CYSTITIS

From Big Medical Encyclopedia

TsISTYT (cystitis; Greek kystis a bladder + - itis) — an inflammation of a wall of a bladder, one of the most frequent urological diseases.

As a rule, the infection is the cornerstone of cystitis. Cystitis of a noninfectious origin arises at irritation of a mucous membrane of a bladder the chemical substances, including pharmaceuticals which are emitted with urine at their prolonged use in high doses (fenatsetinovy C.? urotropi-new C.); at burns of a mucous membrane, napr, in case of introduction to a bladder of strong solution of chemical substance as a result of washing of a bladder solution, temperature to-rogo exceeds 45 ° (burn C.); at injury of a mucous membrane by a foreign body, urinary stone, and also in the course of the endoscopic research; at radiation therapy concerning tumors of female generative organs, a rectum, bladder (beam C.) In most cases, however, the infection soon joins originally aseptic inflammatory process.

Contagiums can get into a bladder in the ascending way — at inflammatory diseases of an urethra (see the Urethritis), a prostate (see Prostatitis), seed bubbles (see the Vesiculitis), a small egg (see the Orchitis) and its appendage (see the Epididymite); in the descending way — most often at tubercular damage of a kidney (see Tuberculosis extra pulmonary, tuberculosis of urinogenital bodies); in the hematogenous way — at inf. diseases or existence of a suppurative focus in an organism — tonsillitis (see), a pulpitis (see), a furunculosis (see the Furuncle), etc.; in the lymphogenous way — at diseases of generative organs — an endometritis (see Metroen to a metritis), a salpingo-oophoritis (see the Adnexitis), a parametritis (see). Infection of a bladder can occur at its catheterization (see) or during a tsistoskopiya (see).

Activators of infectious C. can be colibacillus (see), staphylococcus (see), vulgar proteas (see Proteus), etc., or their associations, napr, colibacillus and staphylococcus, enterokokk and vulgar proteas, the microorganisms sometimes gas-producing — E. coli, Aerobacter aerogenes, etc. In urine at C. druses of the actinomycetes (see) causing mycotic C can be found., vulval trichomonads — activators of mecotic C. (see the Bladder, a trichomoniasis of a bladder).

The mucous membrane of a bladder has considerable resistance to an infection therefore one its infection is not enough for development of cystitis. E.g., at diseases of kidneys and upper uric ways through a bladder bacteria can be carried, however it does not cause C for a long time.; at puzyrnovlagalishchny and vesical pryamokishechnykh fistulas (see. Urinogenital fistulas) or break of an abscess in a bladder inflammatory process in it is usually limited to the small site of a mucous membrane in a circle of fistula. In development of C., in addition to an infection, an important role is played by the accessory contributing factors: decrease re

zistentnost of an organism (see), caused, e.g., by the overcooling, overfatigue, exhaustion postponed diseases, operative measures; disturbance of outflow and stagnation of urine at patients with adenoma of a prostate, a stricture of an urethra, neurogenic dysfunction of a bladder; disturbance of blood circulation in a wall of a bladder or in a small basin.

C. can arise in originally healthy body (primary C.) and as a complication of earlier existing disease of a bladder or other bodies — secondary C. (see tsvetn. the tab. to the Art. of Tsistoskopiya, t. 27, Art. 112, fig. 19). Depending on prevalence of process distinguish focal and diffusion C.; during the involvement in inflammatory process only of a neck of a bladder the cervical C develops., a vesical triangle — trigonite. On character morfol. changes and a wedge, to a current distinguish acute and chronic cystitis. Allocate also special form of chronic cystitis — intersticial cystitis.

Acute cystitis. Morfol. changes at acute C. are usually limited to a mucous membrane of a bladder (see tsvetn. the tab. to the Art. of Tsistoskopiya, t. 27, Art. 112, fig. 17), in a cut find a plethora of capillaries, hypostasis of a stroma, focal limfoplazmotsitarny infiltration with impurity of segmentoyaderny leukocytes without disturbance of an epithelial cover (catarral C.). During the progressing of inflammatory process the mucous membrane of a bladder becomes folded owing to sharp hypostasis, in more hard cases there can come violent hypostasis (violent C). Less often process extends in depth of a wall of a bubble with formation of the expressed leukocytic infiltrates; the epithelium on nek-ry sites of a mucous membrane is exfoliated, formation of erosion, ulcers is possible (phlegmonous C.). On loosened, hyperemic the mucous membrane in some cases can find whitish or dark-purple fibrinous films — fibrinous C. (see tsvetn. the tab. to the Art. of Tsistoskopiya, t. 27, Art. 112, fig. 18). At nek-ry patients, especially at poisoning with poisons, multiple hemorrhages in a mucous membrane with desquamation of an epithelium are observed (hemorrhagic C., ulcer and hemorrhagic C.). In extremely hard cases, usually at a combination of infection of a bladder to disturbance of blood circulation in its wall, there comes the necrosis of a mucous membrane with the subsequent sloughing — the gangrenous C develops. (see the Bladder, gangrene of a bladder). At fusion of a muscular coat of a bladder there can occur spontaneous perforation of its wall. For C., caused by gas-forming microorganisms, existence of vials of gas in a mucous membrane and a submucosal layer is characteristic, is rare — in a muscular coat (emphysema of a bladder).

Acute C. there is usually suddenly, through a nek-swarm time after overcooling or influence of other provocative factor. Its main symptoms are a frequent urodynia, pains in a bottom of a stomach, a pyuria (see the Leukocyturia); intensity of an urodynia increases, pain accepts almost constant character. Due to the speeded-up imperative desires to an urination patients (especially children and teenagers) are not able to hold urine. Expressiveness a wedge, signs at acute C. it is various. In nek-ry, more mild cases patients feel only weight in a bottom of a stomach; moderately expressed pollakiuria (see) is followed by small pains at the end of the act of an urination. Sometimes these phenomena are observed within 2 — 3 days and pass without special treatment. However the acute C is more often. even at timely begun treatment would proceed — 8 days. Longer current demonstrates existence of the associated disease supporting inflammatory process and demands additional inspection.

For severe forms of acute C. (phlegmonous, gangrenous, hemorrhagic) the expressed intoxication, high temperature of a body, an oliguria are characteristic (see); urine muddy, with a putrefactive smell, contains flakes of fibrin, sometimes layers of a nekrotizirovanvy mucous membrane, impurity of blood. Duration of a disease in these cases considerably increases, development of heavy complications is possible.

Diagnosis of acute C. establish on the basis of characteristic a wedge, the signs yielded the anamnesis, results of a research of urine (see). Tsistoskopiya at acute C. it is contraindicated. Find leukocytes, erythrocytes and a small amount of protein in urine (in connection with existence of uniform elements of blood). At hemorrhagic C., besides, the gross hematuria is noted (see the Hamaturia). At acute C. patients need a bed rest, and in hard cases hospitalization are subject. Appoint plentiful drink, a diet with an exception of hot dishes, a pickles, sauces, seasonings, canned food, prohibit the use of alcoholic beverages. Recommend vegetables, fruit, dairy products. Use of broth of the herbs (renal tea, a ptarmigan-berry, corn stigmas) having diuretic effect is useful. For the purpose of reduction of pains appoint heat baths, hot-water bottles. At sharply expressed dysuria apply spasmolytic pharmaceuticals (a papaverine, Nospanum, etc.), microclysters from 2% warm solution of novocaine; in hard cases make pre-sacral novocainic blockade. At not stopped severe pains use of drugs is admissible. As antibacterial treatment at acute C. apply furagin on 0,1 g 2 — 3 times a day, Negramum on 0,5 g 4 times a day, 5-HOK on 0,1 g 4 times a day, etc., antibiotics of a broad spectrum of activity (Oletetrinum, Oxacillinum, tetracycline, erythromycin, etc.) inside or intramusculary. Usually apply one of the listed drugs within 8 — 10 days that leads to bystry reduction of a dysuria and normalization of composition of urine.

The forecast at acute primary C. favorable. At untimely and irrational treatment acute C. can get hron. current.

In prevention of C. an important role is played by observance of rules of personal hygiene, timely treatment of inflammatory diseases, disturbances of urodynamic, the prevention of overcooling, observance of an asepsis at endovesical researches and catheterization of a bladder.

Chronic cystitis. At chronic C. in patol. process is involved usually all wall of a bladder. It is an infiltrirovana, it is edematous, thickened, its elasticity is reduced; more, especially at women, the area of a vesical triangle suffers. The mucous membrane in zones of defeat is hyperemic, loosened with sites of easily bleeding granulyatsionny fabric. In some cases in a wall of a bladder there are micro abscesses, after opening to-rykh ulcers are formed. Ulcers of a mucous membrane at chronic C. have various sizes, depth and a configuration, happen single and multiple; it is long the existing ulcers can be inlaid with salts (the inlaying C.). At dominance of proliferative processes development of granulyatsionny fabric with formation of warty, polypostural and granular growths is noted (polypostural C., follicular C.).

At specific tubercular C. inflammatory changes are found originally in the field of mouths of ureters in the form of tubercular hillocks (see the Bladder, tuberculosis of a bladder).

Wedge, picture of chronic C. it is various and depends on an etiological factor, the general condition of the patient and efficiency of the carried-out treatment. The main a wedge, the same symptoms, as at acute C., but are expressed more weakly. Chronic C. proceeds or in the form of continuous process with the constants which are more or less expressed by complaints and changes in urine — a leukocyturia, a bacteriuria (see), or has a recurrent current with the aggravations proceeding to similarly acute C. and remissions, in time to-rykh all signs of C. no.

In diagnosis of chronic C. and identification of the reasons supporting an inflammation the tsistoskopiya is essential (see). At the same time define extent of damage of a bladder, a form C., existence of a tumor, urinary stone, foreign body, diverticulum, vesical fistula, ulcers. In some cases during a tsistoskopiya find the accompanying C. symptoms of a disease of kidneys and ureters, napr, release of blood or pus from mouths of ureters. If necessary use also other methods of the general and urological inspection.

The differential diagnosis is carried out by hl. obr. with an urethritis (see). Existence patol. changes only in the first portion of urine during the conducting dvukhstakanny test (see Stakanny tests) confirms an urethritis. At the differential diagnosis of chronic C., proceeding with formation of ulcers, with a tumor of a bladder crucial importance belongs to an endovesical biopsy (see Tsistoskopiya).

Treatment of chronic cystitis is directed to recovery broken urodynamic (see), elimination of the centers of reinfection, removal of urinary stones, etc. Antibacterial treatment at chronic C. carry out only after bacterial. researches and definitions of sensitivity of microflora to antibacterial pharmaceuticals. To adults and children of advanced age make washings of a bladder solution of Furacilin 1:5000, solutions of silver nitrate in the increasing concentration (1: 20 000, 1:10 000, 1:1000) within 10 — 15 days; this procedure is especially shown to patients with disturbance of bladder emptying. Apply also instillations (see) in a bladder of oil of a dogrose, a sea-buckthorn, an emulsion of antibiotics. Apply UVCh to improvement of blood supply of the struck wall of a bladder (see UVCh-therapy), an inductothermy (see), mud applications (see Mud cure). Local influence of pharmaceuticals is reached by means of an ionophoresis with nitrofurans (see the Electrophoresis), antiseptic agents. At chronic C., followed by resistant alkali reaction of urine, it is shown a dignity. - hens. treatment in the resorts of Truskavets (see), Zheleznovodsk (see).

The forecast at chronic C. is less favorable, than at acute. Satisfactory results can be received only at persistent complex treatment and elimination of the contributing factors. In case of a complication of chronic C. a vesicoureteral reflux (see) perhaps spread of an infection in the ascending way with development tsistopiyelonefri-that. At secondary C. the forecast is defined by a current and an outcome of a basic disease.

Prevention of chronic C. consists in rational treatment of acute C., and also early detection and treatment of diseases of urinogenital system.

Intersticial cystitis (a simple ulcer of a bladder) — a special form of inflammatory defeat of a wall of a bladder.

Etiology of intersticial C. finally it is not found out. Inflammatory process, beginning in gyud-slime layer, gradually strikes all layers of a wall of a bladder, is followed by the progressing fibrosis and reduction of its capacity (the wrinkled bladder); disturbance of a trophicity leads to formation of ulcers. More often women at the age of 45 — 50 years get sick. The course of a disease long, progressing. Sharply expressed dysuria (see), a terminal hamaturia is characteristic (see).

At a tsistoskopiya on a top of a bladder or on its ookovy wall find roundish sharply erethistic ulcer with a diameter no more than 20 mm. Inflammatory changes on the periphery of an ulcer are usually not expressed. As a rule, only one ulcer in one step comes to light, after healing the cut is formed another.

The differential diagnosis is carried out with tuberculosis and a tumor of a bladder. Lack of mycobacteria of tuberculosis in urine, normal function of both kidneys, lack of signs of scarring in a pelvis and ureters allow to exclude tubercular defeat. In differential diagnosis of intersticial cystitis and tumor of a bladder an important role is played by an endovesical biopsy.

Treatment is conservative, complex. Appoint the sedative, hyposensibilizing, spasmolytic and anti-inflammatory drugs, instillations in a bladder of a hydrocortisone in combination with antibiotics and anesthetics, carry out presakralny novocainic blockade (see), physical therapy.

Improvement can occur only in cases of the intensive treatment begun at early stages of defeat. Progressing of a disease leads to irreversible changes of a bladder with disturbance of its function owing to what there is a need for intestinal plastics (see).

Trigonite — an inflammation of a mucous membrane of a vesical triangle. Acute trigonite, as a rule, is a consequence of spread of an infection at an inflammation of back department of an urethra, and also at prostatitis. The main sign — sharply expressed dysuria, sometimes — a terminal hamaturia. In urine reveal a significant amount of leukocytes. Treatment includes all events held at acute C. (see above), and also treatment of a basic disease.

Hron. trigonite is observed by hl. obr. at women also has usually character of congestive process. The circulatory disturbance in the field of a vesical triangle and a neck of a bladder at the wrong position of a uterus is the cornerstone of it or at omission of a front wall of a vagina; in some cases matters hron. inflammatory process in an iarametriya. At hron. trigonite the wedge, signs are a little expressed; the urination is usually speeded a little up, unpleasant feelings are noted during the act urinations. Changes in urine are absent. At a tsistoskopiya the mucous membrane of a vesical triangle is loosened, edematous, slightly hyperemic.

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symptomatic treatment. Forecast favorable.

Beam cystitis — the complication of radiation therapy (see) developing depending on an exposure dose and sensitivity of the irradiated fabrics in different terms: during a course of radiation therapy, directly after it, in several weeks, months or years. A wedge, manifestations and changes in urine same, as at hron. cystitis. In late stages cicatricial and ulcer changes of a wall of a bladder are characteristic. At beam C., in addition to symptomatic and antibacterial treatment, apply instillations of fish oil, methyluracil, intravezikalny injections of corticosteroids. At extensive damages of a bladder and lack of effect of conservative treatment make a resection of an affected area or its intestinal plastics. The forecast rather favorable only at treatment in early stages.

Prevention consists in rational planning of radiation therapy taking into account radiation sensitivity of fabrics and bodies (see Radiochuvstvitelnost) I, and also use of defensors (see. Beam damages, prevention).

See also Bladder. Bibliography: Arsanukayev M. A. and

Starchuk N. I. Postoperative cystitis at children, At a beater. and nefrol., N» 6, page 14, 1980; D about l e c to and y S. Ya., etc. Use of current of supratonal frequency in complex treatment of cystitis at children, in the same place, No. 6, page 35, 1982;

A. Ya. Urologiya's Dukhans of children's age, page 199, M., 1968; Klimenko B. V. A role of a trichomoniasis in developing of cystitis at men, Urol. and nefrol., No. 6, page 44, 1976; Lavrovsky JI. To., Barybin A. S. and M e z e N of c e in A. I. Use of a dimethyl sulfoxide in complex treatment of early and late beam cystitis, in book: Use of radioisotopes in diagnosis and treatment, under the editorship of A. I. Mezentsev and V. D. Tarasenko, page 60, Sverdlovsk, 1973; JI yulko A. V., Volkov L. N. and With at x about d about l with-to and I am A. E. Cystitis, Kiev, 1983; Pugachev A. G. and Eshmukhambetov S. N. Chronic cystitis at children, Alma-Ata, 1983; Romanenko A. M. Chronic cystitis in aspect of their belonging to a precancer, Arkh. patol., No. 12, page 52, 1982; T and to t and N with to and y O. L. Inflammatory nonspecific diseases of urinogenital bodies, page 193, L., 1984; And yes-bert J., D about yo V. et of That with hard G. La cystite k eosinophiles, J. Urol., t. 89, p. 65, 1983; A u b e of t J. e. a. La cystite incrust6e h urine alcaline, Aspects clini-ques et traitement, ibid., t. 88, p. 359, 1982; In and with k w about 1 d F. J. a. o. Therapy for acute cystitis in adult women,

J. Amer. med. Ass., v. 247, p. 1839, 1982; D about at 1 e P. T. a. o. Abacterial cystitis, Brit. J. Urol., v. 49, p. 647, 1977; Dunn M. a. lake of Interstitial cystitis, treated by prolonged, bladder distension, ibid., p. 641; F a 1 1 M., G a r 1 s s about n C. - A. a. Erlandson B. - E. Electrical stimulation in interstitial cystitis, J. Urol. (Baltimore), v. 123, p. 192, 1980; MufsonM. A. a. BelsheR. B. A review of adenoviruses in the etiology of acute hemorrhagic cystitis, ibid., v. 115, p. 191, 1976; WorthP.H.L.a. T and r-ner-WarwickR. The treatment of interstitial cystitis by cystolysis with observations on cystoplasty, Brit. J. Urol., v. 45, p. 65, 1973.

A. V. Lyulko.

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