Urethral-genital syndrome

The urethral-genital syndrome is a symptom-complex, caused by the pathology of the urethra and glands opening the ducts into the urethral canal: prostate gland, bulb-urethral glands, paraurethral glands, Littre glands, vas deferens. In men, the length of the urethra depends on the size of the penis; in women, the urethra is short (3-4 cm) and its structure is simpler - the canal and the paraurethral ducts of the Skin glands.

Basic pathology

The most common is acute and chronic urethritis: rubbing with urination, discharge from the urethra, swollen and hyperemic sponges of the urethra, hyperemia of the mucosa - the main signs.

On the second place from the diseases of the urethra is stricture, which first violates the act of urination, and then can lead to a complete retention of urine and the development of stagnant hydronephrosis. The reasons for stricture can be many. It is detected radiological and endoscopically, the degree of stricture is determined by bougain with probes of different thicknesses. Given that the strictures are mostly located in the prostate part of the urethra, it is necessary to examine the prostate for adenoma, chronic prostatitis, prostate stones, which can be the cause of narrowing of the urethra and impaired urination.

Developmental flaws: congenital fistulas, valves, hypo- and epispadias, are detected in early childhood and undergo surgical correction. At a later age, the congenital hypertrophy of the seminal tubercle (urination disorder and painful erection when urinating) is revealed; congenital ureterocele and diverticula; (painful urination, during which a protrusion appears in the canal region, disappearing after extrusion of urine); cysts of glands opening the duct to the urethra.

Pathognomonic symptoms of damage to the urethra are: local pain and tenderness in palpation, the discharge of blood from the urethra not only during urination, but also spontaneously, especially when it is palpated, impaired urination, hematoma, in the perineal region.

Given that most of this pathology requires inpatient and surgical treatment, the surgeon can refer the patient to the urological hospital without consulting the urologist, but at the same time has no right to self-surgical correction of pathologies without specialization in urology.

[1], [2]

Prostatitis

Inflammatory diseases of the prostate gland occur quite often. There are acute and chronic prostatitis. Acute prostatitis is more often caused by coccoid pyogenic microflora, chronic infections are most often the result of sexual infection (gonorrhea, chlamydia, trichomoniasis, syphilis, and even a combination of these infections) with insufficient or delayed treatment of urethritis.

Morphologically and clinically distinguish three forms of acute prostatitis: catarrhal, follicular and parenchymal. With catarrhal form, frequent urination is noted, especially at night, blunt pains in the perineum and sacral region.

The general condition is not violated. With follicular prostatitis, urination is not only quickened, but also difficult, perhaps its delay; pain syndrome, expressed, intensified at the end of urination, with defecation, body temperature is often subfebrile. Parenchymal prostatitis manifests itself with a pronounced dysuria, often with an acute delay in urination, a sharp pain, worse with straining and defecation, a general inflammatory reaction in the form of a purulent-resorptive fever.

The diagnosis is based on anamnesis, typical symptomatology, digital prostate examination (with acute prostatitis massage is contraindicated), urine, blood, urethral content. With catarrhal prostatitis, iron palpation is not increased, moderately painful on palpation. With follicular - moderately increased in size; painful, tuberous due to painful seals. In the parenchymal form: one or both lobes are enlarged in size, sharply painful when palpation is deformed, the isthmus is smoothed; when forming an abscess, the softening site is palpated, there may be fluctuation. Abscesses are usually opened in the rectum in the form of submucosal paraproctitis and fistula, less often in pararectal tissue with the formation of subcutaneous paraproctitis and fistula. The patient should be referred to the urologist (with the parenchymal form in the hospital).

Chronic prostatitis. It develops most often with poor-quality treatment of acute urethritis and prostatitis, when the disease does not stop within the first two weeks, but in this case, in its majority, an infectious-allergic form of pathology is formed.

Clinically characterized by a large polymorphism with a focal pattern of changes in the prostate itself, a violation of sexual function, lesion; other parts of the urinary system. There is an alternation of remissions and exacerbations: pain and paresthesia in the perineum, genitalia, suprapubic zone, rectum, hips, often marked pain after sexual intercourse. Violation of the sexual function is manifested by impotence: weakening or lack of erection, premature ejaculation, reduced and painful orgasm, male infertility. In palpation, the prostate gland is more often enlarged in size, but may also be reduced (atrophic), the asymmetry of the lobes is noted, the contours are indistinct, the density of the gland is different (the foci of alternation alternate with the zones of softening and occlusion), the isthmus can not palpate. Pain sensations from minor to very severe pain. In the juice of the prostate microflora may not be detected, which is a sign of an infectious-allergic process. However, the high content of leukocytes, the desquamated epidermis, the decrease in the number of lentin kernels and the Tussaud-Lelemans bodies are characteristic, up to their complete disappearance. Confirms the diagnosis and allows differential diagnosis of ultrasound of the prostate with the determination of residual urine.

Features of the survey

The examination begins with an examination. It must be performed before the act of urination. Thus pay attention to: an extreme flesh and a head condition (revealing a phimosis, a paraphimosis, a balanoposthitis); the location of the external opening - with the vagaries expanding it is not at the end of the penis, but proximal, right up to the perineum. The next point: is the examination of the mucosa of the outlet of the urethra: its condition, color, the presence of secretions, edema. Palpation of the urethra is performed in men on the lower surface of the penis, in the posterior part through the rectum; In women, palpation is carried out through the front wall of the vagina. With palpation, you can identify stones, foreign, body, strictures, tumors, paraurethral abscesses. Of the instrumental methods of research, x-ray-ureterography is the first place. It has very wide diagnostic possibilities for revealing the developmental defects: diverticula, doubling, congenital valves, paraurethral throats, strictures, the nature of the damage, etc. We clearly believe that without the data of ureterography, the use of bougie and ureteroscopy methods is dangerous and contraindicated. This is the opinion of most of the experienced practicing urologists.

The presence of secretions from the urethral canal, even in an anamnesis, if they are not visible at the time of the examination (the patient, for example, could urinate the more that urges are frequent), Requires careful study. Urethritis can be any etiology - from banal infection to specific (venereal), and recently the advantage of microflora associations is noted. On the glass using a glass rod, not only purulent contents of the urethra are taken, but also epithelial scrapings: But this is not enough. Given the ascending nature of inflammation, men should be examined prostate, and in the chronic process - prostate juice obtained by massage. A three-glass urine sample or a routine analysis with microflora examination should be performed. When revealing venereal pathology, an undoubted condition is the referral of such patients to the venereologist.

[3], [4], [5], [6], [7], [8],