a doctor.