Kollikulit - an inflammation of a seed hillock. Can be the independent nosology or secondary pathology caused by transition of an inflammation from a back part of an urethra, a prostate. Symptoms are variable: at a superficial kollikulit clinical manifestations can be absent, the premature ejaculation, painful feelings are typical for widespread defeat during an erection and at an ejaculation, sometimes blood impurity in sperm. The diagnosis is confirmed by an uretroskopiya, for establishment of an etiology use researches on STD, TRUZI. Treatment means etiotropny antibacterial therapy, in hard cases carry out a resection of a seed hillock.
Kollikulit - inflammatory process in a seed hillock (hillock). Normal its length makes 10-20 mm, width - 2-4 mm, height of 3-4 mm. Still the mission of this anatomical structure remains diskutabelny. The fact that in a seed hillock the nervous terminations of afferent ways participating in the act of an ejaculation are concentrated is confirmed by the fact that at mechanical irritation of this anatomic education there is an emission of a seed from mouths of semyavynosyashchy channels. Prevalence of pathology is not connected with geographical accommodation and race in any way. It is considered that any sexually active man can face an inflammation of a hillock. Some authors believe what kollikulit - a special case of a back uretrit with the prevailing changes in this anatomical structure.
Reasons of a kollikulit
Allocate primary (true) and secondary (jet) kollikulit, the reasons of each form are variable. The reasons of a true kollikulit ‒ violation of an innervation and blood circulation in combination with accession of a secondary infection in the limfogenny or hematogenic way. The secondary inflammation of a seed hillock develops at a back uretrit, prostatitis and a vezikulita more often. Pathogenic flora is presented by specific activators: hlamidiya (44%), mycoplasma (31%), trichomonad (13%), viruses of herpes 1 and 2 (7,1% and 2,6%). Less often adenovirus, streptococci, Candida, gramotritsatelny microbes, tuberculosis mikobakteriya and so forth meet. As the contributing factors consider:
- Sexual excesses. The tightened or interrupted sexual intercourse, lack of sex life and excessive masturbation are equally harmful to the man as they provoke stagnation of blood and break natural sexual mechanisms. Duration and frequency of application harmful the practician matters.
- Varicosity. A varicosity of a small pelvis with developments of stagnation under the corresponding conditions (easing of immunity and migration of pathogenic bacteria from any site of an organism - carious teeth, the inflamed almonds, a prostate, a rectum, etc.) can initiate inflammatory process of a seed hillock.
- Local inflammation. At men with chronic recuring uretrity and prostatitis of both a specific, and nonspecific etiology there steps generalization of process with distribution on fabrics of a seed hillock more often. In risk group there are persons practicing homosexual contacts and preferring the out-of-pocket polygamous relations of barrier contraception.
- Traumatic damages. The trauma of a seed hillock can occur when carrying out a number of medical procedures: uretroskopiya, kateterization, a buzhirovaniye or when performing surgical intervention on a prostate gland or an urethra. Microbic flora (gramotritsatelny bacteria are more often) begins to develop actively, extending, including, on a seed hillock.
The leading role in an inflammation of a seed hillock belongs to microcirculation violation. The infected prostate secret which is allocated and stands in back department of an urethra aggravates changes. The inflammation mucous this site of an urethra and a seed hillock is led to violation of an innervation that creates a vicious circle: lack of adequate drainage (reflex violation of evakuatorny function), constant microbic center, strengthening of developments of stagnation.
In formation of spontaneous painful erections, an early ejaculation and change of orgastichesky feelings the hyper irritation of the spinal centers of an erection and ejaculation at an inflammation at the expense of hypostasis matters and a hypertrophy of a seed hillock with a constant impulsation. In general, the pathogenesis of a kollikulit includes damage of epitelialny cells of a mucous membrane or an invasion of the infectious agent (bacterial, virus, fungal) with the subsequent inflammatory changes, including accumulation of leukocytes and chemical mediators (an antibody, a tsitokina and an interleykina) therefore hypostasis, hyperaemia and pain develop.
As well as any inflammatory process, on character of a current kollikulit can be sharp (bright clinical manifestations) or chronic (the erased symptomatology). According to kliniko-morphological classification in andrology distinguish the following types of a kollikulit:
- With soft infiltration. The optimum form, meets at recently existing inflammation. At treatment there are more chances of a complete recovery.
- With firm infiltration. In structure of inflammatory infiltrate soyedinitelnotkanny elements prevail that gives it density. The response to therapy partial, is a tendency to a recidivous current.
- With development of rough cicatricial connecting fabric (atrophic kollikulit). The wrinkled seed hillock considerably is condensed. These changes develop at the long inflammation existing sometimes within several years.
On the basis of an uretroskopichesky picture estimate the nature of changes mucous, degree of expressiveness and duration of existence of process, define maintaining tactics. Allocate three forms of a kollikulit:
- Erosive. It is characterized by emergence of ulcerations against the background of a strong inflammation. Comes to light mainly at patients against the background of the expressed immunosupression. Formation of erosive defects is promoted by excessive fragility of vessels.
- Granulematozny. Growth of granulations, as a rule, happens against the background of the abating inflammation. Thus fabrics are purified of the products of a nekrotization formed as a result of an inflammation.
- Polipozny. Formation of polipovidny or kistovidny growths on a seed hillock meets extremely seldom. Perhaps, it is preceded by long irritation of a seed hillock and the strengthened blood supply.
Symptoms of a kollikulit
Expressiveness of symptoms depends on a stage of an inflammation, a condition of bodies of men's reproductive system, sexual preferences. Temperature reaction and the general weakness meet seldom, their presence speaks about distribution of process on a prostate gland, seed bubbles, a bladder. Initially clinical manifestations erased further there is a discomfort in a crotch, a scrotum, a rectum (feeling of presence of a foreign matter), burning at an urination, constant desires to urinate.
In process of progressing of an inflammation the patient can show complaints to emergence blood a streak in sperm, allocations from an urethra, weakening of a pressure of a stream of urine, its intermittence. Some patients during defecation have an involuntary ejaculation. At 50% weakening of force of natural erections, but emergence of painful spontaneous tension of a penis is observed.
The complications connected with obstruction include a chronic delay of urine, a bladder inflammation (cystitis), violations of an urination at a hypertrophy of a seed hillock. In the absence of adequate therapy kolikullit accepts a recidivous current because of what there is a replacement of fabrics of a seed hillock with rough connecting fabric. It is fraught with an obturatsionny form of infertility as mouths of semyavynosyashchy channels open on a seed hillock. In 70% of cases kollikulit leads to various functional kopulyativny frustration: "fadednesses" of an orgasm, to development of the spontaneous erections which are not connected with sexual excitement, a bystry ejaculation or impossibility to reach the culmination and so forth. These symptoms negatively are reflected in mentality of the patient, in the absence of the timely help of the urologist or the andrologist situation is aggravated by nevrozopodobny states.
The diagnosis of an inflammation of a seed hillock is established on the basis of complaints, by stories of development of a disease, a palpation of a prostate gland and data of a kliniko-urological research. Connection with sexual contact without condom, the sharp beginning are typical for an uretrit and a secondary kollikulit. Gradual development of a disease, lack of changes from a mucous urethra, morbidity during rectal survey when pressing in a projection of a seed hillock testify to primary pathology. Laboratory and tool diagnostics includes:
- Testing for STD. For establishment of the activator use PTsR-diagnostics, biomaterial (separated urethras, a secret of a prostate, sperm) on nutrient mediums, dab microscopy and so forth. If in dab from an urethra at primary microscopy reveal 5 and more leukocytes, carrying out deeper inspection is necessary. Without fail carry out testing for HIV and syphilis.
- Trekhstakanny test of urine. In the first portion of urine reveal a leykotsituriya, a bakteriuriya that testifies in favor of an uretrit. These changes - indications for performing cultural diagnostics. At primary kollikulit inflammatory manifestations in urine can be absent. Changes in the second and third portion of urine are typical for cystitis and pyelonephritis.
- Prostate secret research. At microscopy of juice of a prostate gland find the increased quantity of leukocytes, bacteria, reduction of letsitinovy grains, erythrocytes. These changes allow to assume an inflammation in a prostate gland (seed bubbles). For specification of a condition of a prostate carry out TRUZI.
- To Uretroskopy. The research allows to estimate visually all morphological changes, i.e. to consider an atrophy, erosion, polyps and so forth. The mucous membrane at sharp inflammatory process of a seed hillock, as well as mucous a back urethra, is edematous, hyperemic; can occupy a half or more than diameter of an urethra (an exception - an atrophic form at which the seed hillock is reduced in sizes, there is no hyperaemia).
Differential diagnostics is carried out with adenoma of a prostate gland, striktury urethra (at symptoms of the complicated urination), prostatitis, an infection of urinary tract, cystitis, vezikulity, a hypertrophy of a seed hillock. Consultations of the dermatovenerologist, the andrologist, the vascular surgeon, the psychotherapist (can be required by the patient with kollikulity at the accompanying neurosis).
Treatment of a kollikulit
Treatment is appointed taking into account the allocated activator. If there are no manifestations, resort to dynamic observation and recommend correction of behavior. At inefficiency of conservative therapy and a frequent recurrence the transurethral resection of a seed hillock can be executed. The same intervention is shown at an obturation of seed channels and infertility. Taking into account indications (expressiveness of complaints and changes at inspection, probability of a recurrence) include in the scheme of treatment:
- Antibiotics. Therapy of the first line at the confirmed inflammatory process. Empirical purpose of medicines at a kollikulita is not the best choice because of development of resistance to some antibiotics of a broad spectrum of activity (a ftorkhinolona, a tsefalosporina). During treatment recommend to the patient abstention from sexual life and refusal of extractive dishes, alcohol, marinades and so forth.
- Symptomatic means. At a kollikulita increase in a seed hillock can be so expressed that urine outflow therefore for improvement of quality of an urination appoint alpha is broken. At pains analgetics, spazmolitik, nonsteroid resolvents are shown. Flebotonik, as the all-strengthening means - polyvitamins with minerals apply adaptogens to improvement of blood circulation in a small pelvis.
- Physiotherapeutic influence. Magnitnoinfrakrasny laser therapy, low-intensive laser radiation, ultrasonic therapy, an electrophoresis with anesthetics (helps to reduce symptoms of a kollikulit at pains), with antibiotics, enzymes (at an inflammation), transurethral or transrectal thermotherapy and so forth. At patients 45 years before performance of physiotherapy are more senior investigate the level of the general DOG in blood.
- Local treatment. Instillations of an urethra by solutions with antimicrobic action (the contraindication - accompanying sharp uretrit, under the pressure of liquid there is a risk of distribution of pathogenic microflora), microenemas with broths of herbs, oils are carried out, rectal suppositories are used. Out of an aggravation perhaps sanatorium treatment in profile sanatorium.
Forecasts and prevention
The forecast at timely therapy favorable: dizurichesky symptoms, morbidity, violations of an erection disappear. Preventive actions include commitment to the monogamous relations, use of barrier methods of contraception at casual sexual contacts, timely sanitation of the infectious centers in an organism, and especially - in bodies of a small pelvis, physical exercises, regular sex life, observance of rules of hygiene. If kollikulit developed against the background of an infection, sexually transmitted, both partners are subject to treatment. Renewal of sex life is possible only after control of an izlechennost. Regular survey at the urologist and the timely address at the first symptoms of trouble can help with prevention of a number of complications.