The female genitourinary system is vulnerable due to its anatomical location.

Diseases of the genitourinary system in women and their symptoms often do not begin to appear immediately, so you should be careful about your body, and when the first signs of disease appear -.

What concerns the organs of the genitourinary system in women?

The genitourinary system is a complex of interconnected human internal organs responsible for the urinary system and the reproductive system.

Womens urinary system includes organs:

• two kidneys located in the abdominal region. A paired organ that fulfills the goal of maintaining chemical balance in the body. Cleans it from toxins and harmful substances. On the kidneys there are pelvis - places of accumulation of urine, which systematically enters the ureter;
• ureters. Paired tubes that carry urine from the kidneys to the bladder
• ... Organ of urine fluid accumulation;
• urethra. The organ that facilitates the release of urinary fluid from the body to the outside.

Womens reproductive system includes external and internal organs. External include:

• the labia are large. They are fatty folds of the skin that protect the organ from external influences;
• the labia are small. The folds of skin that are under the large lips. A genital gap is located between the small and large sponges;
• clitoris. It is an organ responsible for sensitivity, it has the main function of the erogenous zone. It is surrounded by the labia minora and is located under the upper junction of the labia majora;
• the entrance to the vagina. This is a small opening in front of the lower junction of the labia majora. Protected by the hymen, between it and the inner lips are concentrated Bartholin glands, which serve to provide lubrication during sexual intercourse.

Internal female genital organs include:

• ovaries. The organ has the form of two oval bodies, which are connected to the body of the uterus from the side of its back wall. The ovaries produce an important hormone for reproduction, as well as for the entire female body - estrogen;
• uterus. The piriformis muscle is located in the pelvic region. Designed for bearing the fetus, as well as for its rejection at birth. In the canal of the uterus, which passes into the vagina, mucus is concentrated, it helps to protect the organ;
• fallopian (fallopian) tubes. They pass from the corners of the uterine fundus to the ovaries, promote the advancement of the mature follicle into the uterine cavity;
• vagina. Muscular tubular organ extending from the cervix to the genital slit. Covered from the inside with a mucous membrane, which provides protection against pathogenic organisms through the secretion of lactic acid.

The state of the woman's urinary system is monitored by a nephrologist, and the reproductive system - by a gynecologist.

Common diseases

Diseases of the female genitourinary organs are most often manifested already at a certain stage of development... If we consider the urinary system, then its most common diseases are:

1. ... An inflammatory disease that occurs in the kidneys is most often concentrated in the renal pelvis. It can occur both on one kidney, and on both. In most cases, it has a bacterial etiology;
2. urethritis. The disease is caused by inflammation of the urethra (urethra), caused by a viral infection or the influence of pathogenic bacteria. The course of the disease can be acute or chronic;
3. urolithiasis disease. It is characterized by a large accumulation of salts in the structure of urine, as a result of which calculi are formed in the bladder or in other ureters;
4. cystitis. Inflammation of the bladder tissue. The mucous membrane can be affected, as a result of which the functioning of the organ is disrupted.

(The picture is clickable, click to enlarge)

Read how to treat cystitis during pregnancy in our article.

Common diseases of the female reproductive system include:

1. vaginitis. An inflammatory process that occurs in the mucous membrane of the walls of the vagina. Has a bacterial etiology;
2. chlamydia. The disease, as a rule, is sexually transmitted, characterized by the presence of pathogenic bacteria chlamydia in the vaginal microflora;
3. thrush (candidiasis). Fungal pathology, which is caused by the spread of yeast fungi. May affect the mucous membranes of the vagina, skin;
4. uterine fibroids. Benign formation of hormonal etiology, which can occur inside the uterus or in its outer walls;
5. ... A benign formation located on the body of the ovary can transform into a malignant one;
6. cervical erosion. It is caused by damage to the epithelium, or the wall of the uterine cervix;
7. endometriosis. It is characterized by the proliferation of the inner mucous layer of the uterus. In some cases, it can spread into the vagina or abdomen.

Any disease of the genitourinary system of women requires treatment. In some cases, surgery is necessary.

When should you see a doctor?

Diseases of the genitourinary system may be asymptomatic only at the initial stage. Most often, signs of the disease can appear as the pathology spreads.

The most common signs of diseases of the female genitourinary system are:

• violation of urination, characterized by too frequent urge (cystitis, urethritis, pyelonephritis);
• painful urination, as well as pain, stinging and odor when emptying the bladder (cystitis, urethritis);
• itching and irritation in the external genital organs (candidiasis, chlamydia);
• edema of the genitals (urethritis, candidiasis);
• pain syndromes in the lower back (cystitis, pyelonephritis);
• high fever (pyelonephritis, chlamydia);
• feeling of a foreign body in the uterus, heaviness (fibroids);
• abundant discharge, the presence of ichor in the discharge, discharge of a curdled structure (thrush, chlamydia);
• pain during intercourse (fibroids);
• Bloody veins in the urine (cystitis)
• rashes of a different nature on the genitals;
• abdominal pain (fibroids, endometriosis).

Any diseases of the female genitourinary system sooner or later manifest themselves and cannot be hidden. If a woman often has a stomach ache, uncharacteristic discharge appears, itching or rashes on the genitals worries, then you need to see a doctor right away.

It is impossible for a woman to diagnose a disease on her own, since many diseases can have similar symptoms.

In addition, improper treatment can aggravate the course of the disease, which negatively affects health.

How to check if there is a disease?

The doctor can prescribe diagnostic measures in accordance with the symptoms with which the woman turned to the medical institution:

• After getting acquainted with the patient's complaints, the doctor can conduct an abdominal cavity, feel the temperature of the muscles of the lower back and peritoneum.
• With a visual examination, the doctor can detect inflammation of the tissues of the external genital organs, probe for neoplasms.
• Examination with a speculum can help examine the condition of the mucous membrane.
• Colposcopy helps to determine the state of the inner lining of the uterus, detect fibroids, erosion, and also take tissue sections for histology.

After examination and palpation, the doctor prescribes the following measures related to to laboratory diagnostics:

• blood, urine (characterizes the presence of inflammatory processes in the blood or urine);
• biochemical blood test (contributes to the detection of renal failure);
• examinations of smears from the vagina, urethra (determine the presence or absence of pathogenic microorganisms);
• , cytology (bacterial culture contributes to the identification of genitourinary infectious agents, cytology determines the presence of infectious and cancerous diseases).

Hardware diagnostic methods give detailed information about the state and structure of the woman's internal urogenital organs:

The complex of diagnostic measures depends on the pathology assumed during the initial examination. The doctor may confine himself to smears and a general blood test (for candidiasis), or prescribe a whole range of measures (for renal failure). In accordance with the results obtained, the specialist makes a diagnosis and selects a treatment.

How to treat?

Diseases of the woman's genitourinary system are most often associated with inflammatory processes. Therefore, to suppress pathogens, you should take antibacterial drug... However, only a doctor can prescribe an antibiotic based on tests and identification of the pathogen.

The course of antibiotics should be drunk completely, otherwise untreated diseases can become chronic.

In addition, along with antibacterial tablets, the doctor may prescribe immunostimulating agents.

Treatment of neoplasms (fibroids, cysts) may be limited to taking hormonal drugs, but may lead to surgery.

In addition to medication, it is possible, with the consent of the doctor, to resort to traditional medicine. For this, vegetable preparations and berries are used as decoctions (blueberries, leeks, dill seeds, steel roots). In addition to decoctions of herbs for inflammation of the urinary tract, a decoction of viburnum with honey is used.

Prophylaxis

In order to prevent female diseases, a girl should monitor the hygiene of the genitals from an early age: care in the intimate area should be done daily. In addition, it is necessary adhere to simple rules:

• do not overcool;
• wear cotton underwear;
• use a condom during intercourse.

It is important to eat right, not to get carried away with spices and fatty foods, to exclude alcohol. If diseases occur, they should be treated on time, lead a healthy lifestyle. Systematic visit to the doctor will help to identify diseases at an early stage of development.

Compliance with the above measures can protect a woman from various diseases associated with the genitourinary system.

A set of exercises to restore the genitourinary system of women in the video:

Urinary tract infection is a condition of infection of the urinary tract by microflora that causes inflammation. In Russia, the prevalence of UTI is 1000 cases per 100 thousand population per year, this is the most common infection. UTIs are 50 times more common in women than in men. Most often, there is acute uncomplicated cystitis, somewhat less often - uncomplicated pyelonephritis. Recurrent UTIs develop in 20-30% of pre-menopausal women. By the age of 50, the frequency of UTIs in men and women is comparable. The cost of treating UTIs in the United States is $ 1.6 billion per year, and one episode of acute cystitis is $ 40-80. Nosocomial UTIs cause death in 50,000 patients annually.

Classification. Distinguish between upper (pyelonephritis) and lower urinary tract infections (cystitis, prostatitis, urethritis) by the presence or absence of symptoms (symptomatic or asymptomatic bacteriuria), by the origin of the infection (community-acquired or nosocomial, complicated and uncomplicated. accompanied by functional or anatomical abnormalities of the upper or lower urinary tract.Risk factors for complicated UTI - anatomical and functional disorders, congenital abnormalities, vesicoureteral reflux, sex life, gynecological surgery, urinary incontinence, frequent catheterization; in men also - uncircumcised foreskin, homosexuality , benign prostatic hyperplasia, intravesical obstruction Metabolic and immunological disorders, foreign bodies in the urinary tract, calculi, urinary disorders, advanced age of the patient, spinal cord lesions and multiple sclerosis, Sakha Diabetes mellitus, neutropenia, immunodeficiency, pregnancy, instrumental research methods contribute to UTI. In men, most UTIs are considered complicated. Complicated UTIs are predominantly nosocomial; complicated forms account for 45% of all UTIs in adult outpatients. UTIs are complicated by urolithiasis, diabetes mellitus, renal cysts, nephroptosis. Among nosocomial infections, about 80% of UTIs are associated with bladder catheterization. The catheter should be removed within 4 days of catheterization.

Etiology. For uncomplicated UTI - E. Coli; with complicated UTIs are more common Proteus, Pseudomonas, Klebsiella, mushrooms.

The source of uropathogenic microorganisms is the intestine, the anal region, the vestibule of the vagina and the periurethral region. Inflammation most often develops in conditions of impaired outflow of urine in combination with a decrease in the general reactivity of the body. UTI is characterized by microbial colonization in the urine of more than 104 colony-forming units (CFU) of microorganisms in 1 ml of urine and (or) microbial invasion with the development of an infectious process in any part of the urethra from the external opening of the urethra to the renal cortex.

The following types of UTI are distinguished: severe bacteriuria, minor bacteriuria, asymptomatic bacteriuria, and contamination. UTIs are verified when the number of microbial bodies is more than 105 CFU in 1 ml in two consecutive portions of freshly released urine and confirmed by microscopic examination of urine in order to exclude vaginal contamination, in which a false-positive result is often observed. A decrease in urine output and a lack of injected fluid contribute to the multiplication of bacteria. Asymptomatic bacteriuria is often detected during routine examinations, and is more typical for older men with benign prostatic hyperplasia.

Contamination refers to two different conditions: bacterial contamination and the moment of infection. Contamination should be considered in cases where there is a small growth of bacteria or several types of bacteria are sown from the urine. The isolation of more than one microorganism from urine should always be interpreted with caution and should take into account the dominance of any one microorganism, the presence of leukocytes and clinical symptoms.

Diagnostics. A common screening test reagent, the biochemical reagent strip, detects the presence of leukocyte esterase (pyuria) and evaluates the reactivity of nitrate reductase. A negative test strip result will rule out infection. In practice, erythrocytes and leukocytes that make up the urinary sediment are lysed at urine pH greater than 6.0, with low urine osmolarity, prolonged standing of urine; therefore, false negative results on urine microscopy are more common than false positive results on a test strip. Leukocyturia does not always indicate the presence of bacteriuria. The source of leukocytes can be inflammatory processes in the female genital organs, it can persist after spontaneous or drug disappearance of bacteriuria. Microscopic examination of urine sediment is mandatory.

The use of phase contrast technique facilitates the identification of most cellular elements in comparison with light microscopy. At high magnification (40 times), the detection of 1-10 microorganisms in the field of view determines bacteriuria, and the presence of more than 10 leukocytes in the field of view - pyuria. Gram stain and acid resistance studies of bacteria should be performed in patients with symptoms of UTI and pyuria when routine urine cultures are negative.

Treatment. The goals of antimicrobial treatment and prevention of UTIs are to eradicate pathogens from the genitourinary system and prevent exacerbation or reinfection. The choice of an antibiotic is based on the spectrum of action of the drug, the sensitivity of microorganisms, the pharmacokinetic and pharmacodynamic properties of the antibiotic, and side effects. According to the recommendations of the Federal Guidelines for Physicians, adult patients should be prescribed fluoroquinolones and fosfomycin trometamol (single dose), children should be prescribed inhibitor-protected β-lactams and oral cephalosporins II-III generation. In pregnant women, the first-line drugs are I-III generation cephalosporins, fosfomycin trometamol (single dose), an alternative to which can be amoxicillin (including with clavulanic acid, nitrofurantoin and cotrimoxazole).

In most cases, lower urinary tract infection is combined with neuromuscular disorders of the smooth muscle elements of the urinary tract and pelvic organs; in this case, the addition of antispasmodics to complex therapy is indicated. The herbal preparation Cyston is effective (2 tablets 2 times a day). The extracts of saxifrage, strawberry and other plant components contained in it have a pronounced antimicrobial, anti-inflammatory, antispasmodic and diuretic effect; other components reduce the risk of urinary tract stones; antimicrobial effect is manifested with any acidity of urine. The drug is effective for antibiotic resistance of microorganisms.

Table 1

Antibiotic regimens for uncomplicated UTIs

In most cases, antibiotic therapy is indicated, except for asymptomatic bacteriuria. The goals of antibiotic therapy are: rapid resolution of symptoms, eradication of pathogens, reduction in the number of relapses and complications, and reduction in mortality. The success of treatment is largely determined by the correction of urogenital pathology. With asymptomatic bacteriuria, antibiotic therapy should only be prescribed:

1) pregnant women, when, due to dilatation of the ureters, the development of an ascending infection is possible, which is associated with a high risk of premature termination of pregnancy (allows to reduce the frequency of pyelonephritis by 75%);

2) patients who are supposed to have an intervention on the gastrointestinal tract;

3) dialysis patients who are supposed to have a kidney transplant;

4) before carrying out invasive diagnostic urological procedures;

5) during immunosuppression.

In elderly patients with asymptomatic bacteriuria, antimicrobial therapy usually does not prevent symptoms. An antibiotic is not prescribed for empirical therapy if the level of resistance of the main pathogens to it exceeds 10-20%. Due to the high level of resistance of microorganisms, ampicillin and cotrimoxazole cannot be recommended for empiric treatment of UTI, the drug of choice is fluoroquinolones. Fluoroquinolones have a bactericidal effect, have a wide range of antimicrobial activity, including against multi-resistant strains of microorganisms, have a high bioavailability when taken orally, have a fairly high half-life, create a high concentration in urine, and penetrate well into the mucous membranes of the urogenital tract and kidneys ... The effectiveness of fluoroquinolones in UTI is 70-100%, these drugs are well tolerated, the frequency of side effects is 2-4%. The optimal duration of the course of treatment for acute uncomplicated cystitis according to the results of the meta-analysis is 3 days. Fluoroquinolones are the drugs of choice for the treatment of complicated and nosocomial UTIs (ciprofloxacin). Bacteriological efficacy - 84%, clinical - 90%, the course of treatment should be at least 7-14 days 500 mg 2 times a day.

In half of women, after the first episode of cystitis, its relapse develops within a year. The frequency of recurrence is associated with the anatomical and physiological characteristics of the female body (short and wide urethra, proximity to the natural reservoirs of infection - anus, vagina; adhesion of gram-negative microorganisms to epithelial cells of the urethra and bladder; frequent concomitant gynecological diseases, hormonal disorders (dysbacteriosis) predisposition, anomalies in the location of the external part of the urethra, the presence of sexually transmitted infections).

The chronization of the process is facilitated by unreasonable and irrational antibiotic therapy. STIs (sexually transmitted infections - chlamydia, trichomoniasis, syphilis, ureaplasmosis, genital herpes) are detected in almost a third of patients with pyelonephritis and in half with cystitis. The causative agents of urogenital infections are detected by the PCR (polymerase chain reaction) method.

Treatment of NIMP (uncomplicated infection of the lower genital tract) should be etiological and pathogenetic and should include antibiotic therapy lasting up to 7-10 days, the choice of drugs is carried out taking into account the isolated pathogen and antibioticogram, antibiotics with a bactericidal effect are preferable. The drugs of choice for non-obstructive pyelonephritis are fluoroquinolones and nitroimidazoles; with recurrent cystitis - fluoroquinolones, fosfomycin trometamol (3 g 1 time in 10 days for 3 months), bacteriophages. Comprehensive treatment should also include, according to indications:

1) correction of anatomical disorders;

2) STI therapy, in which the drugs of choice are macrolides (josamycin, roxithromycin, azithromycin), tetracyclines (doxycycline), fluoroquinolones (moxifloxacin, levofloxacin, ofloxacin), antiviral agents (acyclovir, valacyclovir), treatment of sexual partners;

3) postcoital prophylaxis (cotrimoxazole 200 mg, trimethoprim 100 mg, nitrofurantoin 50 mg, cephalixin 125 mg, norfloxacin 200 mg, ciprofloxacin 125 mg, fosfomycin trometamol 3 g);

4) treatment of inflammatory and dysbiotic gynecological diseases;

5) correction of unfavorable hygienic and sexual factors;

6) correction of immune disorders;

7) local therapy;

8) the use of hormone replacement therapy in patients with estrogen deficiency.

Acute pyelonephritis is a nonspecific infectious inflammation of the calyx-pelvic system and renal parenchyma. The incidence of acute pyelonephritis in Russia is 0.9-1.3 million cases per year. At the age of 2 to 15 years, girls suffer from acute pyelonephritis 6 times more often than boys, the same ratio at a young age; in old age, this disease often develops in men.

Etiology and pathogenesis. Acute pyelonephritis is a consequence of an ascending infection from foci of chronic inflammation in the female genital organs, lower urinary tract, and less often in the large intestine; called Escherichia E. Coli(In most cases), Klebsiella, Proteus, Pseudomonas... The hematogenous path of development of acute pyelonephritis is less common than the ascending one; its source is an acute or subacute inflammatory process outside the urinary tract: mastitis, furuncle, carbuncle. For the development of pyelonephritis, predisposing factors are necessary - a violation of hemodynamics or urodynamics in the kidney or upper urinary tract.

Clinic acute pyelonephritis depends on obstruction in the urinary tract. In a non-obstructive process, the disease begins with dysuria with a rapid rise in body temperature to high numbers. Chills, pain from the affected kidney join body temperature; chills are replaced by pouring sweat with a short-term decrease in body temperature; pain in the lumbar region may appear during urination and in this case manifest itself to chills and flushing (vesicoureteral reflux). If after them the pain no longer recurs (rupture of the fornix of one or more cups and resorption of urine) - fornic reflux. In obstructive acute pyelonephritis (occlusion of the ureter with a stone, products of chronic inflammation of the kidney, external compression - retroperitoneal fibrosis, cancer of the internal genital organs in men and women, enlarged lymph nodes), the disease begins with gradually increasing or acutely developed lower back pain from the side of the lesion with the subsequent development of chills and an increase in body temperature. Shiny eyes, a blush on the cheeks, a clean tongue, pain on palpation of the abdomen in the hypochondrium and a positive symptom of tapping in the lower back (Pasternatsky's symptom) from the side of the affected kidney are also determined.

Diagnostics. Pyuria, bacteriuria are determined by laboratory. Ultrasound examination, computed tomography exclude anatomical and functional abnormalities of the urinary tract. Computed tomography and magnetic resonance imaging provide information about the condition of the affected kidney and surrounding tissues, which is especially important in a purulent-destructive process.

Treatment. Patients should be urgently admitted to a urological hospital in case of obstructive disease, since it is necessary to restore the passage of urine.

An early appointment of antibiotic therapy is necessary to prevent the development of urosepsis.

Empiric antimicrobial treatment is based on history, suspected etiology, and regional resistance of the underlying pathogens. If parenteral antibiotic therapy was originally prescribed, then after 1-2 days it can be replaced with an oral regimen of the drug. Conventional therapy lasts 10-14 days. An increased concentration of C-reactive protein can be considered as a basis for continuing antibiotic therapy; if, with computed tomography, magnetic resonance imaging or scintigraphy, foci of inflammation or abscesses are detected, then it is necessary to extend the therapy to 4-8 weeks. Otherwise, frequent recurrences of UTI with short periods of remission are possible.

The antimicrobial spectrum of antibacterial drugs for empiric therapy should be maximally adapted to the list of the main pathogens.

In the treatment of acute pyelonephritis, the most commonly used cephalosporins of the II-III generation, fluoroquinolones, inhibitor-protected aminopenicillins and aminoglycosides. Because of the resistance of many uropathogens to the most commonly used antibiotics, it becomes necessary to prescribe fluoroquinolones. Drugs from this group, united by a common mechanism of action (inhibit the synthesis of the key enzyme of the bacterial cell - DNA gyrase) are characterized by a wide spectrum of antimicrobial activity and favorable pharmacokinetic properties, their excretion is mainly renal: levofloxacin (tavanic) (500 mg once a day in severe infection ), gatifloxacin (400 mg), moxifloxacin (400 mg), trovafloxacin (200 mg) for 7-10 days. Complete microbial eradication of the pathogen is achieved in 95.5% of cases.

Initial antimicrobial therapy with levofloxacin is justified in such cases as:

1) a history of repeated episodes of UTI within the last 6 months;

2) in patients with diabetes mellitus;

3) the presence of clinical manifestations of the disease for more than 2 days;

4) no effect within 2 days from the start of antimicrobial therapy with other drugs.

Antibiotics are combined with chemotherapy drugs, at the same time they give an abundant drink (cranberry juice), they carry out detoxification therapy. For pain in the area of ​​the affected kidney, thermal procedures (heating pads, warming compresses, diathermy), pain relievers are indicated. Meals should be high-calorie enough (up to 2000 kcal per day), not abundant, without limiting the intake of table salt.

Forecast. Recovery with timely diagnosis and early treatment of acute pyelonephritis. In cases of late recognition, development of bacterial shock or urosepsis, the prognosis is poor. Untimely and irrational treatment of pyelonephritis leads to chronic pyelonephritis. Patients who have undergone acute pyelonephritis are subject to dispensary observation throughout the year. In the coming months after recovery, heavy physical labor, work associated with cooling, dampness, and nephrotoxic substances are contraindicated.

Prevention. General strengthening measures that increase the body's resistance, the fight against common infections, the elimination of aseptic bacteriuria (especially in high-risk groups - among children of preschool and school age, pregnant women, gynecological patients (preventive examination of women by a gynecologist, vaginal sanitation, compliance with hygiene rules)), mandatory treatment of cystitis by a urologist.

Chronic pyelonephritis is observed in 35% of urological patients.

Morphology. This disease is characterized by focality and polymorphism of the inflammatory process in the kidney. There are 4 stages of development of chronic pyelonephritis, in which there is a rapid and pronounced damage to the tubules in comparison with the glomeruli. In stage I, the glomeruli are intact, there is a uniform atrophy of the collecting tubules and diffuse leukocyte infiltration of the interstitial tissue. In stage II, hyalinization of individual glomeruli occurs, tubular atrophy is even more pronounced, there is a decrease in inflammatory interstitial infiltration and proliferation of connective tissue. In stage III, many glomeruli die, most of the tubules are sharply expanded; in stage IV, most of the tubular glomeruli die, the kidney decreases in size and is replaced by scar tissue. The outcome of chronic pyelonephritis depends on the presence and degree of disturbance in the outflow of urine from the renal pelvis: with normal passage of urine, nephrosclerosis (shrunken kidney) develops, and with urinary stasis, pyonephrosis. With bilateral chronic pyelonephritis or damage to a single kidney in the terminal stage, chronic renal failure develops. Nephrogenic hypertension develops in 7-38% of patients with chronic pyelonephritis. Depending on the degree of activity of the inflammatory process in the kidney in chronic pyelonephritis, the active phase of inflammation, the latent phase and the remission phase are distinguished. Variants of the course of chronic pyelonephritis: latent pyelonephritis, recurrent, anemic, hypertensive, azotemic.

Clinic. Chronic pyelonephritis is characterized by a paucity of general clinical symptoms due to the slow, sluggish course of the inflammatory process in the interstitial tissue of the kidney. The disease is usually detected several years after cystitis or other acute process in the urinary tract by accidental examination of urine or by examination for urolithiasis, arterial hypertension, renal failure. Common symptoms of chronic pyelonephritis: low-grade fever, general weakness, fatigue, lack of appetite, nausea, vomiting, anemia, discoloration, dry skin, arterial hypertension. Local symptoms: back pain, impaired urination (polyuria or oliguria) and urination (dysuria, pollakiuria, etc.), changes in urinalysis: leukocyturia, bacteriuria, proteinuria, hematuria. With secondary chronic pyelonephritis, local signs are often expressed due to concomitant or underlying urological disease (pain in the corresponding half of the lower back of an aching or paroxysmal nature). With bilateral chronic pyelonephritis, various signs of chronic renal failure appear.

Diagnostics. Of great importance is the detection of bacteriuria and leukocyturia, the detection of Sternheimer-Malbin cells and active leukocytes in the urine sediment. Latent leukocyturia is detected by provocative tests (prednisolone, pyrogenal).

Immunological methods are used for the diagnosis of chronic pyelonephritis, based on the detection of autoantibodies to renal antigens using the complement binding reaction and the passive hemagglutination reaction. Antirenal antibody titers increase with exacerbation of chronic pyelonephritis. To diagnose chronic pyelonephritis and determine the activity of the process, the titer of antibacterial antibodies is important, which in the phase of active inflammation is more than 1: 160. Patients with chronic pyelonephritis have a more pronounced violation of tubular reabsorption compared with glomerular filtration according to clearance tests; violation or absence of release of indigo carmine during chromocystoscopy. The vertical location of the kidney, as well as an increase in its size and unevenness of the contours are found on the plain urogram, tomograms or zonograms of the urinary tract. Excretory urography, in addition to changing the size of the kidneys and their contours, allows you to establish the deformation of the cups and pelvis, violation of the tone of the upper urinary tract. On excretory urograms in the initial stages of chronic pyelonephritis, there is a decrease in concentration and a slow release of a radiopaque substance by the affected kidney. In the later stages of the disease, the deformation of the cups is noted: they become rounded, with flattened papillae and narrowed necks.

According to angiographic signs, there are 3 stages of chronic pyelonephritis.

Stage I is characterized by a decrease in the number of small branches of segmental arteries until they disappear completely; large segmental arteries are short, conically narrowed towards the periphery, have almost no branches, this phenomenon is called a "burnt tree" symptom.

Stage II of chronic pyelonephritis is characterized by diffuse narrowing of the arterial bed of the entire kidney; small branches of the interlobar arteries are absent. The nephrogram has irregular contours, the cortex is inhomogeneous, and its size is reduced.

In stage III, there is a sharp narrowing of all vessels of the kidney, their deformation and a decrease in the number. The size of the kidney is significantly reduced, the contours are uneven - a wrinkled kidney.

The thermography method notes an increase in temperature in the lumbosacral region in the presence of active chronic pyelonephritis. Isotope renography allows you to determine the functional state of the kidneys, their blood supply, tubular functions. Scanning makes it possible to obtain an image of the size and contours of the kidneys, to reveal large-focal defects in the accumulation of radioisotope substances in the kidney tissue. Dynamic kidney scintigraphy also reveals small foci of pyelonephritis in the form of a decrease in the accumulation of activity, a slowdown in isotope excretion. Sometimes a kidney biopsy is done.

Differential diagnosis carried out with chronic glomerulonephritis, renal amyloidosis, glomerulosclerosis, renal tuberculosis, necrotizing papillitis, spongy kidney, interstitial nephritis, nephrosclerosis, renal hypoplasia, kidney multicystosis.

Treatment. Elimination of the focus of infection in the body: chronic tonsillitis, carious teeth, furunculosis, chronic constipation. In case of violation of the passage of urine, its outflow from the kidney is restored. With unilateral chronic pyelonephritis that does not respond to therapy, or pyelonephrotic wrinkling of one kidney, complicated by arterial hypertension, nephrectomy is indicated. Long-term antibacterial treatment is carried out with intermittent courses in accordance with the nature of the microflora. Antibiotics alternate with taking sulfonamides, chemotherapy drugs, derivatives of the nitrofuran series. In this case, it is necessary to prescribe an abundant alkaline drink to prevent the crystallization of drugs in the tubules. Sequential or combined administration of antimicrobial drugs for 1.5-2 months, as a rule, allows to achieve clinical and laboratory remission in most patients with chronic pyelonephritis. During the next 3-6 months after remission, intermittent maintenance therapy with antibacterial drugs is used (10-day courses 1 time per month). In the intervals between these cycles, herbal treatment is prescribed. With persistent long-term remission of chronic pyelonephritis (after 3-6 months of maintenance therapy), antibacterial agents are not prescribed.

Within a year after acute pyelonephritis and at least 5 years after exacerbation of chronic pyelonephritis, anti-relapse therapy is carried out: the first 7-10 days of each month, taking uroseptic (1 time at night in 1/4 of the daily dose). The next 20 days - collecting herbs (diuretics, antiseptic litholytics, anti-inflammatory, strengthening the vascular wall, improving the vitamin composition of the body). Fees are assigned for 3-6 months. Physiotherapeutic procedures with anti-inflammatory and resorption effects are also used. In a number of cases, the issues of surgical correction of urinary tract anomalies are resolved. Patients with chronic pyelonephritis should consume a sufficient amount of fluids and table salt. The diet excludes foods rich in extractives: spices, marinades, smoked meats, sausages, canned food, spices.

Forecast depends on the primary or secondary nature of the lesion, the intensity of treatment, concomitant diseases. The recovery of primary acute pyelonephritis occurs in 40-60%, primary chronic - 25-35%. The consequence of the timely diagnosis of chronic pyelonephritis, long-term and persistent treatment can be the cure of the patient and the complete restoration of working capacity. Hard physical work, cooling, dampness, contact with nephrotoxic substances are contraindicated. With renal failure and severe hypertensive syndrome, patients are transferred to disability.

Dispensary supervision is constant.

Kidney abscess - a limited purulent inflammation, characterized by the fusion of kidney tissue and the formation of a cavity filled with pus, is one of the forms of acute purulent pyelonephritis.

Etiology. A kidney abscess develops as a result of purulent fusion of the parenchyma in an inflammatory infiltrate. In some cases, granulation, limiting it from healthy tissues, develops in the circle of the focus of suppuration, in others, the process spreads to the surrounding perirenal fatty tissue, leading to the development of purulent paranephritis, in others, the abscess is emptied into the renal pelvis, which leads to cure.

Clinic depends on the presence and degree of impairment of the passage of urine. Hectically, the body temperature rises, chills, sweat, headache, vomiting are observed, pulse and respiration become more frequent, pronounced leukocytosis with a predominance of neutrophilia. The absence of hyperleukocytosis is an unfavorable sign indicating a decreased reactivity of the organism.

Diagnostics. The diagnosis is based on palpation of an enlarged painful kidney, a positive Pasternatsky symptom, the presence of bacteriuria and pyuria, which can be significant when an abscess breaks into the renal pelvis. An overview of the kidneys shows an increase in the size of the kidney and bulging of its outer contour in the zone of localization of the abscess, on excretory urography - restriction of the mobility of the kidney at the height of inspiration and after expiration, deformation or amputation of the renal calyx, compression of the renal pelvis.

On the retrograde pyelogram, in addition to the indicated signs, with a breakthrough of pus into the renal pelvis, additional shadows are determined as a result of filling the abscess cavity with a radiopaque fluid. On isotope scintigrams, an avascular mass is revealed, on echograms - a cavity in the zone of kidney abscess.

Treatment surgical: decapsulation of the kidney, opening of the abscess, drainage of the cavity; in case of violation of the passage of urine, the operation ends with a pyelo- or nephrostomy.

Significant changes in the parenchyma are an indication for removal of the kidney.

At the same time, antibacterial, detoxification therapy is carried out.

A kidney carbuncle is one of the forms of acute pyelonephritis, in which a purulent-necrotic pathological process develops in a limited area of ​​the renal cortex.

Etiology and pathogenesis. Most often, the kidney carbuncle occurs as a result of blockage of a large terminal vessel of the kidney by a microbial embolus that has penetrated from the focus of inflammation into the body (boil, carbuncle, mastitis, osteomyelitis, etc.) with blood flow. At the same time, blood circulation is disturbed in a limited area of ​​the cortical layer of the kidney, which leads to its ischemia and necrosis, and subsequently microorganisms that have penetrated here cause a purulent-inflammatory process. A carbuncle can also develop as a result of the fusion of small abscesses in apostematous pyelonephritis, compression of the final vessel of the renal cortex with a purulent-inflammatory infiltrate. A carbuncle can be single or multiple, it has a different size, is localized more often in the cortex of the kidney, but sometimes spreads to the medulla. The carbuncle is raised above the surface of the kidney, contains a large number of small abscesses.

In later stages, purulent fusion of the carbuncle occurs. The inflammatory process in the perirenal tissue can be limited to leukocyte infiltration, but it can lead to its purulent fusion. With a favorable course, the infiltrate dissolves with the formation of connective tissue in its place.

Clinic. The manifestations of the kidney carbuncle are similar to the clinical picture of other forms of purulent pyelonephritis. The main signs are a sharp general weakness, pallor of the skin, high body temperature of a hectic nature with tremendous chills and torrential sweats, oliguria, a decrease in blood pressure. Local symptoms: tension of the muscles of the anterior abdominal wall and lower back, a sharply positive symptom of Pasternatsky, sometimes an enlarged and painful kidney is clearly palpable, but these local symptoms are not always detected. There is a high leukocytosis with a shift of the leukocyte count to the left.

Diagnostics. The diagnosis is difficult due to the fact that with a single carbuncle of the kidney, the function of the affected kidney is not disturbed for a long time, and there are no changes in the urine. The most valuable in the diagnosis of kidney carbuncle are X-ray, isotopic and ultrasound research methods. An overview of the urinary tract shows an increase in the size of the kidney segment, focal swelling of its outer contour, and the disappearance of the contour of the psoas muscle on the affected side. On excretory urograms or retrograde pyelogram, either compression of the cups or pelvis, or amputation of one or more cups are detected. On renal arteriograms in the arterial phase, an avascular area in the cortical layer of the kidney is determined, and on the nephrogram - a wedge-shaped image defect. Due to the predominance of the general symptoms of the infectious process, the kidney carbuncle can be mistaken for an infectious disease, sometimes for a tumor of the kidney parenchyma, suppuration of a solitary kidney cyst, acute cholecystitis.

Treatment. Massive antibiotic therapy is carried out, but it cannot lead to a cure, since drugs do not enter the lesion due to a violation of the blood circulation in the carbuncle of the kidney. In the first 2-3 days of the disease, surgical treatment is carried out - decapsulation of the kidney, excision of the carbuncle and drainage of the perirenal tissue. At the same time, the disturbed passage of urine is restored. With multiple carbuncles of the kidney, which have destroyed the entire parenchyma, and a functioning opposite kidney, nephrectomy is indicated, especially in elderly and senile people.

Prophylaxis ensured by the timeliness of the initiated rational therapy of acute pyelonephritis, as well as purulent inflammatory processes of various localization.

Forecast. The prognosis depends on the timeliness of the surgical intervention. Delay with it can lead to death and sepsis. With timely surgery, the prognosis is favorable.

Apostematous pyelonephritis - suppuration of the renal parenchyma with the development of multiple small abscesses in it (apostem), is one of the late stages of acute pyelonephritis.

Etiology and pathogenesis. Regardless of the location of the primary purulent focus in the body, the infection enters the kidney through the hematogenous route. Inflammatory infiltrates spread along the interstitial perivenous tissue, reaching the surface of the kidney into the subcapsular space. This leads to the appearance of pustules on the surface of the kidney. Unilateral apostematous pyelonephritis occurs as a result of upper urinary tract obstruction. The kidney, affected by apostematous pyelonephritis, is enlarged, congestively plethoric, a large number of small abscesses are visible through the fibrous capsule; with the progression of apostematous pyelonephritis, the pustules merge, forming an abscess or carbuncle; when the process spreads to the perineal tissue, purulent paranephritis develops.

Clinic disease depends on the presence and degree of impairment of the passage of urine. General weakness, pain throughout the body, decreased appetite, nausea, sometimes vomiting, dry tongue, rapid pulse corresponding to body temperature, tremendous chills followed by a rise in temperature to 39-40 ° C and torrential sweats, pain in the kidney area are characteristic; symptoms of peritoneal irritation appear, muscle tension of the anterior abdominal wall. Exudative pleurisy may develop if the infection spreads through the lymphatic tract. The patient's condition is serious, in the later stages renal function is impaired, renal-hepatic syndrome with jaundice develops.

Diagnostics. The diagnosis is substantiated by laboratory and radiological data: high blood leukocytosis with a shift of the leukocyte formula to the left, bacteriuria, leukocyturia. The plain urogram shows a curvature of the spine towards the disease and the absence of a shadow of the psoas muscle on this side. The kidneys are enlarged. With damage to the upper segment of the kidney, an effusion into the pleural cavity is determined. Excretory urography during the patient's breathing or at the height of inhalation and exhalation determines the limitation of the mobility of the affected kidney, its function is reduced. In a later stage of apostematous pyelonephritis and in violation of the passage of urine, these symptoms are more pronounced, the function of the affected kidney is sharply impaired, significant bacteriuria and leukocyturia are revealed. Dysfunction of the affected kidney can be established with excretory urography and chromocystoscopy. Renograms show a violation of vascularization, secretion and excretion. The differential diagnosis is carried out with infectious diseases, acute pancreatitis, acute cholecystitis, retrocecal appendicular process.

Treatment. Surgical treatment consists in decapsulation of the kidney, opening of abscesses, drainage of the perirenal space, and in case of impaired passage of urine, the renal pelvis by imposing a pyelo- or nephrostomy. In some cases, it becomes necessary to remove the affected kidney. They use broad-spectrum antibiotics, sulfonamides, nitrofurans. A change of antibiotics, infusion therapy, vitamin therapy, taking analgesics, antispasmodics are carried out. Also useful are cranberry juice, a decoction of plantain, horsetail, eleutherococcus extract.

Clinical examination of patients who have undergone apostematous nephritis is reduced to monitoring the function of the remaining kidney, if the patient underwent nephrectomy.

Treatment is carried out after the patient is discharged for 4–6 months.

Forecast always serious due to the high mortality rate, reaching 5-10%, and the subsequent development of a chronic inflammatory process in the kidney.

Infectious toxic shock is a state of circulatory failure, which is caused by a sudden massive effect of bacterial toxins on the patient's body.

Etiology. The process develops as a result of the introduction into the blood stream of a large number of various microorganisms that form endotoxin. Bacteremic shock is preceded by the appearance of a purulent focus in the urinary or genital organs (pyelonephritis, prostatitis), more often in middle or old age, especially in people with concomitant diseases that weaken the body (diabetes mellitus, cardiopulmonary, hepatic, renal failure). As a result of renal-pelvic reflux, a huge number of microorganisms and microbial endotoxin enter the bloodstream. The effect of endotoxin on the vascular wall and the patient's body leads to shock with hypovolemia, a decrease in blood pressure, severe intoxication, often accompanied by acute renal failure.

Clinic. Signs: tremendous chills, an increase in body temperature of a hectic nature, a drop in blood pressure. The patient is pale, covered with cold sweat, pulse is frequent, weak, blood pressure is low, circulating blood is thickened, hyperglycemia, dysproteinemia, dyselectrolitaemia, acidosis, azotemia are detected. Stages of bacteremic shock in urological patients: early (prodromal), developed and irreversible. The first stage is observed on the first day after the provoking moment and is characterized by a slight deterioration in the condition (chills, an increase in body temperature, a moderate decrease in blood pressure). The second stage occurs in the first hours or during the first day and is characterized by collapse, chills, fever, and a sharp deterioration in the condition. The third stage is characterized by severe cardiovascular and renal failure. Lethality is 40-50%.

Diagnostics. The diagnosis is based on the clinical picture of laboratory data (an increase in the number of leukocytes in the blood with a shift of the leukocyte formula to the left, an increase in hematocrit, a small number of platelets, an increase in the number of red blood cells and hemoglobin). The progression of shock is evidenced by hyperglycemia, dysproteinemia, dyselectrolythemia, hyperazotemia. Blood and urine cultures are taken.

Treatment should be intensive, massive antibiotic therapy is needed, and if the focus of inflammation is closed, it should be urgently drained by surgery. In acute pyelonephritis and ureteral occlusion, an urgent ureteral catheterization should be performed; if it is impossible to pass the catheter above the obstacle, then urgent renal decapsulation, nephrostomy is indicated. Infusion therapy includes transfusion of plasma, plasma-substituting fluids, vasopressors, corticosteroids are prescribed, acid-base and electrolyte balance is corrected.

Prevention. Timely start of treatment of purulent-inflammatory diseases of the genitourinary organs, emergency drainage of closed purulent foci, correct management of the postoperative period.

Forecast. The prognosis is relatively favorable only if the necessary measures are applied in the early stage of bacteremic shock; in other cases, the prognosis is often poor.

Paranephritis is an inflammation of the perineal tissue.

Etiology. The causative agents are more often staphylococcus, E. coli, pneumococcus, mycobacterium tuberculosis. Primary paranephritis occurs as a result of hematogenous spread of infection from the focus - a boil, carbuncle, panaritium, tonsillitis. A contributing factor is injury to the lumbar region. Secondary paranephritis is mainly a complication of a purulent-inflammatory process in the kidney (abscess, carbuncle, calculous and tuberculous pyonephrosis), in the retroperitoneal tissue, abdominal organs (purulent appendicitis, liver abscess). The infection penetrates into the perineal tissue by hematogenous, lymphogenous, contact routes.

Paranephritis has an acute or chronic course. In acute paranephritis, edema and infiltration of cellulose are initially observed, which subsequently undergo reverse development or purulent fusion of adipose tissue with the formation of an abscess (purulent paranephritis).

Development of total paranephritis is possible. A purulent focus of perirenal tissue can break through into the abdominal cavity, intestines, bladder, pleural cavity, under the skin of the lumbar region, descend to the iliac region, the anterior surface of the thigh. Chronic paranephritis as a result of an acute or initial disease acquires a chronic course. Chronic paranephritis ends with hardening of adipose tissue or the proliferation of altered adipose tissue.

Clinic. Acute paranephritis begins with a sudden increase in temperature to 38-40 ° C, accompanied by chills, the temperature is initially constant, then hectic. Pain in the lumbar region appears 1-3 days after the onset of the disease, spreads anteriorly and downward to the thigh; their intensity increases with movement, especially when straightening the leg, therefore, the leg on the affected side is bent at the knee and hip joint, slightly brought to the stomach. The patient's condition is usually severe: general weakness, severe intoxication, dry tongue, rapid pulse according to body temperature. In the future, there is a curvature of the spine in the direction opposite to the lesion, smoothness of the contours of the waist; the skin of the lumbar region is infiltrated, edematous, infiltration in the lumbar region with indistinct contours is palpable. In acute secondary paranephritis, the disease is characterized by the symptoms of the disease that caused the paranephritis. Chronic paranephritis is manifested by back pain, symptoms of secondary sciatica. A dense, lumpy formation resembling a kidney tumor is palpated.

Diagnostics. The diagnosis of acute paranephritis is rather difficult before the onset of local symptoms of the disease. The most important diagnostic signs: back pain, aggravated by movement, pasty and hyperemia of the skin in the lumbar region, flattening of the waist, characteristic position of the limb, motionless infiltration in the lumbar region, increased skin temperature of the lower back, high leukocytosis, accelerated ESR, anemia. If the kidneys are not affected, then no changes are found in the urine tests. If the initial purulent process is localized in the kidney, then pyuria, bacteriuria are found. Chest X-ray with secondary paranephritis reveals limited mobility of the dome of the diaphragm, the presence of concomitant pleurisy. On the survey urogram - the curvature of the spine or the absence of the contours of the psoas muscle. On excretory urograms and retrograde pyelogram in primary paranephritis - displacement of the kidney, absence or sharp limitation of the mobility of the kidney on the side of paranephritis during the patient's breathing. With secondary paranephritis, signs characteristic of the primary disease are found. Computed tomography, ultrasound examination is informative for diagnosis.

Differentiate paranephritis with pyonephrosis and kidney tumor.

Treatment conservative and operational. At an early stage of the disease, antibiotics of a wide spectrum of action are shown, a strengthening and symptomatic treatment is carried out: intravenous infusion of solutions, vitamins, heart drugs, analgesics; diet therapy, physiotherapy. When an abscess is formed, lumbotomy and drainage of the abscess cavity are performed. In chronic paranephritis, treatment in the absence of pyonephrosis and enclosed abscesses is conservative: antibiotics, paraffin and mud applications, diathermy.

Prevention. Timeliness of therapeutic measures for inflammatory processes in the kidney, abdominal organs and retroperitoneal space.

Forecast in case of acute paranephritis with early diagnosis and early start of treatment, it is favorable, efficiency is restored. In chronic paranephritis, the prognosis depends on the degree of impairment of urodynamics and kidney function, work capacity is reduced, especially after nephrectomy.

Cystitis is an inflammation of the mucous membrane of the bladder, the most common disease of the urinary tract.

Etiology. The infection is caused by E. coli or pathogenic Staphylococcus aureus, in women, due to anatomical features, it develops much more often, since the ascending infection predominates. Nonbacterial cystitis is possible with allergic conditions, complications of drug therapy. With adenovirus infections, hemorrhagic cystitis develops.

Hypothermia, stressful situations, weakening of the body predispose to disease. The infection enters the bladder by a descending route from the kidneys, an ascending route through the urethra, by hematogenous or contact routes. Distinguish between acute and chronic cystitis.

Clinic. Pain in the lower abdomen, spreading to the perineum, genitals, urge to urinate, frequent urination with cuts. Patients often do not retain urine, sleep and appetite are disturbed, irritability, weakness appear, body temperature is normal. Acute phenomena last 4-7 days. Course: from mild forms (improvement in 3-5 days) to severe with severe intoxication.

Diagnostics. The diagnosis is made on the basis of complaints, discharge of cloudy urine, sometimes with blood clots, proteinuria, leukocyturia, bacteriuria, squamous epithelium, erythrocytes. When urine is cultured, microflora growth takes place. The examination of three portions of urine taken from the bladder with a sterile catheter sometimes helps to exclude inflammatory diseases of the external genital organs during examination.

Endoscopic examinations are contraindicated.

Dysuric disorders can be a symptom of inflammation of the retrocecal or pelvic appendix in combination with frequent loose stools; a finger examination reveals a sharply painful infiltration on the right.

Treatment. In acute cystitis, bed rest, baths with a warm solution of furacilin or a decoction of chamomile, UHF physiotherapy, microwave therapy, drinking plenty of fluids are prescribed; diet excludes acute substances. Broad-spectrum antibiotics in combination with nitrofurans, sulfonamides; for severe pain - baralgin, papaverine suppositories.

Forecast favorable for acute cystitis and proper treatment: relief after 1-2 weeks.

Chronic cystitis is a secondary disease that complicates the course of urolithiasis, kidney tuberculosis, and prostate diseases.

Clinic. Pain in the lower abdomen, frequent urination with sharpness, urge to urinate, pus in the urine.

Diagnostics. The diagnosis is based on anamnesis data, urinalysis, cystoscopy, X-ray examination. In women, the genitals are additionally examined, in men - the prostate gland. Small bladder capacity is noted with tuberculosis.

Differential diagnostics. Differentiate with neurogenic diseases of the bladder, cystalgia.

Treatment. Establish the root cause of the disease for the purpose of treatment. Antibacterial therapy is carried out in combination with nitrofurans, sulfonamides. The bladder is washed with warm solutions of aseptic agents. Trichomonas cystitis is treated in parallel with colpitis.

Forecast depends on the underlying disease, the ability to work is reduced, hard physical labor, work in cold rooms, at chemical plants is contraindicated.

Urethritis is an inflammation of the urethra, infectious or non-infectious.

Etiology. Infectious urethritis are divided into venereal (gonorrheal, trichomonas, viral) and non-venereal (staphylococcal, streptococcal, colibacillary). Pathogens penetrate into the mucous membrane of the urethra by hematogenous or urogenic routes with kidney disease or balanoposthitis. Non-infectious urethritis occurs when irritated by chemicals, contraceptives, and foreign bodies. Non-gonorrheal urethritis can begin acutely, torpidly and latently.

Clinic. Pain when urinating, burning, purulent discharge from the urethra. With a torpid current, these symptoms occur after intercourse, drinking alcohol and spicy foods. With a latent course of complaints, there are no complaints. Periodically, inflammation in the urethra is exacerbated and manifests itself as symptoms of acute urethritis. With a long course, the process extends to the posterior part of the urethra, the prostate gland, and the epididymis. With viral urethritis, the conjunctiva of the eyes and joints are also affected.

Diagnostics. The diagnosis of urethritis is based on the patient's complaints, the results of examination of the external opening of the urethra (hyperemia of the mucous membrane, purulent discharge), urine tests (urethral inflammatory filaments, leukocytosis), microscopy and the results of seeding of urethral secretions.

Differential diagnostics. Differentiate with gonorrheal and Trichomonas urethritis, the basis of differential diagnosis - bacteriological examination of pus, smears and scrapings from the mucous membrane of the urethra, urethroscopy.

Treatment urethritis begins after a thorough microscopic and bacteriological examination of urine and discharge from the urethra. For acute urethritis, broad-spectrum antibiotics are effective; antibiotics are combined with sulfonamides. The course of treatment lasts 5-7 days, at which time sexual intercourse is excluded, a dairy and plant diet is prescribed. Plentiful drinking is prescribed, the use of alcoholic beverages is prohibited. With untimely and irregular treatment, acute urethritis can turn into chronic. Treatment of chronic urethritis consists in the appointment of antibacterial therapy with a change of drugs every 5-7 days, local treatment aimed at eliminating foci of inflammation in the mucous membrane and submucosa, irrigation of the urethra with aseptic agents, fish oil, sea buckthorn and rosehip oil is carried out.

Prophylaxis consists in the exclusion of casual sexual intercourse and the observance of hygienic rules.

Forecast favorable for acute urethritis, with chronic inflammation, reproductive function may be impaired, impotence may develop due to the transition of inflammation to the genitals.

Urethral stricture is a persistent narrowing of its lumen as a result of scar tissue replacement; congenital and acquired strictures are distinguished.

Etiology. The most common causes are inflammatory diseases (most often - gonorrhea), ulceration, chemical, traumatic injuries. Inflammatory narrowings are often multiple and are located in the hanging or bulbose part of the urethra. Inflammatory strictures are elastic, in contrast to gross cicatricial narrowings, which are located in the membranous and bulbose portions of the urethra. Usually, the narrowing of the urethra is short (2-3 cm), the lumen of the narrowing is different; gradually above the urethra, expansion is formed as a result of the pressure and stasis of urine during urination. Constant urinary retention leads to urethritis, urethral stones, and even urinary fistulas that open onto the perineum or scrotum.

Clinic. In the initial period, lasting several weeks, it is still impossible to detect anatomical narrowing of the lumen, and there are no clinical signs; in the second period, the thickness and shape of the urine stream changes, its strength decreases, and the duration and frequency of urination increase. If the short and narrow stricture is in front of the urethra, then the urine stream is thin but strong; if the stricture is located in the back of the urethra, then the urine stream thickens, but loses strength and becomes lethargic; with a long stricture, the urine stream is weak, does not describe an arc, falls vertically at the patient's feet, sometimes it is released in drops. All symptoms gradually progress, fever and pain in the urethra periodically join. Epididymitis, orchitis, prostatitis, painful ejaculation, hypospermia may occur. In the third period, when the narrowing of the urethra reaches an extreme degree, all of these symptoms intensify. To empty the bladder, the patient must strain the abdominal press, take an unusual position. Gradually, the tone of the muscles of the bladder, previously compensatory hypertrophied, weakens, the bladder is not completely emptied. Acute urinary retention may occur, followed by paradoxical ischuria. Impaired dynamics of the upper urinary tract contributes to the development of pyelonephritis, sometimes kidney stones.

Diagnostics. Diagnosis is based on history (trauma, urethritis); determine the localization, caliber and length of the constriction using a bougie; the most valuable diagnostic tool is urethrography.

Treatment instrumental (bougie) or operational. Bougienage is combined with resorption therapy (aloe extract, vitreous humor, hyaluronidase preparations). Surgical intervention consists of urethrotomy and a number of other operations.

Forecast with a timely, correctly chosen method of treatment, favorable; recurrence of stricture even after operations is noted in 8-10%, after bougienage - more often. Patients are subject to dispensary observation.

Prostatitis is an inflammation of the prostate gland, which can be combined with an inflammatory lesion of the posterior part of the urethra, seminal tubercle and seminal vesicles. More often observed at the age of 30-50 years. Acute and chronic are distinguished along the current.

Etiology acute prostatitis: any pyogenic microbe (staphylococcus aureus), getting into the prostate gland, can cause an inflammatory process in it. Ways of infection in the gland are hematogenous (after infectious and purulent diseases), lymphogenous (with inflammatory processes in the rectum), canalicular (from the back of the urethra). Hypothermia contributes to the development of prostatitis. According to the stages of the disease, catarrhal, follicular and parenchymal acute prostatitis are distinguished. Purulent damage to the follicles and fiber can lead to their destruction and the formation of an abscess, which sometimes spontaneously opens into the urethra, rectum, perineum and leads to pelvic phlegmon. With parenchymal prostatitis in advanced cases, paraproctitis and paracystitis, sepsis can develop.

Clinic. Catarrhal prostatitis can be characterized by pollakiuria, especially at night, pain in the perineum, sacrum, and often soreness at the end of urination. With follicular prostatitis, pain in the perineum and sacrum is more intense, intensifies during defecation, radiates to the anus, difficulty urinating is observed, the urine stream is thin, rarely - urinary retention. Body temperature from subfebrile to 38 ° C. Parenchymal prostatitis proceeds with signs of general intoxication (weakness, decreased appetite, nausea, vomiting, adynamia); body temperature rises to 38-40 ° C, chills periodically occur; dysuria occurs day and night; pain in the perineum is intense, throbbing; acute urinary retention is often noted; the act of defecation is difficult. When a prostate abscess occurs, all symptoms become more intense. If the abscess spontaneously opens, then the patient's condition improves significantly.

Diagnostics. The diagnosis of acute prostatitis is based on symptoms, data from palpation of the prostate gland through the rectum, urine and blood tests. In the catarrhal form, the gland is almost not enlarged and is only slightly sensitive to palpation. When follicular - moderately increased, clearly painful, increased density in some areas with uneven contours. With parenchymal, it is sharply tense and painful, of a dense consistency, the longitudinal groove is often smoothed. With an abscess, fluctuation is determined. After palpation and secretion into the urethra, areas of softening are determined. In the analyzes of urine in the second portion, a large number of purulent filaments, leukocyturia, more significant in the last portions, inflammatory changes in the blood (leukocytosis with a stab shift of the formula) are determined.

Treatment. Bed rest, broad-spectrum antibiotics, sulfonamides, analgesics for pain, for constipation - laxatives. Locally: warm sitz baths 38-40 ° C for 10-15 minutes and microclysters with a temperature of 39-40 ° C from 1 glass of chamomile infusion with the addition of 1-2% novocaine solution, sage decoction 3-4 times a day. The liquid is slowly injected into the rectum, where it is left for as long as possible. The patient should take a semi-sitting or semi-recumbent position (the patient lies down on the bed, putting pillows under his head and back). With severe pain and dysuria, paraprostatic novocaine blockade can be performed. Milk-vegetable diet, drink plenty of fluids. With an abscess of the prostate gland, its opening through the perineum or rectum and its drainage are shown.

Prevention. Avoid hypothermia (sitting on cold ground, swimming in cold water), lead an active mobile lifestyle. Prevention of complications of acute prostatitis - long-term treatment with control of the secretion of the prostate gland 2-3 weeks after the elimination of the inflammatory process; compliance with diet and regularity of sexual activity.

Forecast in acute catarrhal and follicular prostatitis favorable. Timely treatment ensures the complete elimination of the inflammatory process within 10-14 days. To eliminate parenchymal prostatitis, you need at least 3-4 weeks; this form of prostatitis often becomes chronic and can be complicated by disorders in the genital area up to complete aspermia, if the inflammatory process affects the ejaculatory ducts.

Prostate abscess is a complication of acute prostatitis.

Etiology. There is a penetration of pyogenic bacteria into the gland, especially often staphylococci. The disease develops with insufficient treatment of acute prostatitis as a result of purulent fusion of the follicles of the prostate gland, the fusion of purulent foci leads to the formation of an abscess.

Clinic. Distinguish between general symptoms (tremendous chills, increased body temperature of a hectic nature, torrential sweat, tachycardia, rapid breathing, headache, general malaise, leukocytosis with a shift in the formula to the left). Local signs - acute pain in the anus, perineum and above the pubis, frequent and difficult urination and defecation, terminal hematuria, often pyuria, which sharply increases when an abscess breaks into the urethra. Perhaps spontaneous opening of an abscess of the prostate gland, not only into the urethra, but also into the rectum, bladder, rarely into the abdominal cavity. In this case, the patient's condition improves significantly. In most cases, the disease develops within 7-10 days.

Diagnostics. The diagnosis is usually straightforward. Severe pain in the perineum and rectum, the general serious condition of the patient, fluctuations in the prostate gland during its rectal examination allow you to determine the abscess. With the spread of the inflammatory process to the surrounding tissue, a breakthrough of the abscess to the surrounding tissue, significant infiltration along the lateral walls of the rectum is determined. A severe complication of abscessed prostatitis is phlebitis of the surrounding venous plexus.

Treatment consists in urgent surgical intervention - opening the abscess by the perineal access or through the rectum and draining its cavity. Antibacterial and detoxification therapy is carried out.

Forecast always serious, lethal outcomes, severe complications, the transition of the disease into a chronic course are possible; with timely surgical treatment, the prognosis for life is favorable.

Chronic prostatitis is an inflammatory disease of an infectious origin of the parenchymal and interstitial tissue of the prostate gland, the result of acute inflammation or primary chronic course.

Epidemiology. It is detected in 8-35% of men 20-40 years old.

Etiology. Infection or congestion with a sedentary lifestyle, alcohol intake, masturbation, disturbed rhythm of sexual intercourse. It is characterized by the focal lesion, the formation of infiltrates, zones of destruction and scarring.

Gram-negative germs are the most common cause. Sexual dysfunction adversely affects the course of chronic prostatitis.

Classification(US National Institutes of Health, 1995).

Phases of the course: the phase of active inflammation, latent and remission.

Pathogenesis. Inflammatory process with the addition of autoimmune disorders.

Clinic. Complaints of discomfort in the genital area, pulling pain in the sacrum, above the bosom, in the perineum; increased pain at the end of intercourse or subsiding during it, difficulty, frequent urination, especially in the morning, prostatorrhea, which occurs in the morning, while walking, physical exertion. It is characterized by a decrease in the tone of the excretory ducts of the prostate gland. Sexual dysfunction - impotence.

Diagnostics. The diagnosis is based on the patient's complaints, data from digital examination of the prostate gland through the rectum, analysis of the secretion of the prostate gland.

A digital examination reveals a slight increase in the size of the prostate gland, moderate pain, uneven surface of the gland due to depressions or infiltrates; the gland is pasty; at the time of its examination, a secret can be abundantly secreted from the urethra. The secretion of the gland contains an increased number of leukocytes (over 6-8 in the field of view) and a decrease in the number of lecithin grains. Great importance is attached to a separate examination of the prostate gland after massage, bacteriological examination with the determination of antibioticograms.

For bacteriological diagnosis of prostatitis, the method is usually used Meares and Stamey, consisting in a sequential study of the first and middle portion of urine, prostatic secretion and urine obtained after massage of the prostate. Analysis of the prostate secretion obtained by massage is not very informative. Only 20% of patients with chronic prostatitis show signs of inflammation in the secretion of the prostate gland; in other cases, normal secretion indicators may indicate obstruction of the excretory ducts of the organ lobules. The diagnosis of chronic bacterial prostatitis is established if the microbial count exceeds 103 / ml. Ultrasound sonography is limited in information content. Uroflowmetry - a way to determine the state of urodynamics, allows you to determine the signs of bladder outlet obstruction. With a prolonged inflammatory process, urethroscopy or urethrocystography is performed. Puncture biopsy of the prostate can differentiate between chronic prostatitis, cancer or benign prostatic hyperplasia. There are no clear diagnostic criteria for chronic abacterial prostatitis.

Treatment. Tasks - stopping the infection, restoring the immune response, prostate function.

Antibiotics are prescribed for chronic bacterial prostatitis, chronic abacterial prostatitis (category III A, if there is clinical, bacteriological, immunological evidence of prostate infection). The nature of microflora, the sensitivity of microorganisms, side effects, the nature of previous treatment, doses and combinations of antibacterial drugs, combination with other methods of treatment are taken into account. A sufficient concentration in the secretion and tissue of the prostate gland is created by tetracyclines, macrolides, fluoroquinolones, rifampicin, cotrimoxazole. The drugs of choice are fluoroquinolones (levofloxacin, mofloxacin, sparfloxacin), the duration of antibiotic therapy is 2-4 weeks, if there is no effect, then therapy continues for another 2-4 weeks. When using cotrimoxazole, the duration of treatment is 1–2 months. In addition to antibacterial drugs, treatment includes the treatment of urethritis, drugs aimed at improving microcirculation, immunomodulators, non-steroidal anti-inflammatory drugs, physiotherapy. New approach - use? 1 -adrenergic blockers; it is advisable to prescribe them for chronic prostatitis of category III B (prostatodynia), with severe urinary dysfunction and the absence of an active inflammatory process; treatment period from 1 to 6 months (doxazosin). Prostatilen, diclofenac, wobenzym, enerion, gelarium, citalopram, pentoxifylline (phosphodiesterase inhibitor) reduce inflammation, troxevasin, detralex improve venous outflow. Levitra (vardenafil) is a selective inhibitor of phosphodiesterase-5, concentrated in the tissues of the corpora cavernosa of the penis and platelets, improves blood supply to the organ, sexual function, and stimulates testicular function.

Also used are suppositories "Vitaprost" of plant origin, containing biologically active peptides isolated from the prostate gland of cattle. The drug helps to normalize microcirculation, spermatogenesis, helps to restore the function of the prostate, increase the activity of the secretory epithelium of the acini, eliminate stagnation of secretions, normalize the content of leukocytes in the secret, eliminate microorganisms from it, increase immunity, nonspecific resistance of the body, normalize hemostasis; pain syndrome decreases, sexual function improves (increased libido, restoration of erectile function). Mode: 20-30-minute walks before and after sleep, limiting food in the evening, sleeping on a hard bed, physiotherapy exercises (skiing, skating, hiking, swimming). Compliance with the regime of work and rest, active movements and physical activity, sexual and emotional life; psychotherapy. Alcohol, spices, spices are categorically excluded from food. The prostate is 3/4 a muscular organ, therefore its electrical stimulation is justified, which leads to sanitation and improved function. The best training for the sexual apparatus is a full sex life.

Physiotherapy:

1) physiotherapy effects daily or every other day (20 sessions);

2) impulse fluctuating stimulation;

3) sinusoidal modulated currents;

4) ultrasound therapy;

5) laser infrared transrectal irradiation;

6) finger massage.

Finger massage of the prostate gland: before the massage, the patient does not completely empty the bladder, but does it after the massage to remove the pathological secretion; massage is performed without tension, gradually increasing its intensity, which allows you to normalize the secretion of the prostate gland, relieve the patient from pain, and improve the consistency of the gland. The absence of a secret after massage is an indication for stopping the massage. If the pain intensifies after the massage, this indicates the intensity of the infiltrative-cicatricial process in the prostate gland, in these cases, thermal procedures, anti-sclerotic and provocative therapy are first carried out. Thermal procedures are carried out in the form of sitz baths and microclysters with chamomile, antipyrine (1 g per 50 ml of hot water).

Prevention. Treatment of acute prostatitis, adherence to recommendations on the regimen, diet, sex life; prevention of intestinal diseases.

Forecast. The prognosis is favorable on condition of persistent long-term treatment.

Orchitis is an inflammation of the testicle.

Etiology. It often develops as a complication of an infectious disease: mumps, influenza, pneumonia, typhus, tuberculosis, brucellosis, trauma. The infection spreads hematogenously or lymphogenously.

Clinic. The disease has an acute or chronic course. In acute orchitis, there is edema of the testicular tunica, infiltration of the interstitial tissue. The testicle is tense, sharply painful on palpation, significantly enlarged, with a smooth surface. There are severe pains in the scrotum with irradiation along the spermatic cord and in the lumbosacral region, the skin of the scrotum is hyperemic, edematous, hot to the touch. The veins of the spermatic cord are dilated, the body temperature is elevated. Chills, leukocytosis, accelerated ESR are noted.

Acute orchitis often abscesses, with spontaneous opening of the abscess, a purulent fistula is formed. A common complication of orchitis is epididymitis. In the case of inguinal, congenital or acquired hernia, abdominal cryptorchidism, orchitis can lead to peritonitis. Acute traumatic orchitis is characterized by persistence of local inflammatory phenomena, a longer duration of the disease and more frequent abscess formation of the testicle with the formation of fistulas. Mumps in about 20% of cases is complicated by orchitis, in adults - more often. The onset is acute, pain, high body temperature for 3-4 days. Chronic orchitis can occur after acute orchitis or immediately acquire a chronic course; the disease proceeds slowly, the testicle grows, thickens, moderate pains appear, subfebrile body temperature; gradually the testicle atrophies, with bilateral orchitis, this leads to azoospermia and impotence.

Diagnostics. The diagnosis is based on clinical signs (syphilitic orchitis is characterized by the absence of pain, the appendage often remains unchanged, the disease proceeds imperceptibly, an increase in the scrotum is detected by chance). Nonspecific orchitis must be differentiated from tuberculosis and testicular tumor, syphilitic and tuberculous orchitis. To diagnose brucellosis orchitis, anamnesis, serological reactions, and leukopenia are taken into account. In tuberculosis, the testicle is usually affected secondarily.

Treatment. With nonspecific acute orchitis, bed rest, a diet with the exception of spicy foods and alcoholic beverages, wearing a suspensor, cold, novocaine blockade of the spermatic cord, broad-spectrum antibiotics are prescribed. As the acute symptoms subside (after 4-5 days), you can use warming compresses, UHF therapy, electrophoresis. The testicular abscess is opened and the wound is widely drained. With significant damage to the testicular tissue, the lack of effect from conservative treatment, especially in old age, removal of the testicle is indicated. Treatment of chronic orchitis occurs through the use of predominantly physiotherapy procedures. Orchitis due to mumps requires broad-spectrum antibiotics, sulfa drugs, and corticosteroids. In case of brucellosis orchitis, brucellosis vaccine is additionally administered.

Prevention. Prevention of orchitis and infectious diseases, wearing a suspensor.

Forecast with timely treatment of the initial forms of orchitis, it improves significantly.

Vesiculitis (spermatocystitis) is an inflammation of the seminal vesicles.

Etiology. The infection enters the seminal vesicles from the back of the urethra through the ejaculatory ducts, the prostate gland, the wall of the rectum and hematogenously, the development of aseptic vesiculitis occurs with prolonged sexual abstinence. Distinguish between acute and chronic vesiculitis.

Clinic. Acute vesiculitis is manifested by pain in the perineum, rectum irradiating to the penis, testicles, pain and painful urging during the act of defecation. Urination is more frequent, accompanied by a burning sensation in the urethra. Sexual excitability is increased, frequent erections and emissions are noted. Painful intercourse; orgasm is accompanied by pain radiating to the prostate gland and perineum. The disease proceeds with chills and a rise in body temperature to 38-39 ° C.

Diagnostics. The diagnosis is based on the history data. Palpation of the prostate gland and seminal vesicles is painful, the secretion of the prostate gland contains pus. The septic state lasts about a week. The contents of the seminal vesicles burst into the surrounding organs or the urethra.

Treatment. Treatment is conservative and surgical. Massive antibiotic therapy is prescribed with 2-3 broad-spectrum antibiotics in combination with nitrofurans, sulfonamides; thermal procedures (thermal baths 37-40 ° C), paraffin applications have a positive effect. For pain, analgesics, antispasmodics are prescribed. The diet is milk-vegetable. Surgical treatment is indicated in the formation of empyema and the threat of its opening into the surrounding organs and the abdominal cavity.

Forecast favorable.

Chronic vesiculitis - the outcome of acute inflammation of the seminal vesicles, develops with untimely and incomplete treatment of acute vesiculitis.

Clinic. Pain in the lower back, groin, above the pubis, in the perineum, burning sensation in the urethra, pain during orgasm, frequent erections.

Diagnostics. The diagnosis is based on anamnestic data, the results of palpation of the seminal vesicles. In the secret of the prostate gland, an increased number of leukocytes, erythrocytes, oligo- or azoospermia is determined. With vesiculography, the degree of changes in the seminal vesicles is specified.

Treatment. Long-term antibacterial therapy, massage of seminal vesicles, use of thermal procedures; for pain - novocaine blockade, suppositories, thermal baths.

Forecast unfavorable for sexual and reproductive function.

Differentitis - inflammation of the vas deferens, observed with epididymitis, prostatitis and vesiculitis.

Etiology. Gram-positive and gram-negative microbial flora growing in the urethra.

Clinic. Pain in the groin, along the spermatic cord, in the sacrum. The spermatic cord is thickened, painful on palpation.

Treatment conservative: antibacterial agents and thermal treatments.

Forecast favorable.

Cavernitis is an inflammation of the cavernous bodies of the penis.

Etiology. Infection can penetrate into the corpora cavernosa from the outside, through the skin of the penis, from the urethra during inflammation or hematogenous from distant foci of inflammation, is relatively rare. May be acute or chronic.

Clinic. It develops suddenly and quickly, accompanied by high body temperature, pain in the penis, painful, prolonged erections, in which the penis is curved, since the process most often develops on one side. A painful infiltration in the corpus cavernosum, sometimes with an area of ​​fluctuation, is determined by palpation. Chronic cavernitis can be the outcome of an acute one or develop gradually, while in the thickness of the cavernous bodies, foci of compaction appear and increase, as a result of which the penis is deformed during erection and sexual function becomes impossible.

Differential diagnostics. Diagnosis in acute cavernitis is relatively simple. Chronic cavernitis must be differentiated from:

1) sarcoma of the corpora cavernosa, which is characterized by faster growth, the absence of inflammation; with gums of the penis, which are less dense in consistency, round and give a positive Wasserman reaction;

2) fibroplastic induration of the penis, in which the seals are located along the periphery of the corpora cavernosa, have the shape of a plate and a cartilaginous consistency;

3) tuberculosis.

Treatment. In acute cavernitis - massive antibiotic therapy, locally - first cold, then warm, with signs of suppuration - opening an abscess, in chronic cavernitis antibiotics and chemotherapy are used, resorption treatment (aloe extract, vitreous body), physiotherapy (diathermy, mud applications).

Forecast. The prognosis is not always favorable in terms of recovery, since the scars remaining at the site of inflammatory foci in the corpora cavernosa impair erection.

Prostate stones are a relatively rare disease.

Etiology. Stones are formed in follicles during inflammatory processes in the prostate gland, stones are multiple, small in size, radiopaque.

Clinic. The disease resembles prostatitis. Patients complain of pain in the sacrum, above the pubis, in the perineum, rectum, and hemospermia. The temperature rises to 39-40 ° C when a stone is pinched in the ejaculatory duct.

The prostate gland is enlarged, with a small knobby surface and areas of softening, the rubbing of stones against each other is determined. On the overview image, multiple small stones are visible, blood and pus are determined in the ejaculate.

Treatment in case of asymptomatic course it is not indicated, in case of infection, antibiotic therapy is recommended, in case of abscess formation - surgical removal of stones with opening of the abscess.

Forecast favorable.

Cooperite is an inflammation of the cooper (retrobulbar) gland, located near the bulbose part of the urethra.

Etiology. Cooperitis is observed mainly in gonorrheal and Trichomonas urethritis, less often caused by nonspecific bacterial flora. Infection through the excretory ducts of the gland, which open into the bulbous part of the urethra, can enter the gland directly. There are the following forms of the disease: catarrhal, follicular, parenchymal.

Clinic. Pain in the perineum, especially when sitting, discharge from the urethra after walking, enlargement of the gland. In some cases, symptoms may be very poor.

Diagnostics. The diagnosis is difficult due to the deep location of the gland in the thickness of the perineal tissue. For diagnostic purposes, palpation and bacterioscopy of the gland secretion obtained after massage, ureteroscopy, and ultrasound are performed. The presence of leukocytes in the secret of the cooper gland is considered a pathological sign.

Treatment. In the acute period of the disease - bed rest, rest, cold on the perineum, antibiotics. The abscess is opened. When acute phenomena subside, diathermy of the Cooper gland and its massage are prescribed. For chronic cuperite, hot sitz baths, warmth on the perineum.

Forecast favorable.

Epididymitis - inflammation of the epididymis - is one of the most common genital diseases in men. Most often, men get sick with epididymitis during the period of greatest sexual activity at the age of 20-50 years.

Etiology. Etiology is infectious, most often the source of infection is nonspecific bacterial flora, gonorrhea, Trichomonas invasion, malaria, brucellosis, rarely tuberculosis, syphilis. At the same time, the prostate gland, sometimes the seminal vesicles, and the urethra are affected. The testicular membrane, the testicle itself, the vas deferens are involved in the inflammatory process. The inflammatory process is provoked by trauma to the scrotum, hypothermia, physical stress, horse riding, masturbation, interrupted sexual intercourse, sexual excesses. Infection into the epididymis often penetrates hematogenously, less often - through the lymphatic tract, along the lumen of the seminal tract and by contact from the affected testicle.

The inflammatory process is divided in character into acute, subacute and chronic epididymitis. Chronic epididymitis is the result of a previous acute or subacute.

Clinic. Acute epididymitis begins acutely with an increase in body temperature, severe pain, a sharp increase and induration of the epididymis, redness and swelling of the skin of the scrotum. Often there is a simultaneous involvement in the inflammatory process of the vas deferens and testicular membranes with effusion into their cavity (dropsy of the testicular membranes), less often - testicular damage. In the blood, leukocytosis is noted with a shift of the leukocyte formula to the left, lymphopenia. Appropriate treatment of acute symptoms helps to subside, but the enlargement and compaction of the epididymis persists for a long time. Subacute epididymitis is characterized by a less violent onset, moderate pain, subfebrile body temperature, and a slower course of the process. During chronic epididymitis, normal body temperature, minor pain, moderate increase and compaction of the epididymis with a uniform consistency, with a smooth surface are observed, the epididymis is clearly delimited from the testicle.

Diagnostics. The diagnosis is based on the history data, complaints of patients, the results of examination and palpation; in chronic and recurrent epididymitis, certain diagnostic information is a biopsy of the epididymis, excretory urography, and semen examination. The differential diagnosis is carried out during tuberculosis and epididymal tumors, testicular tumors. Serological tests are performed if syphilis is suspected. Epididymal tuberculosis is characterized by a specific lesion of the prostate gland, the vas deferens, early abscess formation with the formation of fistulas on the skin of the scrotum and the detection of mycobacteria in the fistulous discharge, the urographic picture corresponds to tuberculous kidney damage.

Treatment. The goal of treatment for acute epididymitis is to eliminate pain, fight infection, and prevent abscess formation. Patients at this time are disabled. Recommended bed rest, immobilization of the scrotum using a suspensor. Before the abatement of acute phenomena, sexual abstinence, a diet with the exception of spicy foods, extractives, and alcohol is indicated. Prescribe broad-spectrum antibiotics; in case of acute dropsy of the membranes of the testicles, a puncture is indicated for the evacuation of fluid. Use novocaine blockade of the spermatic cord, until the acute symptoms subside, cold is placed on the scrotum. An abscess of the epididymis requires its surgical opening and drainage; in the elderly, it is sometimes necessary to remove the epididymis. Treatment for chronic nonspecific epididymitis depends on the cause. With the transition of an acute process to a chronic one, antibiotic therapy is continued in combination with resorption therapy; if conservative treatment is ineffective, the epididymis is removed. Treatment of concomitant prostatitis and vesiculitis is also prescribed.

Funiculitis is an inflammation of the spermatic cord.

Etiology. As a rule, it is a consequence of epididymitis, it can be specific (tuberculous), nonspecific, acute or chronic.

Clinic. In the acute process - severe pain in the scrotum and groin region, radiating to the lower back, a sharp thickening, induration and soreness of the spermatic cord, with chronic funicular pain is moderate, the spermatic cord is slightly thickened, but compacted. Tuberculous funiculitis is characterized by a sharp density and moderate tuberosity of the spermatic cord. The diagnosis is based on clinical signs.

Treatment, usually conservative. In acute funiculitis - bed rest, support, in the first 1-2 days - cold on the groin and scrotum, antibiotic therapy; in chronic course - physiotherapy.

Forecast with nonspecific funiculitis, it is favorable, with tuberculosis, it depends on the course of the primary focus of the disease.

Urolithiasis (urolithiasis)- metabolic disease, which, due to a violation of the physicochemical balance of urine under the influence of endogenous and exogenous factors, manifests itself in the formation of stones in the urinary tract. Stones can be located in all parts of the urinary tract - from the calyx to the external opening of the urethra (Fig. 8.1). Most often they are localized in the kidney, ureter and bladder (Fig. 8.2; Fig. 60, see color insert).

8.1. Kidney and ureteral stones

Epidemiology. The incidence of urolithiasis in the world ranges from 1.5 to 4.0% of the population, although the frequency of this pathology varies widely in different countries. The disease is most common in the countries of the Balkan Peninsula, Brazil, Turkey, India, and several regions of the United States. In Russia, urolithiasis (Urolithiasis) is most common in the Volga region, Central Asia, the North Caucasus, and the Urals. It, as a rule, ranks third in prevalence among urological diseases, accounting for 30-35% in their structure and second only in frequency to urinary tract infections and prostate pathology. Most susceptible to this disease are people of active working age - from 25 to 55 years. Disability due to nephrolithiasis is up to 6% in the total structure of disability.

Etiology and pathogenesis. KSD is a polietiologic disease. The occurrence and formation of urinary stones is influenced by a variety of endogenous and exogenous causes. General and local factors take part in their formation. Urolithiasis is a disease of the whole organism, and the presence of a stone in the urinary tract is its consequence, a local manifestation of ICD.

In recent years, interest in the fundamental aspects of ICD has noticeably revived, which is due to the emerging opportunities for in-depth study of the molecular, crystallographic and biochemical processes underlying stone formation.

Currently, there is no unified theory of the pathogenesis of ICD. Distinguish between causal (etiological) and formal (pathogenetic) genesis of the formation and growth of urinary stones.

Causal Genesis. The leading place among the factors of stone formation belongs to congenital enzymopathies (tubulopathies), anatomical malformations of the urinary tract and hereditary renal syndromes. Enzymopathy (tubulopathy), hereditary or acquired - these are disorders of metabolic processes in the body or the functions of the renal tubules. Most

Rice. 8.1. Localization of urinary stones

1 - calyx stone; 2 - pelvis stone;

3 - stone of the middle third of the ureter;

4 - a stone of the juxtavesical section of the ureters; 5 - bladder stone; 6 - stone of the urethra

common enzymopathies - oxaluria, uraturia, aminaciduria, cystinuria, galactosuria and etc.

Etiological factors of KSD are usually divided into exogenous and endogenous. To exogenous geographic factor, gender, age, dietary habits, drinking water composition, living and working conditions, lifestyle (physical inactivity), etc. mineralization of drinking water.

Endogenous factors divided into general and local. TO common include hypercalciuria, vitamin D deficiency, vitamin D overdose, bacterial intoxication in general infections and pyelonephritis, prolonged immobilization in large bone fractures, weightlessness, prolonged use or large doses of a number of substances and drugs (sulfonamides, tetracyclines, antacids, acetylsalicylic acid and , glucocorticoids, etc.). Local factors- these are various congenital and acquired diseases of the urinary tract, leading to impaired urodynamics: narrowing of the pelvic-ureteric segment and ureter, nephroptosis, kidney and urinary tract abnormalities, vesicoureteral reflux, urinary tract infection, neurogenic urinary outflow disorders, urine into the intestinal segments, long-term presence of drainages in the urinary tract, etc. If the patient has several factors predisposing to stone formation, the risk of developing ICD increases significantly.

Rice. 8.2. Urinary stones of the kidney (a), ureter (b), bladder (c)

Formal genesis ICD is explained by two main theories: colloidal and crystalloid.

Colloidal, or matrix, theory is based on the fact that in case of violation of the quantitative and qualitative relationships between colloids and crystalloids in urine, pathological crystallization can occur. The initial phase of stone formation is the agglomeration of specific organic molecules from mucopolysaccharides and mucoproteins. The matrix substance is found in all urinary stones of patients with nephrolithiasis, as well as in their urine tests. According to the matrix theory, a high molecular weight substance should form an organic matrix that adsorbs calcium and other ions. Subsequently, hardly soluble salts crystallize on it. However, comparative studies of the amount of uromucoid in healthy people and in patients with ICD did not reveal significant differences in its content.

This concept of stone formation is opposed by crystallization theory, which rejects the matrix as the primary stone-forming factor. According to her, the main importance is attached to the crystallization processes that occur in supersaturated solutions, such as urine. In this case, a stone is formed as a result of a physicochemical process, when precipitation of lithogenic salts from supersaturated urine is observed. However, quite often there are no differences in the composition of the urine of a healthy person and a patient with urolithiasis, and only taking into account the laws of equilibrium of solutions and crystallography data, it became possible to explain these contradictions.

Thus, stone formation consists of two mutually conditioning processes - the formation of the nucleus and the actual stone formation.

The variety and inconsistency of theories of formal genesis do not allow us to recognize a single pathophysiological cause of ICD or a combination of factors that determine the formation of urinary stones. Currently, in the causes of stone formation, taking into account the above theories, much attention is paid to the peculiarities of urine. In recent years, many researchers have paid attention to the fact that not the chemical composition of the nucleus and the stone itself, but various changes in the physicochemical properties of urine (pH, colloid content,

the presence of crystallization inhibitors, saturation with hardly soluble compounds, electrolyte composition, etc.) determine the formation and growth of the stone.

The process of stone formation begins with a violation of the colloidal-crystalloid relationships in the urine. Under these conditions, crystallization of sparingly soluble substances occurs, which are normally in a state of thermodynamic equilibrium, the maintenance of which, along with crystallization inhibitors, is largely facilitated by the so-called protective colloids of urine. The latter consist mainly of low molecular weight protein compounds, nucleoalbumins and mucins. The penetration of glycoproteins and proteins from blood serum into the urine sharply violates the colloidal-crystalloid balance and contributes to the formation of stone formation centers, which may be precipitated crystals of salts or protein-glycoprotein substances. In general, the process of stone formation still seems to be complex and multifaceted, in which the factors that determine the foundations of the theories of the formal and causal genesis of ICD play a role.

Classification of urinary stones. The generally accepted classification of urinary stones, although it assumes (by name) their monominerality, in fact, the presence of one or another mineral in greater quantities compared to others determines its name. In most cases, urinary stones are polymineral, that is, they have a mixed chemical composition.

Currently, the mineralogical classification of urinary calculi is used. In this case, the most common type of kidney stones are calcium-containing urinary stones, namely calcium oxalate (70%), or calcium phosphate, which account for up to 50% of all stones. Among urinary stones, oxalates (wevellite, veddellite), phosphates (hydroxylapatite, struvite, carbonatapatite, etc.), as well as urates (uric acid and its salts) are most often found. Other biominerals are much less common.

Oxaluria occurs with increased excretion of oxalates in the urine (more than 40 mg / day). It is common in chronic inflammatory bowel disease and other conditions that cause chronic diarrhea and severe dehydration. Only in rare cases, calcium oxalate stones are formed due to excessive formation of oxalates during poisoning with ethylene glycol, oxalic acid, as well as vitamin B 6, phenyl ketonuria and primary oxaluria. With prolonged diarrhea, oxalate metabolism changes. Due to impaired absorption, fats accumulate in the intestinal lumen, with which calcium easily binds. The low content of free calcium in the intestine leads to easy absorption of oxalates through diffusion. Even a slight increase in this process and an increase in the level of oxalates in urine creates conditions for the formation of nuclei of crystallization and their subsequent growth. As a result, the oxalic acid anion combines with the calcium cation and a sparingly soluble salt is formed - calcium oxalate in the form of monohydrate (wevellite) or dihydrate (wevellite).

Oxalates, as a rule, are dark in color with an uneven prickly surface, very dense.

Phosphate stones most often they are of infectious origin and are called struvite stones. They consist of a mixture of ammonium and magnesium phosphate and carbonate apatite. The formation of these stones is associated with bacteria that break down urea into ammonia and carbon dioxide (Escherichia coli, Pseudomonas aeruginosa, Klebsiella, etc.), which leads to the release of bicarbonate and ammonium. As a result, the urine pH rises above 7.0, and with an alkaline reaction, it is supersaturated with magnesium, ammonium, phosphate and carbonate apatites, which leads to the formation of a stone. Conditions that contribute to the development of urinary tract infections (malformations, neurogenic dysfunction, nephro- and epicystostomy, prolonged catheterization of the bladder) predispose to the formation of phosphate stones. Their formation is also associated with the development of hyperfunction of the parathyroid glands, which leads to a decrease in phosphate resorption in the kidneys. Among all kidney stones, phosphates are found in 15-20% of cases, and in women they are found 2 times more often than in men.

Phosphate stones are usually grayish or white in color, their structure is fragile.

Urate stones make up 5-7% of all urinary stones. The risk of their formation is especially high in gout, myeloproliferative diseases, and in cancer patients receiving chemotherapy. Uraturia is a consequence of impaired purine synthesis. The main risk factor for the formation of urate stones is a persistently low urine pH.

Urates consist of crystals of uric acid and (or) its salts, therefore they are yellow-brown, sometimes brick in color with a smooth or slightly rough surface, rather dense.

Cystine and xanthine stones are rare. Cystine stones occur with cystinuria, when the tubular reabsorption of four basic amino acids (cystine, ornithine, lysine, arginine) is disturbed, and therefore their concentration in the urine increases. Cystine, in comparison with other amino acids, has poor solubility in urine, therefore it precipitates with the formation of cystine stones. Xanthine stones are formed when there is a congenital defect in the xanthine oxidase enzyme. Due to the impossibility of converting xanthine into uric acid, its excretion by the kidneys increases. Xanthine is a difficult-to-dissolve salt, which is why xanthine stones are formed.

Even less often observed cholesterol stones.

The modern classification of urinary stones basically contains the division of urinary stones into two large groups - crystalline and proteinaceous. The main and predominant group is the first group, in which two subgroups are distinguished - inorganic and organic calculi. In the first subgroup, the decisive factor is the cation - inorganic calcium or magnesium. This subgroup includes oxalates and phosphates, they basically have a chemical substance that is homogeneous in composition. In the second subgroup, the anion is in the first place. It includes uric acid and its salts, cystine, xanthine. Thus, distinguish between inorganic and organic-crystalline group of stones, which is the basis of their classification.

A very important factor in the classification of urinary stones is urine pH. The crystalline component of the urinary stone is formed from the salts of uric, oxalic and phosphoric acids at specific concentrations of hydrogen ions in the urine for each type of stones. Urinary pH is a risk factor for the development of ICD and must be taken into account when dividing urinary stones into groups. The optimal pH values ​​for crystallization of uric acid salts are up to 5.5, oxalic acid - 6.0-6.8, phosphoric - above 7.0. Thus, in a generalized form, the classification of urinary stones is as follows:

A. Crystalline calculi.

I. Inorganic stones:

■ at urine pH 6.0: calcium oxalate (wevellite, veddellite);

■ at urine pH 6.5: calcium phosphate (hydroxylapatite, brushite, vitlokite);

■ at urine pH 7.1: magnesium ammonium phosphate (struvite).

II. Organic stones:

■ at urine pH 5.5-6.0: uric acid, its salts (urates), cystine, xanthine;

■ at urine pH 6.0: ammonium urate.

B. Protein stones (at urine pH 6.0-7.5).

Classification of urolithiasis. By localization in the organs of the urinary system, they are distinguished: renal pelvis stones and cups(nephrolithiasis), ureters(ureterolithiasis), Bladder(cystolithiasis), urethra(urethrolithiasis), multifocal lithiasis(various combinations of the indicated localizations). Kidney and ureteral stones can be one- and bilateral, single and plural. In special groups, due to their specificity, they distinguish coral and recurrent kidney stones, stones of a single kidney, urolithiasis of pregnant women, children and the elderly.

Symptoms and clinical course. The shape, size, mobility of stones, their localization greatly affect the symptoms of the disease. Nephrolithiasis is characterized by a triad of symptoms: pain, hematuria, and passing of a stone in the urine. In a certain proportion of patients, the disease manifests itself with only one or two symptoms, and sometimes it is asymptomatic for a long time. The latent course is observed most often in the presence of large, inactive stones that do not interfere with the outflow of urine.

The pains are localized mainly in the lumbar region or in the corresponding flank of the abdomen, they can be acute or dull, periodically occurring or constant. Moving stones of small size when passing through the ureter lead to its obstruction and the development of a characteristic symptom complex called renal colic (see chapter 15.1).

Clinical picture renal colic is characterized by a sudden onset of severe paroxysmal pain in one of the sides of the lumbar region. It immediately reaches such intensity that patients are unable to tolerate it, behave restlessly, rush, constantly change their body position, trying to find relief (see chapter 15.1).

Hematuria is observed in 75-90% of patients with urolithiasis and is mostly microscopic. The flow of blood into the urine, as well as pain, increases with movement. With kidney and ureteral stones, it has

the place is total hematuria, and with calculi of the bladder, terminal hematuria is observed, accompanied by dysuric phenomena. Hematuria is absent with complete obstruction of the ureter with a stone, as a result of which urine from the blocked kidney does not enter the bladder.

The passage of stones in the urine is pathognomonic, that is, a reliable sign of ICD. It is observed in 10-15% of patients with urolithiasis. After the stone has been removed, the pain syndrome stops. The sizes of calculi leaving with urine are small and range from 0.2 to 1 cm in diameter. In some patients, stones are excreted many times over a long period of time, which is why they are called "stone separators."

Diagnostics ICD begins with an assessment of the patient's complaints and the study of the history of the disease (stone passage, hereditary factors, previous methods of conservative and surgical treatment). Pallor and dryness of the skin as a manifestation of chronic renal failure and anemia are observed in patients with severe forms of nephrolithiasis. Palpation and tapping in the lumbar region can cause soreness (positive Pasternatsky symptom). In the presence of calculous hydro or pyonephrosis, an enlarged kidney is palpable.

Blood test they begin with a clinical analysis, which, outside the exacerbation of the disease, most often does not deviate from the norm. With exacerbation of calcous pyelonephritis, leukocytosis is observed with a shift of the leukocyte formula to the left, an increase in ESR, which indicates the degree of activity of the inflammatory process in the kidneys. Moderate leukocytosis can occur with renal colic. Anemia and creatininemia are characteristic of chronic renal failure. Determination of the electrolyte composition of blood serum and acid-base state is indicated for patients with bilateral kidney stones, with recurrent urolithiasis, especially complicated by chronic renal failure. The detection of hypercalcemia and hyperphos-phatemia indicates the need for more detailed studies of the function of the parathyroid glands (determination of the level of parathyroid hormone, calcitonin).

Urine examination after a macroscopic assessment, they begin with a general analysis. It contains a moderate amount of protein (0.03-0.3 g / l), single (usually hyaline) casts, leukocytes, erythrocytes, bacteria. The constant presence of salt crystals in the urine indicates a tendency to form stones and their possible composition, especially with the characteristic pH of the urine. Indicators of urine acidity must be determined in numbers, taking into account the importance of pH in the formation of urinary stones. In cases where the patient's general urine analysis does not deviate from the norm, one of the methods of accurate counting of blood cells (the Nechiporenko method, etc.) is used to detect latent erythrocyte and leucocyturia. To assess the concentration function of the kidneys, a urine sample according to Zimnitsky is used. Excretion of products of nitrogen metabolism (urea, creatinine, uric acid) and electrolytes (sodium, potassium, calcium, phosphorus, chlorine, magnesium) is studied. These studies are most valuable for patients with severe nephroureterolithiasis. It is imperative to study urine for microflora with the determination of its sensitivity to antibiotics, as well as the determination of the microbial number of urine. For efficiency purposes

Rice. 8.3. Sonogram. Kidney pelvis stone (arrow)

the therapy of calculous pyelonephritis, urine culture must be repeated several times during the course of treatment.

Radiation methods are the main ones in making the final topical diagnosis.Ultrasound allows you to assess the shape, size and position of the kidneys, their mobility, determine the localization of the stone and its size, the degree of expansion of the cavity system of the kidney and the state of its parenchyma. On the sonogram, the stone is visualized as a hyperechoic formation with a clear acoustic shadow distal to it (Fig. 8.3). In and-

Dimmable areas of the ureter on sonograms are its pre-pelvic and prevesical sections. With their sufficient expansion, the stones of these departments are well visualized (Fig. 8.4).

The advantages of sonography are:

■ the ability to use during an attack of renal colic;

with intolerance to iodine-containing X-ray contrast agents; with severe allergic reactions; in pregnant women;

■ the possibility of frequent use in the control of stone migration or the discharge of its fragments after extracorporeal lithotripsy;

■ diagnosis of X-ray stones.

The disadvantage of sonography is the inability to visualize most of the ureter.

Survey and excretory urography. Most urinary stones are radiopaque, only a tenth of them do not give images on radiographs, that is, they are radiopaque (stones of uric acid and its salts, cystine, xanthine, protein, etc.). An overview image of the kidneys and urinary tract during the examination of patients with KSD should always precede the X-ray contrast methods of research. On the plain roentgenogram, shadows of various shapes, quantity and size are determined, located in the area of ​​the projection of the kidneys and urinary tract (Fig. 8.5, 8.6).

Rice. 8.4. Sonogram. Prevesical ureteral calculus (1) causing its dilatation (2)

Rice. 8.5. Plain X-ray of the urinary tract. Left kidney stone (arrow)

Rice. 8.6. Plain X-ray of the urinary tract. Stone of the middle third of the right ureter (arrow)

It is difficult to discern the shadows of calculi if they are projected onto the bones of the skeleton. Sometimes with the help of a survey X-ray by the density of the shadows obtained, their surface, size and shape, one can even judge the chemical composition of the stone. These shadows must be differentiated from shadows from gallbladder stones, phlebolitis, fecal stones, calcified lymph and myomatous nodes, lesions in renal tuberculosis, neoplasms, echinococcosis, etc. stomach, etc.).

Excretory urography allows you to confirm or exclude the belonging of the shadow, revealed on the survey image, to the urinary tract, to clarify the localization of the stone, to reveal the presence of X-ray-negative calculi and to obtain information about the separate functional state of the kidneys and urinary tract (Fig. 8.7). It is advisable to perform it in a painless period, since at the time of an attack of renal colic, the radiopaque substance does not enter the urinary tract from the affected side. By itself, this fact confirms the diagnosis of renal colic, but does not provide complete information about the state of the calyx-pelvic system and the ureter. With a ureteral calculus, a radiopaque contrast agent is positioned above it in the dilated ureter, indicating the stone (Figure 8.8). In case of radiopaque stones of the kidneys or ureters against the background of a contrast agent, filling defects corresponding to stones are determined. Excretory urogram is not informative in chronic renal failure, since due to impaired renal function, the release of a radiopaque substance does not occur.

Rice. 8.7. Excretory urogram. Left renal pelvis stone (arrow), hydronephrosis

Rice. 8.8. Excretory urogram. Dilation of the ureter and cavity system of the right kidney (1) over the stone (2)

Retrograde ureteropyelography at present, for the diagnosis of ICD has become less common. It is indicated in the absence of a contrast agent release according to excretory urography, doubts about the belonging of the shadow revealed in the survey image to the ureter (performed in two projections) and the detection of X-ray negative stones. Antegrade

Rice. 8.9. CT, axial projection. Right kidney stone (arrow)

Rice. 8.10. CT, frontal projection. Bilateral stones of the kidneys (1) and middle third of the right ureter (2)

Rice. 8.11. Multislice CT with 3D construction. Right ureteral calculus (arrow)

Pyeloureterography for the same indications is performed in the presence of non-frostomy drainage.

CT scan allows you to clarify the localization, especially of X-ray negative stones, to determine their density, to study the anatomical and functional state of the kidneys and urinary tract, to identify concomitant diseases of the abdominal cavity and retroperitoneal space (Fig. 8.9, 8.10). The informative value of the method increases with the use of such modifications as spiral and multispiral CT with three-dimensional image reconstruction and virtual endoscopy. With their help, you can reliably

but to establish the presence of stones of any size, localization and radiopacity (Fig. 8.11), including in abnormal kidneys (Fig. 8.12).

One of the advantages of CT is the ability to perform computed densitometry, which allows determining the structural density of the stone at the preoperative stage and choosing the optimal method of treatment. Relatively

the relative density of the kidney and stone in computed densitometry is measured in Hounsfield units (Hounsfield unit- HU).

MRI allows you to identify the level of urinary tract obstruction by a stone without the use of contrast agents, including in patients with renal colic (Fig. 8.13). It has undeniable advantages over other methods when examining patients with renal insufficiency or intolerance to X-ray contrast agents.

Radionuclide(radioisotope renography, dynamic and static scintigraphy) research methods allow you to get an idea of ​​the anatomical and functional features of the kidneys, observe them in dynamics and study their separate function. The practical value of these methods increases with intolerance to X-ray contrast agents.

Rice. 8.12. Multislice CT with 3D construction. Ilium-dystopic kidney stone (arrow)

Rice. 8.13. MRI. Calculi of the lower calyx (1), renal pelvis (2) and ureter (3) on the right

Via endoscopic methods studies can not only establish a diagnosis, but also, in the presence of a stone, proceed to therapeutic manipulations to destroy and remove it. Cystoscopy can reveal bladder stones (Fig. 17, see color insert) or see a ureteral stone emerging from the mouth and restrained in it (Fig. 16, see color insert). An indirect sign of calculus of the intramural ureter is elevation, edema, hyperemia and dehiscence of the orifice of the ureter. In some cases, mucus, cloudy urine or urine stained with blood is released from it.

Chromocystoscopy- the simplest, fastest and most informative

mativny method for determining the separate function of the kidneys (Fig. 14, see color insert). It is of great importance in the differential diagnosis of renal colic with acute surgical diseases of the abdominal organs. If the shadow, suspicious of calculus, is in doubt, resort to catheterization of the ureter (Fig. 21, see color. Inset). In this case, the catheter can either stop near the calculus, or after sensing an obstacle, it can be held higher. After the introduction of the catheter, X-rays are taken of the corresponding section of the urinary tract in two projections. If the shadow and the shadow of the catheter are combined on the radiographs, this indicates a ureteral stone. The diagnosis is undeniable if the catheter manages to push a suspicious shadow up the ureter.

Ureteroscopy(fig. 28, see color insert) and nephroscopy(Fig. 31, see color. Inset) are the most informative methods for diagnosing kidney and ureteral stones.

Differential diagnosis urolithiasis is performed with some urological diseases such as nephroptosis, hydronephrosis, neoplasms and renal tuberculosis. At the same time, it must be remembered that a combination of ICD with the listed diseases is also possible.

It is especially important in the presence of pain syndrome to distinguish stones of the kidneys and ureters from acute surgical diseases of the abdominal organs, since in the first case, treatment is usually conservative, and in the second, emergency surgical intervention is required. Renal colic most often has to be differentiated from acute appendicitis, cholecystitis, perforated stomach and duodenal ulcer, acute intestinal obstruction, strangulated hernia, acute gynecological diseases (see Chapter 15.1).

Coral nephrolithiasis- This is the most severe form of ICD, accompanied by the formation of large stones that fill the calyx-pelvic system of the kidneys in the form of an impression (Fig. 8.14).

Such a stone with numerous appendages in the cups resembles coral, which is why it got its name. In the structure of the ICD, coral nephrolithiasis is 5-20%. This uniform can be worn one- and bilateral character. The disease has a long chronic course, accompanied by exacerbations of chronic pyelonephritis and increasing symptoms of chronic renal failure. Coral nephrolithiasis is easily diagnosed using modern research methods such as Ultrasound(fig. 8.15), overview(fig. 8.16) and excretory urogram, CT(fig. 8.17) and MRI.

An obligatory research method is to determine the state of the parathyroid glands. For this, blood parathyroid hormone and sonography of the parathyroid glands are examined. Stones often and quickly recur, especially if the cause is hyperparathyroidism.

Complications ICD are often observed. First of all, this is the addition of a secondary infection, which is manifested by calculous pyelonephritis, papillary necrosis, pyonephrosis and paranephritis. When a stone is located in the lower urinary tract, cystitis, urethritis, orchiepididymitis develop. With an exacerbation of pyelonephritis in patients, there is a rise in body temperature with chills, a large number of leukocytes is determined in the analysis of urine. Together

Rice. 8.14. Coral kidney stone

Rice. 8.15. Sonogram. Coral kidney stone

Rice. 8.16. Plain X-ray of the urinary tract. Coral stone of the right kidney (arrow)

However, it must be remembered that leukocyturia can be a leading symptom of many other diseases of the urinary and genital organs: prostatitis, urethritis, cystitis, tuberculosis of the urinary system, etc. In clinical practice, there are also combinations of ICD with these diseases, which further complicates the diagnosis.

The most common complication of ureterolithiasis is hydronephrotic transformation, which, in a bilateral process, leads to chronic renal failure. The latter is also observed with large bilateral kidney stones (often coral) and with stones of a single kidney. Less common is nephrogenic hypertension caused by chronic pyelonephritis with cicatricial degeneration of the renal parenchyma.

A formidable complication of ICD is excretory anuria. It occurs when the stones of both ureters or the ureter of a single kidney are obstructed and requires emergency intervention to restore the patency of the urinary tract.

Treatment ICD is complex and is aimed at eliminating pain, restoring impaired urine outflow, destruction and / or removal of a stone, correction of urodynamic disorders, prevention of inflammatory complications, preventive and metaphylactic measures. Given the many

a variety of clinical forms of ICD, for each patient a treatment plan is drawn up individually.

Conservative treatment includes relief of an attack of renal colic (see chapter 15.1.), stone-exorcising (lithokinetic) therapy and litholysis (dissolution of stones).

Stone expelling therapy. Spontaneous passage of stones can occur in 80% of cases if the stone is not more than 4 mm in diameter. At large sizes, the probability of spontaneous passage of a calculus

Rice. 8.17. Multispiral CT

with three-dimensional construction. Bilateral

coral kidney stones

decreases. The probability of discharge of ureteral stones, depending on the localization, for the upper third of the ureter is 25%, the average - 45%, with stones in the lower third of the ureter - 70%. The complex of therapeutic measures aimed at expelling the stone includes: an active regimen, physiotherapy exercises (walking, running, jumping), an increase in urine output (diuretics, drinking plenty of fluids or intravenous fluids), analgesic, antispasmodic drugs, alpha-blockers ( tamsulosin, alfuzosin, doxazazin), herbal uroseptics, antibacterial therapy, physiotherapy (amplipulse, ultrasound stimulation, local vibration therapy, etc.).

Litholysis (dissolution of stones) can be descending and ascending. Descending litholysis effective for uric acid stones and is based on the appointment of drugs that promote their dissolution (blemaren, uralit-U, magurlite). Ascending litholysis is performed by administering drugs through a urinary catheter or renal drainage.

Dynamic observation and stone-expelling therapy are indicated for stone sizes not exceeding 5 mm without disturbing urodynamics in case of arrested pain syndrome. In all other cases, the stone must be destroyed and / or removed. For this purpose, distance lithotripsy, contact ureterolithotripsy and ureterolithoextraction, percutaneous nephroureterolithotripsy, laparoscopic and rarely open operations are currently used.

Extracorporeal shock wave lithotripsy- a method consisting in the destruction of a stone focused and directed at it through the soft tissues of the human body by a shock wave generated by a special apparatus - remote lithotripter. Modern remote lithotripters consist of a shock wave generator, a system for focusing and aiming at a stone. The shock wave is created by a generator that forms a high-pressure front, which focuses on the stone and, quickly moving in the water

Rice. 8.18. Remote Shock Wave Lithotripters: a- MIT firms (Russia); b- Dornier Lithotriptor S(Germany)

Rice. 8.19. Plain X-ray of the urinary tract. Before the remote lithotripsy session for the pelvic stone of the left kidney (arrow), a stent was placed

environment, affects it with its destructive energy. The pressure in the focus area reaches 160 kPa (1600 bar), which leads to the disintegration of the stone. In modern models of remote lithotripters, the following methods of generating shock waves are used: electrohydraulic, electromagnetic, piezoelectric, laser radiation (Fig. 8.18).

The location of the stone and the focusing of the shock wave on it are carried out using X-ray and / or ultrasonic guidance.

Remote shock wave lithotripsy is indicated and is most effective for renal pelvis stones up to 2.0 cm in size and ureteral stones up to 1.0 cm. The density of the calculus is also of some importance. In some cases, crushing of larger stones is possible, but with the obligatory preliminary drainage of the kidney with a stent (Fig. 8.19).

Contraindications to extracorporeal lithotripsy are divided into technical, general somatic and urological. The first include the patient's body weight over 130 kg, height over 2 m and deformation of the musculoskeletal system, which does not allow the patient to lay down and bring the stone into the focus of the shock wave. Generally somatic are pregnancy, disorders of the blood coagulation system, gross disturbances in the rhythm of cardiac activity. Urological contraindications are considered to be an acute inflammatory process in the genitourinary system, a significant decrease in kidney function and obstruction of the urinary tract below the stone. Due to the constant improvement of devices for disintegration of stones, its efficiency is increasing every year, and today it is 90-98%.

In order to prevent complications of extracorporeal lithotripsy associated with ureteral occlusion (acute pyelonephritis, stone path, non-occluding renal colic), long-term drainage of the urinary tract with a ureteral stent is used (Fig. 22, see color insert).

Endoscopic contact lithotripsy carried out by bringing a source of energy to the stone under the control of vision and destroying it as a result of direct (contact) impact. Depending on the type of energy generated, contact lithotripters can be pneumatic, electrohydraulic, ultrasonic, laser and electrokinetic. Distinguish between contact ureterolithotripsy and nephrolithotripsy.

Rice. 8.20. Stone extractors: four-trench (a) and six-trench (b) Dormia loop, gripper for stones (c)

For ureteral stones, retrograde or antegrade ureteroscopy is preliminarily performed. Stones less than 0.5 cm can be immediately removed under visual control (ureterolitho extraction). For this purpose, various specially designed extractors are used. Among them, the most common loop (basket) Dormia and metal grips for stones (Fig. 8.20).

Contact ureterolithotripsy is performed for larger stones, after which their fragments can also be removed. Retrograde ureteroscopy, ureterolithotripsy and ureterolitho-extraction(fig. 8.21) most effective for calculi in the lower third of the ureter(fig. 8.22).

Percutaneous contact nephro- and ureterolithotripsy consists in puncture of the calyx-pelvic system of the kidney through the skin of the lumbar region. After that, the created canal is expanded to the appropriate size and an endoscope is installed along it into the cavity system. Under the control of vision, contact crushing of the stone is carried out with the removal of its fragments (Fig. 8.23; Fig. 33, see color insert). This method in one or two sessions can be destroyed stones of any size, including coral (Fig. 8.24).

Currently, due to the high efficiency of the above treatment methods, laparoscopic and, especially, open organ-preserving operations for kidney and ureteral stones (nephro-, pyelo-, ureterolithotomy) are rarely used. Nephrectomy is performed with cicatricial degeneration of the kidney with the absence of its function or calculous pyonephrosis.

Metaphylaxis is an important part of the complex treatment of patients with urolithiasis. In the early postoperative period, it is aimed at the removal of stone fragments, the elimination of the inflammatory process in the urinary tract.

Rice. 8.21. Retrograde ureteroscopy (1) with ureterolitho-extraction with Dormia loop (2), ureterolithotripsy (3)

Rice. 8.22. Plain radiograph

urinary tract with ureteroscopy

with contact crushing of stone (arrow)

ureter

pathways, normalization of urodynamics and restoration of kidney function. The listed activities are needed by patients with both low and high risk of recurrence of ICD. Subsequent long-term metaphylaxis is necessary to prevent recurrence of urolithiasis and includes the identification of specific metabolic disorders, their drug correction, dynamic monitoring of metabolic parameters in blood and urine.

Prevention of recurrence of stone formation consists in the consumption of up to 2.5-3 liters of fluid per day, maintaining a daily urine output of more than 2 liters, a balanced diet with restriction of table salt to 4-5 g / day and animal protein to 0.8-1.0 g / kg / day. Normalizing common risk factors includes: limiting stress, getting enough physical activity, balanced fluid loss. Patients with a high risk of recurrent stone formation, along with general metaphylaxis, are shown to carry out specific measures for the prevention of recurrent urolithiasis, which depend on the mineral composition of the stone. For hyperparathyroidism, parathyroidectomy is performed.

Depending on the composition of urinary stones and crystalluria, an appropriate diet and drugs are prescribed to correct the pH of urine.

Rice. 8.23. Nephroscopy and nephrolithotripsy

Uric acid urolithiasis (uraturia). Patients with urate crystal luria need to exclude from the diet foods rich in purine bases and nucleoproteins (liver, kidneys, brains, fish roe). With hyperuricemia, limit alcohol consumption, recommend the intake of foods containing a large amount of fiber and citrus. Recommended drinks include bicarbonate mineral waters, diluted apple juice. Limited to coffee beans (up to two cups a day), black tea (up to two cups a day). The level of concentration of hydrogen ions in urine must be maintained within

affairs of pH 6-6.5 due to a dairy-vegetable diet and the introduction of alkalis into the body. The patient is prescribed 0.5 mmol of alkali per 1 kg of body weight in the form of NaHCO 3 or a mixture of potassium citrate and citric acid (5-6 doses per day). Citrate mixtures are absorbed more slowly in the intestines and, accordingly, are excreted in the urine for a longer time. Prescribe drugs urolit-U, magurlit, blemaren, which contain granules of alkali, a pH indicator and a comparison scale with the determination of urine pH. The presence of hyperuricemia in a patient with urate crystalluria is an indication for the use of allopurinol, which blocks the transition of hypoxanthine to xanthine and uric acid. Treatment begins with 200-300 mg / day, the dose may be increased to 600 mg / day.

Rice. 8.24. Plain radiograph of the kidney during percutaneous contact ultrasound nephrolithotripsy

Oxalate urolithiasis (oxaluria). Limit the use of foods containing oxalic acid and calcium (spinach, lettuce, rhubarb, sorrel, tomatoes, onions, carrots, beets, celery, parsley, asparagus, coffee, cocoa, strong tea, chicory, milk, cottage cheese, strawberries, gooseberries, red currants, plums, cranberries, etc.). Meat, boiled fish, rye and wheat bread, boiled potatoes, pears, apples, melons, dogwood, quince, peaches, apricots, fruit and berry juices, cauliflower and white cabbage, turnips, cucumbers are introduced into the diet. Treatment of oxaluria is based on limiting the introduction of exogenous oxalate into the body, correcting dysmetabolic disorders and restoring the crystal-inhibiting activity of urine. Prescribe calcium supplements, vitamin D, ascorbic acid, alpha-tocopherol, nicotinamide, unitiol and retinol. With hypersecretory function of the stomach, retinol is used simultaneously with magnesium oxide, 0.5 g three times a day.

Phosphate urolithiasis (phosphaturia). The diet involves the use of meat food, since its intake is accompanied by the most intense urine oxidation. Patients are advised to increase the consumption of meat, poultry, fish, various flour, cereals and pasta, butter, sugar and sweets, decoction of coarse wheat, bread kvass, honey. Citric acid is added to food, which binds calcium. Useful sauerkraut juice, sour and salted fruits and vegetables, birch sap. Limit the use of sour cream and eggs, vegetables (pumpkin, Brussels sprouts, peas), fruits and berries (cherry plum, apples, lingonberries, prunes, currants). The use of dairy products (except for sour cream, which can be eaten in small quantities), smoked meats, canned food, spices (pepper, horseradish, mustard), tea and coffee is prohibited.

Treatment is to acidify the urine. For this purpose, methionine is prescribed, 500 mg 3 times a day. To reduce the absorption of phosphates in the intestine and their excretion, aluminum hydroxide is used, 2-3 g 3 times a day.

Spa treatment is indicated for uncomplicated urolithiasis with or without a stone during remission of the disease. The most famous resorts are: Kislovodsk (Narzan), Zheleznovodsk (Slavyanovskaya, Smirnovskaya), Essentuki (No. 4, Novaya), Pyatigorsk and Truskavets (Na-Ftusya). The intake of mineral waters for therapeutic and prophylactic purposes is possible in doses of no more than 0.5 liters per day under strict laboratory control of the metabolic parameters of stone-forming substances.

Our genitourinary system is subject to very high risks of disease if we lead the wrong lifestyle. All this leads to the appearance of inflammatory processes and infectious diseases in the genitourinary system. Let's look at the main diseases of the genitourinary system, their signs and possible treatments.

The main diseases of the genitourinary system

The human urinary system includes the urethra, bladder, ureters, and kidneys. Anatomically and physiologically, the urinary tract is closely related to the organs of the reproductive system. The most common form of urinary tract pathology is infectious diseases - diseases of the genitourinary system.

Urethritis

Many people know too little about this disease to see a doctor in time and start treatment. It is about the causes, methods of treatment and other features of the disease of the urethra that we will talk about further.

Unfortunately, many suffer from urological diseases, including urethritis. To date, this disease has already been sufficiently studied, effective methods of treatment have been developed, which are developing more and more every day. The symptoms of urethritis are not always pronounced, so the patient may turn to a specialist late, which greatly complicates the treatment.

Causes of urethritis

The main cause of this disease is an infection of the urethra, which is a tube with layers of epithelium inside. It is the tube that can be the center of the spread of infection. Complicating the disease is that the virus may not give any signs of its existence for a long time. Only when exposed to negative factors (cold, stress) does the infection make itself felt. The disease can be chronic or acute. The first form is more dangerous, because its signs are not as pronounced as in the second.

But inflammation of the urethra is even more serious. The disease can be caused by chlaminadia, Trichomonas, dangerous condylomatous growths, herpes viruses.

Urethritis infection

You should always remember about the safety of sexual intercourse, because this is the main threat to contract viral infections of the genitals, urethritis is no exception. Note that the disease in women is much easier than in men. Urethritis in the stronger sex can occur with significant pain and complications. It is important to remember that the disease does not make itself felt during the incubation period - it proceeds without pronounced signs. And only in the next stages of the disease will you begin to notice that not everything is in order with your genitourinary system. But the treatment will already be much more difficult. Therefore, periodically for your own safety, check with a specialist.

The main signs of urethritis and possible consequences

The disease has a number of signs that everyone needs to remember in order to start treatment on time:

• Burning pain that worsens when urinating.
• Discomfort in the urethra.
• Mucopurulent discharge that has an unpleasant odor.
• Cutting and cramping in the lower abdomen.

In cases where a person does not consult a doctor on time, complications and spread of the inflammatory process to other organs and systems arise. Remember that treatment of the urethra should be started on time, and only after consulting a doctor.

Treatment for urethritis

A good specialist, before prescribing treatment, carefully examines the causes of the disease, because not all of them are caused by infections. An allergic reaction caused by the influence of chemicals can also be the cause of urethritis. Treatment of this form of urethral disease is different from infectious.

Before starting treatment for viral urethritis, it is necessary to conduct laboratory tests so that the prescribed medications effectively affect the disease. Acute urethritis responds well to pharmacological treatment. In cases where it has developed into a chronic form, treatment can be delayed for a long time.

Every person who understands what urethritis is, understands that self-medication will not give any positive result. Only under the supervision of doctors, the patient has every chance to get a healthy genitourinary system again.

Folk remedies for urethritis

Balanoposthitis

This disease has many different forms, the occurrence of which depends on the reasons. Symptoms of the disease:

• Soreness.
• Plaque.
• Swelling.
• Allocations.
• Rash.
• The appearance of ulcers on the genitals.
• Bad smell.

Vesiculitis is a fairly long-term disease that is difficult to cure. It takes a lot of effort to fully recover. Very rarely, this disease occurs without concomitant diseases. It is sometimes considered a complication of prostatitis.

Types of vesiculitis

There are acute and chronic forms of vesiculitis. But the first one is found many times more often.

Acute vesiculitis is characterized by sudden onset, high fever, weakness, and pain in the lower abdomen and bladder.

Chronic vesiculitis is a complication after an acute form, which is characterized by pulling pain. Erectile dysfunction.

The most terrible complication is suppuration, which is associated with the formed fistula with the intestine. This form is characterized by a very high temperature, poor health. An urgent need to take the patient to the doctor.

Source of vesiculitis infection

When a person is already sick with a prostate, the prostate gland is the main source of infection. Also, urethritis can be the cause of vesiculitis. Less often, but sometimes the urinary system is a source of infection (if a person is sick with cystitis or pyelonephritis). Also, infection can get through the blood from other organs (with angina, pneumonia and osteomyelitis). Various injuries of the lower abdomen can also be the cause of the disease.

Vesiculitis symptoms

There are no specific symptoms that indicate this particular disease. Therefore, it is very important that the doctor carefully diagnoses the patient. Signs that may indicate vesiculitis:

• Pain in the perineum, above the pubis.
• Increased pain when filling the bladder.
• The presence of mucous discharge.
• The presence of erectile dysfunction.
• Painful sensations during ejaculation.
• Deterioration of health.

Diagnostics of the vesiculitis

The latent course of the disease and the absence of clear signs significantly complicate diagnosis and treatment. If you suspect vesiculitis, doctors perform a number of procedures:

• I examine for the presence of genital infections.
• A series of swabs are taken to determine if there is an inflammatory process.
• Check the prostate and seminal vesicles by palpation.
• Examine the secret of the prostate and seminal vesicles.
• Ultrasound of the urinary and reproductive systems is performed.
• Blood and urine tests are taken.
• A spermogram is performed.
• Throughout the entire treatment process, careful monitoring of the dynamics of the disease.

Vesiculitis treatment

An important condition for the disease is bed rest. If a person is constantly tormented by high fever and acute pain, doctors prescribe antipyretic and pain relievers.

Also, in order to reduce pain, the doctor prescribes drugs with an analgesic effect. The patient periodically undergoes physiotherapy, massage. At the advanced stages of vesiculitis, surgical intervention can be prescribed. Removing the seeds is sometimes recommended.

In order to avoid this serious illness, there are a number of recommendations that must be followed:

• Avoid constipation.
• Get exercise.
• See your urologist periodically.
• Avoid a lack or an abundance of sexual relationships.
• Don't overcool.
• Eat healthy foods.
• See your venereologist regularly.

Orchoepidymitis

This is an inflammation that occurs in the area of ​​the testicle and its appendages. The disease is caused by infection. The testicle and its appendages are enlarged and hardened. All this is accompanied by severe pain and increased body temperature.

There are two forms of orchiepididymitis: acute and chronic. Most often, the first passes into the second form due to an untimely visit to a doctor or an inaccurately established diagnosis. The chronic form of the disease is very difficult to cure.

Methods of infection with epididymitis

You can become infected with the disease through unprotected intercourse. There is also a risk of disease with prostatitis. Rare cases of infection with the help of the circulatory system have been recorded. The cause of the disease can be trauma in the scrotum, hypothermia, excessive sexual activity, cystitis. It is necessary to be treated very carefully, because with the wrong treatment, the disease can return.

Orchiepididymitis is a very dangerous disease, because it entails sad consequences. The acute form can lead to problems with an abscess, provoke the appearance of a tumor or infertility.

Treatment of orchiepididymitis

The main weapon against the disease is antibiotics. But medications must be selected very carefully, taking into account the individual characteristics of the organism. Also, the form of the disease, the age of the patient and the general state of his health affect the treatment. Doctors prescribe medications for inflammation and high fever. If the disease comes back again, then its treatment is carried out with the help of surgical interventions.

Preventing a disease is much easier than treating it. It is necessary to avoid hypothermia, casual sexual relations, trauma to the scrotum. It is also worth wearing underwear that fits snugly to the body. This will improve blood circulation in the genital area. You should not reboot the body either physically or mentally. You need to rest well and take care of your health. It is necessary to periodically undergo examination by a doctor. By following all these recommendations, you save yourself from infection.

Cystitis

Cystitis is a disease characterized by impaired urination, soreness in the pubic area. But these signs are characteristic of other infectious and non-infectious diseases (prostatitis, urethritis, diviculitis, oncology).

Most often, inflammatory processes in the bladder occur in girls. This is due, first of all, to the distinctive anatomical structure of the woman's body. Cystitis has two forms: chronic and acute (the upper layer of the bladder lends itself to inflammation). The disease most often begins to develop with infection or hypothermia. As a result of improper treatment, the disease can turn into chronic cystitis, which is dangerous with a weak manifestation of symptoms and the ability to mask other diseases. As you can see, it is very important to start the correct treatment on time.

What causes cystitis?

Most often, the disease is caused by an infection that enters the body through the urethra. Sometimes, in people with weak immunity, infection occurs in a hematogenous way. Cystitis can be caused by the following bacteria:

• Escherichia coli.
• Proteins.
• Enterobacteriaceae.
• Bacteroids.
• Clibsiells.

The above bacteria reside in the intestines.

Cellular bacteria can also cause cystitis:

• Chlamydia.
• Mycoplasma.
• Ureaplasma.

Often the disease can be caused by thrush, ureaplasmosis, vaginosis and diabetes mellitus.

Non-infectious cystitis can be caused by medications, burns, and trauma.

Cystitis symptoms

The symptoms of the disease to some extent depend on the characteristics of the organism. Therefore, it is impossible to name any clear symptoms of cystitis. Let's pay attention to the most common features of the disease:

• Cramps and pain when urinating.
• Painful sensations in the pubic area.
• Frequent need to urinate.
• Changed color, consistency and odor of urine.
• High fever (in acute form).
• Digestive disorders.

It is worth remembering that the symptoms of cystitis can hide a much more serious illness, so you cannot self-medicate.

Diagnosis of the disease

The examination for cystitis is not difficult enough. The main thing is to determine what caused the disease. And sometimes it is difficult to determine this factor, because there are many sources of infection. In order to confirm the diagnosis of cystitis, it is necessary to pass a number of tests:

• Analysis for the presence of infection.
• Clinical analyzes of urine.
• Biochemical blood tests.
• Conduct a urine culture.
• Tests for the presence of a sexually transmitted disease.
• Tests to detect other genitourinary diseases.
• Ultrasound of the genitourinary system.

And, having received the results of all analyzes, it is possible to determine the causes of the disease and prescribe a treatment method.

Folk remedies for cystitis

Pyelonephritis

Infectious kidney disease, which is accompanied by inflammatory processes. The disease is caused by bacteria that enter the kidneys from other, already inflamed organs through the blood, bladder or urethra. There are two types of pyelonephritis:

• Hematogenous (the infection enters through the blood).
• Ascending (gets from the genitourinary system).

Types of pyelonephritis

There are two forms of the disease:

• Acute (pronounced symptoms).
• Chronic (sluggish symptoms, periodic exacerbations of the disease).

The second form of the disease is most often the result of improper treatment. Chronic pyelonephritis can also occur as a result of the presence of a hidden focus of infection. The second form of the disease can be considered a complication.

Pyelonephritis most often affects children under seven years of age, as well as young girls. Men are much less likely to suffer from this ailment. Most often, the stronger sex has pyelonephritis - a complication after other infectious diseases.

Symptoms of pyelonephritis

The acute form of the disease is accompanied by the following symptoms:

• Elevated temperature.
• Intoxication.
• Acute back pain.
• Frequent and painful urination.
• Lack of appetite.
• Feeling nauseous.
• Vomit.

More rare signs of pyelonephritis may include the following symptoms:

• Blood in the urine.
• Changes in urine color.
• The presence of an unpleasant, pungent urine odor.

In order for the treatment of the disease to be effective, it is necessary to accurately determine the diagnosis. When prescribing medications, it is necessary to take into account the individual characteristics of the organism.

Treatment and diagnosis of pyelonephritis

It is most effective to diagnose the disease with a general blood test. Also, if you suspect pyelonephritis, doctors prescribe an ultrasound of the genitourinary system and a urinalysis.

Correct treatment of the disease consists of taking antibiotics, anti-inflammatory drugs, and physical therapy. Vitamin intake also has a positive effect on the results of treatment.

You must remember that delayed access to a doctor can lead to complications that slow down the healing process.

Prevention of pyelonephritis

The most effective way of prevention is the treatment of diseases that contribute to the development of pyelonephritis (prostatitis, adenoma, cystitis, urethritis and urolithiasis). You also need to protect the body from hypothermia.

Folk remedies for pyelonephritis

Urolithiasis disease

The second place after viral diseases of the genitourinary system is taken by urolithiasis. Note that, according to statistics, men are at times more likely to suffer from the disease. The disease is most often characteristic of one kidney, but there are cases that urolithiasis affects both kidneys at once.

Urolithiasis is characteristic for any age, but most often it occurs in young able-bodied people. When the stones are in the kidneys, they make themselves felt a little, but when they go outside, they begin to give a person discomfort, cause irritation and inflammation.

Symptoms

The fact that a person has stones in the genitourinary system may be indicated by the following signs:

• Frequent urination.
• Pain when urinating.
• Cutting pains, most often in one part of the lower back.
• The urine changes color and chemistry.

Causes of the disease

Most often, stones in the genitourinary system are a genetic problem. In other words, those who suffer from diseases of the genitourinary system have such a problem.

Also, the occurrence of stones can be the cause of improper metabolism. Calcium is problematically excreted through the kidneys. The cause of the disease may be the presence of uric acid in the blood.

The reason for the presence of such a problem may be the intake of an insufficient amount of fluid. The rapid loss of water in the body caused by diuretics can also lead to the formation of stones. The disease sometimes occurs as a result of previous infections of the genitourinary system.

Diagnosis and treatment of the disease

If you suspect such a problem, stones can only be detected by a specialist who will prescribe a number of diagnostic measures:

• Delivery of urine.

Having determined the diagnosis and the causes of the disease, the urologist selects an individual treatment regimen. If the disease has just begun to develop, medication (taking diuretics that promote the breakdown of stones) will be sufficient.

Also, the doctor prescribes anti-inflammatory therapy in order not to cause cystitis or urethritis. The release of stones irritates the urogenital canals, which leads to inflammation. In case of illness, it is recommended to take a lot of fluids. This will improve the functioning of the whole body. Surgical intervention of the disease is prescribed when large stones are formed. It is important for urolithiasis to adhere to a diet and conduct periodic examinations.

Folk remedies for urolithiasis

So, we examined the most common diseases of the genitourinary system, their main signs and symptoms. It is important to have information about the diseases that may lie in wait for you, because whoever is forewarned is armed. Be healthy!

In women, the genitals include the uterus with fallopian tubes, ovaries, vagina, vulva.

The organs of the urinary and reproductive systems are closely related due to the peculiarities of the anatomical structure. Inflammation of the genitourinary organs is quite common in both men and women.

Diseases

Due to the peculiarities of the anatomical structure of the urogenital system in women, infection of the urogenital tract with pathogenic microorganisms occurs in them much more often than in men. Female risk factors - age, pregnancy, childbirth. Because of this, the walls of the small pelvis from below weaken and lose the ability to maintain organs at the required level.

Inflammation of the organs of the system is also facilitated by ignoring the rules of personal hygiene.

Among the inflammatory diseases of the genitourinary system, the most common are:

Moreover, chronic forms of diseases are more common, the symptoms of which are absent in remission.

Urethritis

Urethritis is an inflammation of the urethra. The symptoms of this disease are:

• painful difficulty urinating, during which there is a burning sensation; the number of urges to the toilet increases;
• discharge from the urethra, which leads to redness and adhesion of the opening of the urethra;
• a high level of leukocytes in the urine, which indicates the presence of an inflammation focus, but there are no traces of the pathogen.

Depending on the causative agent that caused the urethritis, the disease is divided into two types:

• specific infectious urethritis, for example, as a result of the development of gonorrhea;
• nonspecific urethritis, the causative agent of which are chlamydia, ureaplasma, viruses and other microorganisms (pathogenic and opportunistic).

In addition, the cause of inflammation may not be an infection, but a banal allergic reaction or trauma after incorrect insertion of the catheter.

Cystitis

Cystitis is an inflammation of the mucous membrane of the bladder. This disease is more common in women than in men. Infectious cystitis is caused by E. coli, chlamydia or ureaplasma. However, ingestion of these pathogens does not necessarily cause disease. Risk factors are:

• prolonged sitting, frequent constipation, preference for tight clothing, as a result of which blood circulation in the pelvic region is impaired;
• deterioration of immunity;
• irritating effect on the walls of the bladder of substances that are part of the urine (when eating spicy or overcooked food);
• menopause;
• diabetes;
• congenital pathologies;
• hypothermia.

In the presence of an inflammatory process in other organs of the genitourinary system, there is a high probability of infection in the bladder.

The acute form of cystitis is manifested by the frequent urge to urinate, the process becomes painful, the amount of urine decreases sharply. The appearance of urine changes, in particular, transparency disappears. Pain also appears between the urge in the pubic area. It is dull, cutting or burning in nature. In severe cases, in addition to the indicated symptoms, fever, nausea and vomiting appear.

Pyelonephritis

Inflammation of the renal pelvis is the most dangerous among other infections of the genitourinary system. A common cause of pyelonephritis in women is a violation of the outflow of urine, which happens during pregnancy due to an increase in the uterus and pressure on nearby organs.

In men, this disease is a complication of prostate adenoma, in children - a complication of influenza, pneumonia, etc.

Acute pyelonephritis develops suddenly. First, the temperature rises sharply and weakness, headache and chills appear. Sweating increases. Concomitant symptoms may include nausea and vomiting. In the absence of treatment, there are two pathways for the development of the disease:

• transition to a chronic form;
• the development of suppurative processes in the organ (signs of such are sharp jumps in temperature and a deterioration in the patient's condition).

Endometritis

This disease is characterized by an inflammatory process in the uterus. It is caused by staphylococcus, streptococcus, Escherichia coli and other microbes. The penetration of infection into the uterine cavity is facilitated by ignoring the rules of hygiene, promiscuous sexual intercourse, and a decrease in general immunity.

In addition, inflammation can develop as a result of complicated surgical procedures, such as abortion, probing, or hysteroscopy.

The main symptoms of the disease are:

• temperature increase;
• pain in the lower abdomen;
• vaginal discharge (bloody or purulent).

Cervicitis

Inflammation of the cervix occurs as a result of a sexually transmitted infection entering its cavity. Viral diseases can also provoke the development of cervicitis: herpes, papilloma, etc. Any damage (during childbirth, abortion, medical manipulations) is the cause of the disease due to a violation of the integrity of the mucous membrane.

Clinical manifestations are typical for the inflammatory process:

• discomfort during intercourse, sometimes pain;
• vaginal discharge of a mucous nature;
• discomfort or pain in the lower abdomen;
• rise in temperature, general malaise.

Colpitis

Colpitis, or vaginitis - inflammation of the vagina, which is caused by Trichomonas, candidiasis fungi, herpes viruses, E. coli. At the same time, the patient complains of symptoms:

• discharge;
• heaviness in the lower abdomen or in the vaginal area;
• burning;
• discomfort while urinating.

During the examination, the doctor observes hyperemia, edema of the mucous membrane, rashes, pigmented formations. In some cases, erosive patches appear.

Vulvitis

Inflammation of the external genital organs. These include the pubis, labia, hymen (or its remains), the vestibule of the vagina, Bartholin's glands, and the bulb. Vulvitis is caused by infectious agents: streptococci, E. coli, chlamydia, etc.

The provoking factors are:

• oral sex;
• taking antibiotics, hormones and drugs that suppress the immune system;
• diabetes;
• leukemia;
• oncological diseases;
• inflammatory processes in other organs of the genitourinary system;
• urinary incontinence;
• frequent masturbation;
• taking an excessively hot bath;
• lack of personal hygiene.

The presence of an inflammatory process can be detected by the following symptoms:

• redness of the skin;
• swelling;
• pain in the vulva;
• burning and itching;
• the presence of bubbles, plaque, ulcers.

Prostatitis

Inflammation of the prostate gland. The chronic form of the disease affects about 30% of men from 20 to 50 years old. There are two groups, depending on the cause of the occurrence:

• Infectious prostatitis caused by bacteria, viruses, or fungi
• stagnant prostatitis, which occurs due to the corresponding processes in the prostate gland (in violation of sexual activity, sedentary work, preference for tight underwear, alcohol abuse).

There are risk factors that further provoke the development of the inflammatory process. These include:

• decreased immunity;
• hormonal disorders;
• inflammatory processes in nearby organs.

The disease can be identified by its characteristic symptoms. The patient feels unwell, which may be accompanied by an increase in temperature, complains of pain in the perineum and frequent urge to urinate. The chronic form of prostatitis can be asymptomatic and remind of itself only during periods of exacerbation.

Diagnostics

Before prescribing treatment, patients with suspected inflammation of the organs of the genitourinary system need a urological examination.

• ultrasound examination of the kidneys, bladder;
• examination of urine and blood;
• it is possible to carry out cystoscopy, computed tomography, pyelography according to individual indications.

The results of the examination determine what diagnosis will be made and what treatment is prescribed to the patient.

Treatment

To stop the inflammatory process, medications are used.

The goal of etiological treatment is to eliminate the cause of the disease. To do this, you need to correctly identify the pathogen and its sensitivity to antibacterial agents. Common causative agents of urinary tract infections are E. coli, enterococcus, staphylococcus, Proteus, Pseudomonas aeruginosa.

The selection of the drug takes into account the type of pathogen and the individual characteristics of the patient's body. Broad-spectrum antibiotics are often prescribed. The selectivity of these drugs is high, the toxic effect on the body is minimal.

Symptomatic treatment is aimed at eliminating the general and local symptoms of the disease.

During treatment, the patient is under the strict supervision of a physician.

You can speed up the healing process by observing the following rules:

• Consume a sufficient amount of water per day and at least 1 tbsp. cranberry juice without sugar.
• Exclude salty and spicy foods from the diet.
• Limit the use of sweet and starchy foods during treatment.
• Maintain hygiene of the external genitalia.
• Use acidic soap (Lactophil or Femina).
• Cancel visits to public waters, including jacuzzis and pools.
• Refuse from frequent changes of sexual partners.

Attention should also be paid to increasing immunity. This will avoid relapses of the disease.

Inflammation of the genitourinary system is a common problem in modern society. Therefore, regular check-ups and preventive visits to the doctor should become the norm.

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Diseases of the genitourinary system in women

Common diseases of the genitourinary system in women.

To monitor your health, you must first of all have an idea of ​​the structure of your body. In women, the organs of the genitourinary system are extremely vulnerable, diseases are very unpleasant and easily flowing from an acute form to a chronic one. Knowing about the symptoms when infections occur, it will be easier for a woman to protect herself from them.

The organs of the female genitourinary system include:

The female genitourinary system consists of the genitals and excretory organs. The main difference from the male is the length of the urethra (female - about five cm, and for a man - about twenty cm). Consequently, the processes of inflammatory women are disturbed more often than men. With the same disease, it is usually more difficult for a woman to recover.

Infections are the main causes of inflammation. It can be urological and gynecological. And if the organs of both systems are in close proximity, then the infection can affect both. With the symptoms of the first woman, a specialist should be consulted; in the absence of treatment, serious complications may occur. The consequences of infectious diseases can be ectopic pregnancy, infertility, etc.

INFLAMMATORY SYMPTOMS IN WOMEN

Symptoms of inflammation in the female genitourinary system may differ. The organs of the female reproductive and urinary system are closely located and interact with each other. Well, when the inflammation has already begun in one place, it quickly spreads to the organs that are located nearby.

DISEASES OF THE UROGENITAL SYSTEM IN WOMEN

Cystitis in women. Symptoms Video

Cystitis (inflammation of the bladder) is characterized by frequent urge to urinate, pain when urinating in the lower abdomen. Urine is often cloudy with blood impurities. The patient may have a feeling of emptying of an incomplete bladder. A complicated form of cystitis leads to the development of pyelonephritis. The patient complains of pain in the lumbar region, discoloration of urine, chills, fever, which has a fetid odor, etc.

Almost every woman has encountered this unpleasant disease, cutting pains characterized by urination, a feeling of discomfort in the lower abdomen. With cystitis, exacerbation of blood with urine can be observed, pain syndrome is strong, a significant increase in T. By the way, unpleasant sensations in the urethra canal is a common phenomenon and may indicate various diseases, a characteristic symptom of not being one of some kind. More often women suffer from cystitis, their urethra canal is short and is located near the anus and the vagina, which allows microbes to easily enter the bladder.

If proper attention is not paid to the treatment of cystitis, then it can "develop" in the renal pelvis inflammation - pyelonephritis. Cystitis symptoms will add back pain, nausea, edema.

Sexual bacterial infections include: syphilis, chlamydia, gonorrhea, ureaplasma and mycoplasma.

Viral genital herpes infections include genital warts, cytomegalovirus infection.

Infections are sexually transmitted mainly; infection is not excluded by household and transplacental infections.

Microorganisms and bacteria organs affect the genitourinary system, have an adverse effect on the reproductive function of a woman.

DISEASES OF THE UROGENITAL SYSTEM IN WOMEN, TREATMENT

Bacterial vaginosis (vaginitis), symptoms and prevention. Video

With this disease, a woman feels pain during sexual intercourse, a burning sensation in the vagina and a urethral canal, discharge is present (with acute vaginitis, discharge is abundant, and the pain is quite sharp; in the form of chronic pain, it may completely disappear and rarely appear, but the disease manifests itself with a new force with hypothermia, stress, etc.)

Treatment of any "female" disease should be carried out under the supervision of a gynecologist. Self-medication is dangerous and can be as if untreated. Any bacterial infection is treated with antibiotics. In case of diseases of the urinary system, herbal infusions and decoctions are used as an additional means to therapy, and you can drink them to remove the infection from the body, and do douching.

Gonorrhea in women. Symptoms Video

Gonorrhea. Its causative agent is gonococcus, which affects the mucous membranes of the urinary tract and genital organs. The process of inflammation spreads to various departments of the genitourinary system. The main symptoms of gonorrhea: inflammation in the vaginal area, discharge, the presence of mucopurulent from the cervical canal, pain during urination, urethral edema, itching in the vagina.

Genital herpes in women. Symptoms Video

Genital herpes. Unlike other sexually transmitted infections, the appearance is characterized on the mucous membrane of small vesicles with a cloudy liquid. Their formation is preceded by itching, burning and redness at the localization site. In addition, an increase in lymph nodes occurs in the patient, T appears, in the muscles of pain.

Warts. Gynecology. Symptoms Video

Condylomatosis. This disease is characterized by genital warts occurring in the vaginal area. The causative agent is a papilloma viral infection. Warts are small warts, which gradually grow, resembling cauliflower.

Syphilis in women. Symptoms Video

Syphilis is a venereal disease caused by pale treponema. appears in the patient on the membranes of the mucous membranes of the chancre, the lymph nodes increase. Distinguish between primary, secondary and tertiary syphilis, which differ in the degrees of localization on the mucous membrane of treponema.

Chlamydia in a woman. Symptoms Video

Chlamydia The main symptom is the presence of chlamydia in the body, pale yellow discharge from the genital organs, pain sensation during urination, sexual intercourse, pain before menstruation. The main danger of chlamydia is that complications can lead to lesions of the uterus and appendages in a woman.

Ureaplasmosis in women. Symptoms Video

Ureaplasmosis. This is a microorganism ureaplasma urealitikum, causes the appearance of ureaplasmosis, if it enters the body for a long time, it does not make itself felt. The disease is almost asymptomatic, and therefore women rarely pay attention to insignificant changes in the body. After the end of the incubation period, the patient worries about a burning sensation during urination, mucous discharge, pain in the lower abdomen. With a decrease in immunity, any physical factors (stress, colds, hypothermia, great physical exertion) activate the infection.

DISEASES OF THE Urogenital Organs

Mycoplasmosis. Symptoms in women. Video

Mycoplasmosis. The disease manifests itself in the form of colorless, white or yellow discharge, burning during urination. After intercourse, groin pain often appears in the area. With weakened immunity, pathogens of mycoplasmosis can be transferred to other organs (urinary tract, kidneys, urethra).

Most infections are asymptomatic, passing over time from the acute stage to the chronic form.

When symptoms appear, it is imperative that you visit a gynecologist for a qualified diagnosis and elimination of infection.

Thrush (candidiasis). Symptoms Video

Thrush (candidiasis). This is a fungal disease, the most common in women. The main reason is personal hygiene, non-observance and violation of the microflora of the normal vagina (for example, after long-term use of antibiotics). Thrush is accompanied by a burning sensation, severe itching, white cheesy discharge, redness of the labia minora when urinating. It is treated simply (flucostat or fluconazole, vaginal suppositories). The disease is not dangerous and does not have serious consequences, but it causes a lot of discomfort, and it is better not to delay treatment and cure it quickly (drugs are sold in any pharmacy and are quite inexpensive).

Urethritis in a woman. Symptoms Video

Urethritis. A sharp pain in the patient's urethritis disturbs before urination, mucus discharge from the urethra, with impurities of pus sometimes and with a characteristic odor. A woman can bring the infection into the urethra, and then into the bladder, if personal hygiene rules are not followed. This can also happen during intercourse or as a result of trauma to the resulting vulva. Symptoms of urethritis are much less common, more often cystitis develops, since the urethra canal is very short. Even, when the infection gets into it, it is washed out from there with a powerful stream of urine.

More about alternative treatment of diseases of the genitourinary system of women:

Diseases of the genitourinary system in women. Video.

New articles

Cystitis in women and drugs for its treatment

Cystitis is one of the most "popular" urological diseases. It is more common in young women. Even without treatment, unpleasant symptoms can disappear, but the disease cannot be ignored. Launched infectious inflammation can cause serious damage to the organs of the genitourinary system.

What is cystitis

Cystitis is an inflammation of the bladder or urinary infection that causes inflammation of the mucous membrane. Most often, the causative agent of the disease is Escherichia coli, less often infections.

Women are more likely to suffer from cystitis due to anatomical features: their urinary canal is wider and shorter, it is easier for a stick to get onto the mucous membrane. A stick in the urinary tract destroys the mucous membrane. Bleeding ulcers appear on it. Without the necessary treatment, the process spreads throughout the body, passing to the kidneys.

Cystitis is often called a "cold" disease: it is believed that it occurs due to hypothermia. This is not the case: the pathogen enters the urethra from the rectum. Cold weather can be beneficial and accelerate inflammation by lowering immunity.

Associated reasons also include:

• stagnant urine;
• difficult childbirth;
• pregnancy;
• operations on the organs of the urinary system;
• avitaminosis;
• improper nutrition;
• hormonal disorders;
• non-compliance with hygiene rules.

Acute cystitis can also occur after unprotected intercourse with an unverified partner. In this case, the causative agent will be chlamydia.

Symptoms and Signs

In the acute form of the disease, the symptoms are pronounced; during chronic cystitis, the symptoms are smeared and may not cause much discomfort. The first obvious sign of cystitis is discomfort when urinating. A burning sensation appears in the urethra, the process of emptying the bladder is delayed.

• frequent false urge to urinate;
• soreness in the external genital area;
• lower abdominal pain;
• cloudy sediment in the urine;
• temperature increase;
• weakness;
• unpleasant odor;
• feeling of incomplete emptying;
• general malaise.

In advanced cases, blood appears in the urine. The further the inflammatory process goes, the more often the symptoms recur. If at the initial stage the urge to urinate occurs every 1-1.5 hours, then later the time is reduced by the dominant. Pain syndrome first manifests itself during urinary emptying, after - constantly.

Forms of the disease

There are two forms of cystitis: acute and chronic. In the first case, the inflammatory process is "one-time", in the second, clinical cases appear more often than twice a year. Chronic inflammation is one of the most important causes of functional and structural changes in the bladder.

In rare cases, a third form is diagnosed - sluggish cystitis. It has no characteristic pronounced exacerbations. The main symptom is frequent urination, characterized by discomfort and a slight burning sensation.

Acute cystitis has two forms of flow. It is subdivided into:

Primary occurs due to infection, secondary often develops due to diseases of nearby organs or the bladder.

Possible complications

Under favorable conditions, the symptoms of primary acute cystitis can resolve on their own. For many women, this is a reason to refuse a visit to the doctor. But the disappearance of obvious signs of the disease is not always evidence that the inflammatory process is arrested.

If the infection remains in the urinary tract, hemorrhagic cystitis may develop. It occurs due to the strong destruction of the mucous membrane. At the same time, the permeability of the vessels increases, hemorrhage occurs. The most obvious sign of such a complication is urine with a rich red tint and sharp sharp pains in the lower abdomen.

The following negative consequences are possible:

• Iron-deficiency anemia;
• dysfunction of the bladder;
• overgrowth of the walls with connective tissue;
• urinary incontinence;
• ruptured bladder;
• peritonitis;
• pyelonephritis.

If sexually transmitted infections join cystitis, the age is the risk of adhesions of the fallopian tubes, which causes infertility. In addition, the disease significantly reduces immunity. The body loses its ability to resist disease and infection.

Required diagnostics

At the first symptoms of cystitis, it is necessary to consult a therapist or urologist. In some cases, the diagnosis can be made after the first visit, solely on the basis of the patient's complaints. The prescribed treatment is carried out at home under the supervision of a doctor.

To confirm the diagnosis, it is necessary to pass a number of tests. This should be done before using any medications: they begin to act quickly, and the next day the clinical picture may change and affect the research results.

Symptoms characteristic of cystitis overlap with signs of other pathologies - urolithiasis, sexually transmitted diseases, uterine cancer or neoplastic processes in the urinary tract. It is possible to exclude all these diseases only after receiving the test results.

• urine;
• blood;
• a smear from the mucous membrane of the vagina or cervix;
• cystoscopy;
• Ultrasound of the genitourinary system.

Additionally, in controversial cases, a biopsy may be required.

Traditional treatment

The following drugs are used to treat female cystitis:

In most cases, the main "stake" is on antibiotics. You cannot choose a medicine yourself. When selecting, the doctor takes into account many factors, from the age of the patient to the clinical picture of the disease. The duration of the course is of particular importance: extra pills "hit" the body, and untreated inflammation is dangerous as a secondary exacerbation.

Before use, you need to carefully study the instructions, paying attention to contraindications. Some products are allowed even for children (for example, Nolitsin), others are prohibited for people with kidney failure, allergy sufferers, pregnant or lactating women.

To relieve the most unpleasant symptoms of cystitis (pain and burning), antispasmodics and analgesics are needed - Papaverine and No-shpa (Drotaverin). Phytopreparations help to restore the normal microflora: Cyston, Phytolysin, Kanephron, Spasmocysthenal. To stimulate the immune system, vitamin and mineral complexes are used.

With chronic cystitis, it is necessary:

• normalize hormonal disorders;
• support the immune system;
• eliminate structural urinary pathology;
• activate the blood supply to the affected organs;
• adjust the rules of personal hygiene.

During an exacerbation, antibiotics and anti-inflammatory drugs are used.

Folk remedies

Folk remedies can relieve pain and stop inflammation, but it is forbidden to completely replace the recommended drug therapy with them. When choosing a suitable recipe, you need to focus on its composition: if you are allergic to at least one component, you must refuse to use it. If possible, you should consult with your doctor about the chosen method of supportive treatment.

• rosehip roots: pour two tablespoons with hot water and boil for 15 minutes. After two hours, the cooled broth is filtered. You need to drink everything in a day, dividing the liquid four times. Consume before meals for one week.
• dry or fresh herb celandine: 150 gr. plants are crushed in a blender. The resulting gruel is wrapped in a bandage or gauze and immersed in a liter jar of warm water. Insist for three hours, drink a third of a glass every three hours.
• lingonberry leaves: two teaspoons in a glass of boiling water, heat on a medium flame, cool and strain. Drink in small sips four times a day. You cannot store the broth, every day you need to prepare a new one. Consume until symptoms disappear.
• bedstraw herb: four tablespoons of dry herb in a glass of boiling water. Cool at room temperature. Drink half a glass before meals. The course is two weeks.

With an exacerbation of cystitis, it is recommended to stay in bed and give up exercise. You need to follow a simple diet: exclude foods with high levels of calcium (milk, kefir, cheeses and yoghurts) and add as many fresh vegetables and fruits to the diet as possible.

Drink should be plentiful and natural - blueberry, cranberry or lingonberry fruit drinks or non-carbonated mineral water at room temperature are suitable. Bad habits during this period are especially dangerous - they undermine the already impaired immunity. Alcohol that is incompatible with medications falls under the complete ban.

Prophylaxis

To avoid re-illness, you must carefully monitor your health. Even mild colds need urgent treatment. Problem teeth, dysbiosis or tonsillitis can provoke secondary cystitis.

To avoid stagnant processes in the small pelvis, you need to move as much as possible. This is especially true for office workers. Although once an hour, a small warm-up is done, consisting of bends, squats and calm walking. It is better to give up the elevator in favor of the stairs.

During washing, it is undesirable to use scented soaps and gels with a large amount of fragrances: they negatively affect the mucous membrane, drying it out. You need to go to the bath at least once a day, change your linen regularly. During critical days, tampons are replaced with sanitary pads.

Tight underwear made of synthetic fabrics often provoke circulatory disorders of the pelvic organs. With a tendency to cystitis, the choice is made in favor of comfortable cotton panties.

At least twice a year, preventive visits to the gynecologist and urologist should be made. Secondary cystitis is rarely an independent disease. In order to block the inflammatory process in the urinary on time, it is necessary to timely identify the underlying disease.

First aid for cystitis

Of course, at the first signs of cystitis, you should immediately consult a doctor. But at the initial stage, the disease often proceeds imperceptibly, and the obvious symptoms are so acute that they cannot be tolerated. To quickly get rid of pain, antispasmodics or any suitable pain relievers are suitable - Drotaverin, Ketorol, Pentalgin, Nurofen.

To provoke the withdrawal of the infection from the urinary tract, an abundant warm drink is used - at least two liters of fluid per day. They refuse strong tea, coffee, soda and packaged store juices during a problem period.

Despite the abundance of antibiotics that act for cystitis, you should not prescribe them yourself. It is better to replace medicines with natural decoctions of calendula, bearberry, chamomile, lingonberry, nettle, St. John's wort and yarrow.

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