URETHRITIS

From Big Medical Encyclopedia

URETRYT (urethritis; Greek urethra an urethra + - itis) — inflammatory process in a wall of an urethra.

At. divide on gonorrheal and not gonorrheal, or not gonococcal. Gonorrheal uretrita — see Gonorrhoea. The present article is devoted not gonorrheal At., to the Crimea the extensive group various on an etiology and a pathogeny of inflammatory diseases of an urethra belongs. Not gonorrheal At. divide on infectious and noninfectious. On character of the activator infectious At. can be bacterial, virus, spiro-hetny, kandidomikotichesky, mecotic, amoebic, mycoplasmal. To infectious At., sexually transmitted (venereal At.), carry mecotic, Chlamidia and nek-ry types bacterial At.

Noninfectious At., as a rule, arise at injury of an urethra, usually in the course of diagnostic or to lay down. procedures (traumatic At.), and also as reaction to food-borne, medicamentous and other allergens (allergic At.). Noninfectious At. develop at disbolism at patients, it is long suffering from a fosfaturiya, an oksal-uriya, an uraturia, at a diabetes mellitus. In these cases At. are a consequence of mechanical irritation of a mucous membrane of an urethra. Carry to noninfectious kongestivny At., to-ry appears as a result of venous stagnation in prostatovezikulyarny vascular network.

On localization patol. process distinguish front, back and total At., and on a wedge, to a current — acute and chronic.

Various inf. agents, getting on a mucous membrane of an urethra and being implemented into its numerous lacunas and glands, cause an inflammation or remain in it more or less long time without symptoms of a disease (a resistant or tran-zitorny carriage). At venereal At. infection quite often occurs at the same time two activators and more. Pyogenic bacteria, fungi, etc. are, as a rule, capable to cause At. only after preliminary disturbance normal fiziol. conditions of a mucous membrane of an urethra or its injury. In such conditions sometimes show invasiveness nek-ry saprophytes of an urethra, to-rye support the inflammation which is originally caused by the exogenous activator (post-gonorrheal, post-mecotic

Morfol. changes at At., caused by various agents, are almost same and depend not from etiol. a factor, and from sharpness of process and a stage of development of a disease. At acute and subacute At. reveal diffusion exudative changes in an epithelium of a mucous membrane of an urethra with destruction it on certain sites, leukocytic infiltration in podepitelial-number a layer, vasodilatation.

At hron. a current At. proliferative join exudative changes. Inflammatory infiltrates in a submucosal layer gain focal, limited character and afterwards can be replaced with cicatricial fabric that leads to an urethrostenosis — to strictures (see the Urethra, pathology). Inflammatory process extends to glands and lacunas of an urethra. The cylindrical epithelium of an urethra on certain sites is exposed to a metaplasia in multilayer flat and even occasionally in keratosic. On nek-ry sites granulations and papillomatous growths, especially in a prostatic part of an urethra at men can develop.

For traumatic (thermal and chemical) At. more or less expressed necrosis of a mucous membrane is typical.

At. various etiology proceed with identical symptoms, differing only on expressiveness a wedge, signs of an inflammation. At acute At. there are pain, burning or an itch at the beginning of an urination, allocations from an outside opening of an urethra. At survey find a hyperemia, hypostasis of a mucous membrane in the field of an outside opening of an urethra, a plentiful purulent or mucopurulent discharge; the palpation in the field of a back wall of an urethra is painful. Further the hyperemia and puffiness in the field of an outside opening of an urethra decrease; the discharge becomes insignificant or stops. In some cases At. from the very beginning proceeds with a little expressed subjective and objective signs (a torpid form). At the same time the scanty discharge is noted only in the mornings, sometimes only in the form of the crust which is sticking together an outside opening of an urethra; urine usually transparent, with single purulent threads.

At dragged on At. the inflammation often is not limited to a front urethra, and extends to its back department and a neck of a bladder, passing in total U. Ostry total At. it is characterized frequent, sometimes by uncontrollable desires to an urination, pains at the end of it, macroscopically defined pyuria (see the Leukocyturia), sometimes a terminal hamaturia (see).

The inflammatory phenomena gradually abate and later 1 — 3 week there comes the wedge, remission. At insufficiently effective treatment At. can get hron. current. At hron. At. complaints of patients are various, usually they. are connected with complications or neurotic frustration. Symptoms At. can be absent, the course of a disease sluggish with the periodic aggravations arising under the influence of provocative factors — alcohol, sexual excitement, cooling, etc.; at most of patients scanty allocations from an urethra remain.

At At. complications as are possible from bodies of urinogenital system, and extragenital (damages of skin and mucous membranes, joints, eyes, etc.). Clinically they remind complications of gonorrhea (see Gonorrhoea, complications), but proceed more inertly and will worse respond to treatment. The most frequent complication is prostatitis (see), quite often it is combined with a vesiculitis (see) and an epididymite (see). From extragenital complications at a Chlamidia urethritis conjunctivitis most often meets (see Blennorey).

The diagnosis acute At. in most cases comes easy and is based on typical complaints, data of survey and results of a research of urine (see). An essential role in topical diagnosis is played by stakanny tests (see). Make a tank-terioskopichesky and bacteriological research for specification of the diagnosis separated from an urethra. At chronic At. these researches make repeatedly, taking away material in the form of smears and scrapings from a mucous membrane; in doubtful cases make an uretroskopiya (see). Sometimes resort to rentge-nol. to a research — retrograde at a retrografiya (see).

At diagnosis of an urethritis it is necessary to exclude first of all gonorrheal At. As the wedge, signs do not allow to reject a gonorrheal etiology At., resort to laboratornykhm to methods of a research. At acute gonorrheal At. in most cases gonokokk find in smears from an urethra, at a torpid current At. make crops separated on special environments.

Bacterial At., caused by pathogenic bacteriums, diagnose at detection them in separated and smears from an urethra. A certain significance is attached to stay in repeatedly taken smears of a large number of fagotsitirovanny bacteria of the same look.

At. at inf. diseases meet extremely seldom; they are malosimptomna, are diagnosed at allocation of the corresponding activators (naira., paratyphoid, typhoid).

Tubercular At., as a rule, arises for the second time owing to distribution of process of a prostate or seed bubbles, and almost always defeat is limited to back department of an urethra. Constant crotch pains are characteristic. The direct microscopy and crops on usual environments help the diagnosis a little; it is necessary to investigate a deposit of daily urine on a mycobacterium. At an uretrografiya reveal accumulation of radiopaque substance in the field of a seminal hillock and flow it into canals of a prostate.

Kandidomikotichesky U., sexually transmitted or arising owing to dysbacteriosis, proceeds, as a rule, torpidno. At an uretroskopiya the characteristic whitish-gray plaque reminding the milkwoman after removal is visible to-rogo edematous and sharply hyperemic mucous membrane is bared. Elements of a fungus in a large number find in scrapings from an urethra at direct microscopy.

For mecotic At. it is characteristic oligosymptomatic hron. a current, cases of an acute or subacute inflammation occasionally meet. The diagnosis is based on detection of trichomonads in separated from an urethra or at crops on mediums (see the Trichomoniasis).

Amoebic At. the hl is observed extremely seldom. obr. at the male homosexual-sualistov at implementation of the causative agent of amoebic dysentery (see the Amebiasis), to-ry comes to light in the smears painted by hematoxylin or in native drugs.

At mycoplasmal At. (see. Mycoplasmal infections) the activator allocate on special mediums.

At Chlamidia At. at most of patients the wedge, signs are expressed poorly, allocations from an urethra scanty, mucous or mucopurulent character. Chlamydias in scrapings from an urethra can be found in the smears painted across Romanovsky — to Gimza, but the method of a direct immunofluorescence and crops on cells of IAC-which is more effective (see Chlamydias). It is necessary to consider that Chlamidia At. enters a triad of symptoms of a disease of Reuters (see Reuters a disease).

For kongestivny At., the arising hl. obr. at frequent sexual intercourses, an onanism, and also at hron. locks, hemorrhoids, scanty vitreous allocations from an urethra, almost free of leukocytes and bacteria are characteristic. Defeat of back department of an urethra, the expressed colliculitis, congestive prostatitis, dominance of symptoms of sexual frustration is typical.

At allergic At. in separated from an urethra find a large number of eosinophils, pathogenic microflora usually is absent.

Traumatic At., caused by chemical, thermal or mechanical influences, usually violently develops and quickly disappears after elimination of an irritant. This form U. it is diagnosed on the basis of the anamnestic data testimonial of endouret-ralny tool interventions or wrong introduction to an urethra of solutions of chemical substances.

Treatment of an infectious urethritis at prescription of a disease up to 2 months is limited to prescription of medicines, the choice to-rykh depends on an etiology of a disease. At prolonged and chronic At. appoint fortifying therapy, carry out treatment of associated diseases (anemia, a diabetes mellitus, a hypovitaminosis, etc.) and topical treatment according to localization and prevalence patol. process; e.g., washing of an urethra antiseptic solutions (potassium permanganate, silver nitrate, etc.). At mecotic At. apply specific therapy (see the Trichomoniasis), at bacterial, Chlamidia and mycoplasmal At. tetracyclines (e.g., chlortetracyclin on

1,5 — 2 g a day during 2 — 3 weeks), and also doxycycline, erythromycin, rifamnitsin, etc. are most effective. Fresh front candidosis At. treat by means of instillations (see) in a lobby uret-

RU of solutions of levorinum, Amphotericinum of B, etc.; at chronic and complicated candidosis At. antifungal means give also inside. At noninfectious At. elimination of the reason, as a rule, leads to disappearance of symptoms of an inflammation of an urethra.

The forecast at uncomplicated At. favorable. Timely begun rational treatment allows to achieve a wedge, treatment from most of patients.

Prevention venereal At. includes the personal prevention similar carried out at others of veins. diseases (see Gonorrhoea), and public (identification and treatment of patients, dispensary observation and control of quality of treatment, a dignity. - a gleam. work among the population, etc.). For the prevention At. not sexual origin observance of rules of personal hygiene is necessary; carrying out endourethral interventions in strictly sterile conditions with restriction of traumatic manipulations.

Bibliography: Veynerov I. B. and Porn and N with and and y L. M. Diseases of urinogenital bodies at men, Kiev, 1961; Gal-provioza (clamidioses) of the person and animals, under the editorship of O. V. Baroyan, century 1, page 5, M., 1979; Zadorozhny B. A. and Petrov of B. R. Uretrita, Kiev, 1978, bibliogr.; Both l and I. I N. Not gonococcal uretrita at men, M., 1983, bibliogr., L I x about in and c to both y N. S. Uretroskopiya and vnutriuretralnys interventions. M, 1969; T e about x and r about in B. A. Gonorey, trichomoniasis and other urinogenital venereal diseases, M., 1968;

Sh and t to and and A. A. and the Moor about in I. I. Urogenital clamidioses, Kiev, 1988, bibliogr.; Shekhter D., G.'s Braid and T and r and z z about M. Chlamydias as causative agents of diseases, sexually transmitted, Bulletin WHO, t. 54, No. 3, page 789, 1977; To about with v and of a Sv. Prosta-tourethritis a prostatismus, Praha, 1972; Nongonococcal urethritis and related infections, ed. by D. Hobson and. To. K. Holmes, Washington, 1977; Oriel J. D. a. R i d ~ g w an at G. L. Genital infection by chlamydia * trachomatis, L., 1982; Recent advances in sexuallv transmitted diseases, ed. by R. S. Morton a. J. R. W. Harris, Edinburgh, 1975; Schofield O. B. S. Sexually transmitted diseases, Edinburgh, 1975; Sexually transmitted diseases, ed. by R. D. CatteraiJ a. C. S. Nicol, L. — N. Y., 1976; S 6 1 t z - S z about t s J. Urethritis non gonorrhoica des Mannes, B., 1973.

I. I. Ilyin.

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