Cystitis at men
Cystitis at men – the inflammatory process of urinary tract striking mucous a bladder and leading to violation of its functions. As displays of cystitis at men serve frequent painful urinations, pains in nadlobkovy area, emergence in urine of pathological impurity. The diagnostic complex at cystitis includes an urine research (microscopic, bacteriological), ultrasonography of a bladder, a tsistoskopiya, a tsistografiya, MSKT. Treatment of cystitis demands purpose of antimicrobic therapy, phytotherapy, physical therapy, symptomatic treatment from men.
Cystitis at men
Prevalence of cystitis among men is much lower, than among women. In urology cystitis is diagnosed for 0,5% of men, 40 years are mainly more senior. Not typicalness of cystitis for men is explained by features of a male urethra: the long, narrow, curved urethra in most cases detains an infection and interferes with its ascension in a bladder. At the same time, development of cystitis in men more often happens is caused by infravezikalny obstruction – the podpuzyrny sdavleniye of uric ways (at the level of an urethra or a neck of a bladder) interfering free outflow of urine.
Classification of cystitis
On etiofaktor allocate primary and secondary cystitis. At men refer sharp and chronic damages of a bladder to primary cystitis. In turn, sharp cystitis can be infectious genesis (nonspecific and specific), to be caused by thermal, chemical, medicinal, toxic, alimentary factors. Primary chronic cystitis can have an infectious, post-traumatic, parasitic etiology. More often cystitis at men has secondary and chronic character and develops against the background of the accompanying urological pathology of puzyrny or vnepuzyrny localization.
On degree of prevalence of an inflammation in a bladder cervical, focal and diffusion cystitis differs. Taking into account the nature of kliniko-morphological changes and endoscopic picture cystitis at men can carry the catarrhal, granulyatsionny, hemorrhagic, fibrinozny, ulcer, flegmonozny, gangrenous, necrotic, cystous, polipozny, inlaying, interstitsialny form.
The cystitis reasons at men
As the main reasons for cystitis at men the urological problems which are followed by infravezikalny obstruction and stagnation of urine act. Mechanical obstacles for outflow of urine can be created by foreign matters and stones of a bladder, tumors, diverticulums, adenoma of a prostate gland, striktury urethra. At boys cystitis quite often accompanies a fimoz – narrowing of extreme flesh, neurogenetic dysfunction of a bladder.
Infectious cystitis at men, as a rule, develops against the background of an uretrit, prostatitis, an orkhit, a vezikulit, an epididymite. Causative agents of cystitis at men, also as well as cystitis at women, nonspecific bacteria - E.coli (80%), as St mainly act. saprophyticus, Klebsiella, Proteus (15%), sinegnoyny stick, drozhzhepodobny fungi of Candida, etc. Specific cystitis at men is caused by mycoplasmas, hlamidiya, trichomonads, tuberculosis mikobakteriya, gonokokky. At men treat rare forms of cystitis actinomycosis, purple, , etc.
Infectious cystitis at men can develop ascending, descending, limfogenny, hematogenic, direct in the ways. At the ascending way of penetration activators get into a bladder from an urethra, a prostate gland, a small egg or its appendage, seed bubbles. The descending mechanism is noted at tuberculosis of kidneys, pyelonephritis, a pionefroza more often. The hematogenic drift of pathogenic microorganisms in a bladder comes from the remote purulent centers at the available tonsillitis, antritis, a furunkuleza, a pulpitis etc. Direct infection is, as a rule, connected with carrying out endourological manipulations - kateterization of a bladder, a tsistoskopiya. Also direct hit of pathogens in a bladder can happen in the presence of bladder fistulas, opening in a cavity of a bladder of appendicular infiltrate, prostate gland abscess.
Among the other factors increasing probability of development of cystitis in men it should be noted diabetes, spine injuries, transurethral operations (a resection of a prostate, tumors of an urethra, a bladder), stresses, overcoolings, abuses of alcohol, spicy food.
Cystitis symptoms at men
As the leading displays of sharp cystitis at men serve frequent urinations (including a nikturiya), imperative desires, the complicated and painful character of an urination (stranguriya), a terminal gematuriya, urine turbidity. Fever and oznoba, decrease in working capacity can be the accompanying symptoms.
Pain in the course of an urination, especially in its initial and final stage, is followed by gripes and burning in an urethra. Out of a miktion morbidity in nadlobkovy area, a groin, a scrotum, a penis is felt. The volume of a single portion of urine decreases to 10-20 ml, in some cases development of an incontience of urine is possible. The leykotsituriya and a piuriya, a microscopic or macroscopic gematuriya are typical signs of cystitis at men.
At severe forms of cystitis at men (hemorrhagic, flegmonozny, gangrenous) intoxication caused by high temperature of a body, an oliguriya develops. Urine has muddy color, a putrefactive smell, contains impurity of blood, fibrin, layers of a sawn-off mucous membrane.
Chronic cystitis at men is characterized by more poor symptomatology, can have wavy or continuously stable current. At chronic cystitis at men an urination not so frequent and painfully painful; the leykotsituriya, a proteinuria, a periodic mikrogematuriya, slime impurity in urine remains. At men paracystitis (an inflammation of okolopuzyrny cellulose), pyelonephritis, a sclerosis of walls of a bladder with sharp reduction of its capacity can be cystitis complications.
Diagnosis of cystitis at men
Men with suspicion of cystitis have to be exposed to comprehensive examination at the urologist. At men with cystitis survey of genitals, a scrotum palpation, a prostate gland research through a rectum is obligatory. These researches allow to confirm or exclude communication of cystitis with fimozy, orkhoepididimity and prostatitis.
For definition of the pathological flora causing cystitis in men bacteriological sowing of urine and urethral dab, a scrape PTsR-research on sexually transmitted infections are carried out. In the general analysis of urine erythrocytes, leukocytes, slime and an epithelium in a large number are found; sour reaction of urine is characteristic of tubercular cystitis. For an exception of the organic obstruction which is quite often accompanying cystitis at men the urofloumetriya is carried out; for the purpose of confirmation or an exception of a detruzorno-sfinkterny dyssynergia - urodinamichesky inspection.
Performing ultrasonography of a bladder at sharp cystitis at men is complicated as patients cannot save up the urine allowing to visualize bubble walls in the straightened state. Therefore paramount value the pathological changes of uric ways allowing to reveal, cystitis complications get ultrasonography of a prostate from men with determination of residual amount of urine and ultrasonography of kidneys.
At a makrogematuriya, and also chronic cystitis at men the tsistoskopiya is shown. During endoscopic inspection it is possible to distinguish character and a form of an inflammation, to reveal stones, tumors, foreign matters of a bladder, to take a biopsy. In doubtful situations, and also for a difdiagnostika the tsistografiya, a multispiral tsistouretrografiya is carried out.
Treatment of cystitis at men
In a sharp phase of cystitis observance of a bed rest, plentiful drink (not less than 2-2,5 l of liquid a day), an exception of sharp, spicy, salty, sour products, alcohol, abstention from intimacy is required from men. At a sharp delay of urine or not stopped pain hospitalization can be required.
Etiotropny treatment of cystitis demands reception of antimicrobic means from men: more often than ftorkhinolon, tsefalosporin, nitrofurans; more rare - penicillin, within 5-7 days. In therapy of cystitis at men purpose of phytotherapy, vegetable uroseptik is shown. For removal of a pain syndrome the injection and tableted NPVS forms, spazmolitik are used.
Washings of a bladder by antiseptics carrying out predpuzyrny, vnutripuzyrny, presakralny novokainovy blockade are in certain cases carried out. After knocking over of an acute inflammation treatment of cystitis at men is supplemented with physical therapy: sessions of an induktotermiya, electrophoresis, UVCh-therapy, ultrasound, magnetotherapy and magnetolaser therapy, mud applications. spazmolitik.
At identification at the man of the urological diseases accompanying cystitis, their elimination – therapy of pyelonephritis, prostatitis, an epididimoorkhit, an urolithic disease, prostate adenoma, an adenomektomiya is necessary. At deformations of a neck of a bladder it is shown the TOUR of a bladder; at striktura of an urethra its buzhirovaniye is carried out. The cicatricial sclerosis of a bladder can demand performance of a unilateral nefrostomiya, imposing of an ureteroureteroanastomoz, an ureterosigmoanastomoz, carrying out an ileotsistoplastika.
Prevention of cystitis at men
Respect for intimate hygiene, prevention of STD, exception of stressogenny factors and overcooling, timely treatment of diseases of the men's sexual sphere, pyelonephritis, sanitation of the purulent centers allows to prevent development of cystitis in men. When performing endovezikalny researches and manipulations careful observance of an asepsis, a preliminary antibiotikoprofilaktika is necessary.