Chronic cystitis – the proceeding inflammation leading to structurally functional changes of walls of a bladder is long. Chronic cystitis can proceed latentno, with alternation of aggravations and remissions or with constant symptomatology. Diagnosis of chronic cystitis is carried out by results of analyses of urine, vagina microflora at women, analyses on STD, ultrasonography of uric bodies, a tsistografiya, a tsistoskopiya, an endovezikalny biopsy. At chronic cystitis carry out antibacterial treatment, correction of the hormonal and immune status, microcirculation processes, local therapy and prevention of aggravations, according to indications - surgeries.
Prevalence of chronic cystitis in urology, quite often steady against etiotropny treatment is enough, does it by a serious medical problem. Transition of sharp cystitis to a chronic form is observed approximately in a third of all cases. At chronic cystitis inflammatory process proceeds for a long time (more than 2 months), at the same time not only the mucous membrane, but also deeper layers of a wall of a bladder is surprised. The long inflammation in a bladder wall can lead (cystitis) to sclerous changes of soyedinitelnotkanny elements of a muscular layer and wrinkling of a bubble.
Classification of chronic cystitis
On character of a current chronic cystitis is divided on latent, actually chronic (persistiruyushchy) and interstitsialny (a bladder syndrome). Chronic cystitis has the infectious nature more often and Candida, protozoa can be called by bacterial agents (gramotritsatelny enterobakteriya, stafilokokka, specific causative agents of gonorrhea, tuberculosis, clamidiosis, mycoplasmosis), viruses (herpes, adenoviruses), mushrooms. Exacerbations of chronic cystitis are caused in most cases by a reinfitsirovaniye other activator or a persistiruyushchy infection of the same look or strain.
Depending on a morphological picture chronic cystitis can be catarrhal, ulcer, cystous, polipozny, inlaying or necrotic. Morphological changes at chronic cystitis are characterized by a metaplaziya of a transitional epithelium - formation of the centers of an orogoveniye, mucous cysts, sometimes - polipozny growths and leykotsitarny infiltrates in a podepitelialny layer. At interstitsialny cystitis ulcerations of a mucous membrane, signs of a gialinoz and multiple glomerulyation are observed, at allergic cystitis - eozinofilny infiltrates in podepitelialny and muscular layers.
Reasons of chronic cystitis
Chronic cystitis develops against the background of the available diseases of urinogenital system or at the serious accompanying pathology promoting infection of a bladder and development in it inflammatory process. Long violation of outflow of urine, rare urinations with incomplete depletion of a bladder, decrease in protective properties of his mucous membrane in the presence of the centers of a chronic infection (pyelonephritis, a vulvovaginit, prostatitis, an uretrit, STD, tuberculosis, tonsillitis, caries) create favorable conditions for development of chronic cystitis. Can provoke an inflammation in a bladder the tumoral educations which are available in his cavity, polipozny growths, diverticulums, stones.
Anatomic features of an urethra cause high prevalence of cystitis at women as promote hit in a microflora bladder from a vagina and an anus, in particular after sexual intercourse or at violation of hygienic rules. Chronic cystitis at men often proceeds against the background of urethras in its various departments, prostate gland adenomas. Synchronization of an inflammation in a bladder is promoted by incompleteness of process of regeneration an uroteliya after sharp cystitis against the background of the broken fabric homeostasis.
Diabetes, hormonal changes (pregnancy, climax), overcooling, non-compliance with personal hygiene, active sex life, spicy food, stress can be risk factors of developing of chronic cystitis. The etiology and a pathophysiology of noninfectious interstitsialny cystitis are definitely not established so far.
Symptoms of chronic cystitis
Chronic cystitis can proceed asymptomatically, with rare (once a year) or frequent (2 and more times a year) aggravations, in the form of continuous slow process or with rather expressed symptomatology. At chronic cystitis with steadily latent current of the complaint are absent, and inflammatory changes in a bladder are found only at an endoscopic research.
The exacerbation of chronic cystitis can develop as an acute or subacute inflammation. At the catarrhal nature of chronic cystitis are observed the speeded-up urination which is followed by sharp pain, painful feelings in the bottom of a stomach. Blood impurity availability in urine indicates hemorrhagic or ulcer damage of a mucous membrane of a bladder. Less expressed symptomatology at undisturbed reservoir function of a bladder is characteristic of persistiruyushchy chronic cystitis.
Quite severe interstitsialny form of chronic cystitis is shown by constant frequent desires to an urination, pain in a basin and the lower departments of a stomach, a dizuriya, feeling of incomplete depletion of a bladder, a nikturiya, dispareuniy. Pain, insignificant at the beginning of a disease, becomes the leading symptom over time, weakens after a miktion and accrues in process of filling of a bladder owing to reduction of its sizes and permanent decrease in reservoir function. The course of interstitsialny cystitis - chronic, progressing, with alternation of remissions and aggravations. At chronic cystitis symptoms of the main background pathology can be also shown (an urolithic disease, a gidronefroz, etc.).
Diagnosis of chronic cystitis
To establish the diagnosis of chronic cystitis often can be difficult because of the erased, low-expressed symptomatology. The initial stage of diagnosis of chronic cystitis includes careful collecting the anamnesis (taking into account the available diseases of the urinogenital sphere, and also communication of displays of cystitis with sex life), women have a gynecologic inspection with survey in mirrors; men have a rectal research of a prostate. The following stage of diagnosis of chronic cystitis is performance of laboratory researches: analyses of urine – the general, across Zimnitsky, Nechiporenko, a bakposeva of urine with antibiotikogrammy, dab from an urethra on STD, at women - vaginal dab on microflora and STD.
The functional research of an uric path at chronic cystitis includes ultrasonography of kidneys and a bladder, a tsistoskopiya (in a remission phase), an urofloumetriya, a tsistografiya. Against the background of a chronic inflammation in an epithelium of a bladder precancer changes, such as a giperplaziya, a dysplasia, a metaplaziya therefore if necessary the endovezikalny biopsy and the morphological analysis of bioptat is made can develop. The differential diagnosis of chronic cystitis is carried out with cancer of a bladder and prostate gland, a simple ulcer, tuberculosis, shistosomozy.
Treatment of chronic cystitis
In each case of chronic cystitis the differentiated approach to the choice of a method of the treatment adequate to the reasons and the mechanism of development of inflammatory process, specifics of a course of a disease at this patient is necessary. In treatment of chronic cystitis in a complex apply etiologichesky, pathogenetic and prophylactics.
Etiologichesky treatment of chronic cystitis includes antibacterial therapy lasting not less than 7-10 days (sometimes up to 2-4 weeks) medicine to which this activator is sensitive (or an antibiotic of a broad spectrum of activity), then within 3-6 months courses - nitrofurans or baktry. Pathogenetic therapy of chronic cystitis consists in normalization of immune and hormonal violations, structural pathology of uric bodies, improvement of blood supply of a bladder, correction of hygienic skills and sexual contacts, local treatment.
For elimination of a chronic inflammation of a bladder carry out the corresponding treatment of the main disease, including surgical (removal of stones, bladder polyps, a bladder neck resection, an adenomektomiya and so forth). At identification of the centers of a chronic infection carry out their sanitation, women have a treatment of inflammatory gynecologic diseases and a disbioz of genitals. For stimulation of immune protection of an organism immunotherapeutic and immunomodulatory medicines are shown.
At chronic cystitis antigipoksant, venotonik, antiagregant, antihistamines surely appoint. The expressed pain syndrome is stopped by means of nonsteroid anti-inflammatory medicines. As local anti-inflammatory treatment at sufficient indications carry out instillations to a bladder of medicines (solution of nitrate of silver, colloidal silver, heparin). Physiotherapy exercises, physical therapy help to strengthen muscles of a basin and to normalize pelvic blood circulation.
At the interstitsialny chronic cystitis which is quite difficult giving in to treatment apply medicamentous and local therapy, physiotreatment (ultrasound, a diathermy, a medicinal electrophoresis, electrostimulation of a bladder, laser therapy, magnetotherapy). Carry out predpuzyrny, vnutripuzyrny and presakralny novokainovy blockade; in case of cicatricial wrinkling of a bladder surgeries are shown: ureterosigmo-and , unilateral nefrostomiya, ileotsistoplastika.
Prevention of chronic cystitis
Exacerbations of chronic cystitis the preventive courses of therapy appointed by the urologist allow to warn (antibiotic treatment, including postkitalny; vegetable diuretics; in a postmenopause - ZGT estrioly).
An important role in prevention of chronic cystitis is played by respect for intimate hygiene and hygiene of sex life, timeliness of elimination of urogenital pathology, the accompanying purulent processes in an organism, hormonal violations.