PARACYSTITIS (paracystitis; Greek para near + kystis a bubble + - itis) — an inflammation of the cellulose surrounding a bladder. Sometimes P. call a pericystitis that is not absolutely correct since at a pericystitis only the serous cover of a bladder is involved in inflammatory process (peritoneum). It is correct to consider an inflammation of paravesical cellulose paracystitis.
The item meets rather seldom. Distinguish inflammatory process in prevesical and pozadipu-zyrny cellulose.
the Great value in P.'s development is attached to the infection getting into paravesical cellulose in the hematogenous or lymphogenous way or from nearby bodies and also at injuries of a bladder.
The pathological anatomy
N. A. Lopatkin (1977) distinguishes the following forms P.: acute infiltrative, acute purulent, hron. purulent, hron, fibrous and lipomatous.
At acute infiltrative and acute purulent P. process proceeds in the form of phlegmon of paravesical cellulose. It can sometimes extend in retroperitoneal space.
Hron. purulent (the sacculated abscess) and fibrous and lipomatous P. most often are an outcome acute. At hron, fibrous and lipomatous P. paravesical cellulose is edematous, in thickness can reach several centimeters.
The clinical picture
Acute P. begins with temperature increase, the general weakness, a dysuria, pain over a pubis where at a palpation define a muscle tension and sharp morbidity. At suppuration of inflammatory infiltrate and formation of abscess fluctuation appears. Pozadipuzyrny abscess can be found at rectal or vaginal examonation. The high temperature, a fever, weakness, loss of appetite, dry language, sharp pains in suprapubic area irradiating to the area of a rectum are characteristic of purulent P. The act of defecation becomes painful, paresis of intestines develops. The urination is speeded up, painfully, in urine, in case of break of an abscess in a bubble, pus appears. Sometimes the disease on a wedge, reminds a picture sepsis.
Hron. The item most often is a consequence of the acute P. which is quite often not distinguished. In this case inflammatory infiltrate turns into the sacculated abscess or fib-rozno-lipomatous process. Are characteristic the dull aching ache over a pubis, subfebrile temperature. At a palpation it is possible to find low-painful consolidation over a pubis. Development sclerous - fibromatous (lipomatous) process in paravesical cellulose leads to fibrous changes and deformation of a bladder, reduction of its capacity. Clinically it is shown by the speeded-up urination, pain in the bottom of a stomach.
P.'s current depends on virulence and character of a contagium, the general reactivity of an organism. The item can spontaneously recover, after break of abscess outside or in a cavity of a bladder, in a gut or a vagina, but the break and in a peritoneal cavity with development of peritonitis is possible.
the Diagnosis is based on complaints of the patient, a wedge, displays of a disease, and also on data of special methods of a research. Special significance in diagnosis is attached to a cystoscopic research: often decrease in capacity of a bladder, deformation and protrusion in a wall of a bladder is defined (see. Tsistoskopiya ). Clearer data are obtained at tsistografiya (see), peri-and politsistografiya (see. Bladder, methods of a research ). In case of break of paravesical abscess in a cavity of a bladder at a tsistoskopiya the zone of hypostasis and a hyperemia on a mucous membrane decides on the crateriform ulceration, fistula, on Krom pus separates. The wall of a bladder remains slow-moving. Differential diagnosis is carried out with a fatty necrosis of paravesical cellulose.
acute P.'s Treatment in an early, exudative stage conservative; appoint rest, locally cold, plentiful drink, antibiotics of a broad spectrum of activity in combination with himiopreparata (5-HOK, nitroxoline, Nevigramonum, Biseptolum, furagin, etc.). All this promotes stopping of inflammatory process and a rassasyvaniye of infiltrate. In case of formation of abscess its emptying and drainage is shown. Front paravesical abscess is opened with suprapubic access, back — perineal access or across Buyalsky — to Makuorter through a locking opening (see. Bladder ).
Treatment hron. The item consists in antibacterial therapy, opening and drainage of an abscess, and also in use of drugs of resorptional action (an aloe, a lidaza), corticosteroids, physiotherapeutic procedures.
the Forecast at timely and rather vigorous treatment in case of the acute and sacculated hron, (purulent) P., as a rule, favorable. Hron, fibroznolipomatozny P. leads to deformation and reduction of capacity of a bladder. At a chronic current of P. the recurrence is possible.
Bibliography: Bekkerman A. G. About paracystitis, Urology, No. 4, page 29, 1958; Wars o-Ya hay of N V. F cue. Sketches of purulent surgery, L., 1956; D obrokhoto-in and G. P. O paracystitis, Is new. hir. arkh., No. 2, page 76, 1958; Laptev P. N. iginzburg I. 3. To a question of clinic and treatment of patients with paracystitis, Surgery, No. 9, page 23, 1953; L and with about in with to and I am S. I. O breaks of pelvic abscesses in uric ways, Vestn, hir. and frontier. Region, t. 11, book 32, page 9, 1927; Perelman V. M. About clinicoradiological recognition of paracystitis, the Doctor, business, No. 2, page 130, 1967; Polonsky B. L. Paracystitis, Works 1st Ukrainsk. congress Urals., page 145, Kiev, 1939; P y t of e of l A. Ya., etc. Elected heads of nephrology and urology, p. 3, page 192, L., 1973; Ushakova H. T. To a question of paracystitis, Surgery, No. I, page 141, 1960; CorbusB.C. Pericystitis, J. Urol. (Baltimore), v. 69, p. 374, 1953; Henning D. C. a. R a t-ledge H. W. Perivesical fat necrosis simulating neoplasm, ibid., v. 104, p. 102, 1970.
A. M. Mukhtarov.