TsISTALGYYa (cystalgia; Greek kystis a bladder + algos pain) — the complex of various symptoms of defeat of the lower uric ways at women revealed in the absence of changes in analyses of urine.
For designation of a symptom complex the large number of terms is offered. Before implementation in at a beater. similar states designated practice of endoscopic methods of a research as «цистоспазм», «an irrita-tivny bladder», «neuralgia of a bladder», «a hysterical bladder», etc. that met expectations of the neurogenic nature of defeat dominating earlier. With implementation of a tsistoskopiya and uretroskopiya began to use the terms «cystauchenitis», «uretrotrigonit», «papillary cystauchenitis». However these terms, coming from ideas of inflammatory genesis of C., do not explain an origin of a number of the signs characteristic of a cystalgia. Considerable frequency of a symptom complex at ginekol. patients caused emergence of the terms «genitalno-vesical dysfunction», «acute and chronic dyskinesia of a bladder», «gynecologic neurosis of a bladder», «pseudo-cistala-giya». In a crust, time in connection with implementation of functional methods of a research of the lower uric ways the terms «unstable detruzor», «spastic syndrome of an outside sphincter» and some other appeared. In domestic literature the greatest distribution was gained by the term «cystalgia».
According to various researchers, C. meets approximately in 0,4 — 30% of cases from об#цего numbers of the patients addressing the urologist in policlinic. Most often C. it is observed at women at the age of 30 — 40 years. According to a number of urologists, at the heart of C. the inflammatory changes of an iodslizisty layer in the field of a vesical (lyetodiye-v) triangle and a neck of a bladder which are followed by dystrophic changes of nerve fibrils lie. According to Momberts (J. Mombaerts, 1953), C. arises on a certain hormonal background that is followed by hypostasis and lymphoid infiltration of tissues of bladder. According to March (F. River of Marcii) and sotr. (1974), lympho-plazmotsitarnye the infiltrates found in the field of a vesical triangle and a neck of a bladder at C., reflect immune shifts in an organism. Great value in a pathogeny of C. give to changes in the receptor device of a bladder under the influence of infectious, hormonal, mental disturbances. Really, in many cases at an urodynamic research the so-called unstable bladder (between acts of an urination the detruzor creates supertension in a bladder in response to any weak irritants — a hyperreflexia) comes to light. In a crust, time it is established that imperative desires to an urination at an unstable bladder the hyperactivity cholinergic is the cornerstone and and-adrenotropnykh of receptors. It is confirmed by a favorable effect cholinolytic and and - hell-renoblokiruyushchikh of means. Believe also that the similar symptom complex can be caused by various diseases of an urethra (see).
Main symptoms of C. the dysuria, pain in a bladder and a prokhmezhnost irradiating to ileal and sacral areas are. Pain arises at the time of an urination or at sexual intercourse, quite often it is preceded by cooling, alcohol intake, hot dishes. Frustration of an urination can have character of a pollakiuria, imperative desires, feelings of incomplete bladder emptying. These symptoms usually are expressed more in the afternoon. At C. the spontaneous remissions and aggravations provoked by periods, pregnancy, a climax are observed.
Diagnose C. only after an exception of other diseases of a bladder and an urethra, to-rye can be followed by a dysuria; for this purpose use laboratory, endoscopic, radiological methods of a research. For C. absence patol is characteristic. changes in urine; a hyperreflexia at the normal capacity of a bladder; the easy hyperemia and hypostasis of a mucous membrane in the field of a lyetodiyev of a triangle and proximal department of an urethra can be noted.
At treatment of C. favorable impact is made by physical therapy, sedative pharmaceuticals, remedial gymnastics. Apply also novocainic blockade — pre-sacral, paravesical or intradermal (see. Novocainic blockade). In some cases the reflexotherapy is effective (see). A certain place in treatment belongs to a dietotherapy: exclude hot dishes and alcohol from a diet. At C., proceeding against the background of a hormonal imbalance, recommend use of a complex of sex hormones (estrogen) in combination with vitamin E.
The forecast favorable at elimination of pathogenetic factors of Ts. Odnako it demands prolonged, persistent treatment; chronic current of C. with the expressed symptomatology at most of patients leads to development of neurotic states and disturbance of working capacity.
Bibliography: Darenkova. T. and the Ball *
h and y - About about D. K. Refleksoterapiya's l of a cystalgia, Urol. and nefrol., No. 1, page 32, 1982; Marion G. The guide to urology, the lane with fr., page 130, M. — L., 1931; P e r-m I to about in A. N. and T and that in and G. P. Changes of a mucous membrane of an urethra and a bladder at an urethral syndrome, Arkh. patol., t. 44, No. 2, page 42, 1982.
D. V. Kan.