Urethral-genital syndrome.

Urethral-genital syndrome is a symptom complex caused by pathology of the urethra and glands opening into the urethral canal: prostate gland, bulbourethral 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 paraurethral ducts of the Skene glands.

The underlying pathology

The most common are acute and chronic urethritis: pain during urination, discharge from the urethra, swollen and hyperemic lips of the urethra, hyperemia of the mucous membrane are the main symptoms.

In second place among diseases of the urethra itself is stricture, which initially disrupts the act of urination, and then can lead to complete urinary retention and the development of congestive hydronephrosis. There can be many causes of stricture. It is detected radiologically and endoscopically, the degree of stricture is determined by bougienage with probes of different thicknesses. Considering that strictures are mostly located in the prostatic part of the urethra, it is necessary to examine the prostate for the presence of adenoma, chronic prostatitis, prostate stones, which can cause narrowing of the urethra and urination disorders.

Developmental defects: congenital fistulas, valves, hypo- and epispadias, are detected in early childhood and are subject to surgical correction. At a later age, congenital hypertrophy of the seminal tubercle is detected (urination disorder and painful erection during urination); congenital ureterocele and diverticula; (painful urination, during which a protrusion appears in the canal area, disappearing after squeezing out urine); cysts of the glands opening through the duct into the urethra.

Pathognomonic symptoms of damage to the urethra are: local pain and tenderness upon palpation, bleeding from the urethra not only during urination but also spontaneously, especially upon palpation, impaired urination, hematoma in the perineal area.

Considering that most of this pathology requires inpatient and surgical treatment, the surgeon can refer the patient to a urological hospital without prior consultation with a urologist, but at the same time does not have the right to independently perform surgical correction of pathologies without specialization in urology.

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Prostatitis

Inflammatory diseases of the prostate gland are quite common. Acute and chronic prostatitis are distinguished. Acute prostatitis is often caused by coccal pyogenic microflora, chronic prostatitis is most often a consequence of a sexually transmitted infection (gonorrhea, chlamydia, trichomoniasis, syphilis, or even a combination of these infections) with insufficient or delayed treatment of urethritis.

Morphologically and clinically, three forms of acute prostatitis are distinguished: catarrhal, follicular and parenchymatous. In the catarrhal form, frequent urination is observed, especially at night, dull pain in the perineum and sacral region.

The general condition is not disturbed. In follicular prostatitis, urination is not only frequent, but also difficult, and may be delayed; the pain syndrome is pronounced, intensifying at the end of urination, during defecation, the body temperature is often subfebrile. Parenchymatous prostatitis is manifested by severe dysuria, often with acute urinary retention, the pain is sharp, intensifying with straining and defecation, the general inflammatory reaction is in the form of purulent-resorptive fever.

The diagnosis is based on the anamnesis, typical symptoms, digital examination of the prostate (massage is contraindicated in acute prostatitis), urine, blood, and urethral contents. In catarrhal prostatitis, the gland is not enlarged by palpation and is moderately painful upon palpation. In follicular prostatitis, it is moderately enlarged; painful, lumpy due to painful seals. In the parenchymatous form, one or both lobes are enlarged, sharply painful upon palpation, deformed, the isthmus is smoothed out; when an abscess is formed, a softening area is palpated, fluctuation may occur. Abscesses usually open into the rectum as submucous paraproctitis and fistula, less often into the pararectal tissue with the formation of subcutaneous paraproctitis and fistula. The patient should be referred to a urologist (in the case of the parenchymatous form, to a hospital).

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

Clinically characterized by high polymorphism with focal changes in the prostate itself, sexual dysfunction, lesions; other parts of the urinary system. Alternation of remissions and exacerbations is noted: pain and paresthesia in the perineum, genitals, suprapubic area, rectum, thighs, often there is an increase in pain after sexual intercourse. Sexual dysfunction is manifested by impotence: weakening or absence of erection, premature ejaculation, decreased and painful orgasm, male infertility. During palpation, the prostate gland is often enlarged in size, but can also be reduced (atrophic), asymmetry of the lobes is noted, the contours are unclear, the density of the gland varies (foci of compaction alternate with zones of softening and recession), the isthmus may not be palpable. Pain from minor to very sharp pain. Microflora may not be detected in the prostate juice, which is a sign of an infectious-allergic process. But a high content of leukocytes, desquamated epidermis, a decrease in the number of leucine grains and Trousseau-Leleman bodies, up to their complete disappearance, are characteristic. Prostate ultrasound with residual urine determination confirms the diagnosis and allows differential diagnostics.

Features of the examination

The examination begins with an inspection. It should be done before urination. At the same time, pay attention to: the foreskin and the condition of the head (detection of phimosis, paraphimosis, balanoposthitis); the location of the external opening - in case of defects, it is not at the end of the penis, but proximally, up to the perineum. The next point is an examination of the mucous membrane of the outlet of the urethra: its condition, color, presence of discharge, edema. Palpation of the urethra is performed in men along the lower surface of the penis, to the back through the rectum; in women, palpation is carried out through the anterior wall of the vagina. Palpation can determine stones, foreign bodies, strictures, tumors, paraurethral abscesses. Of the instrumental methods of examination, X-ray ureterography is in first place. It has very broad diagnostic capabilities for detecting developmental defects: diverticula, doubling, congenital valves, paraurethral passages, strictures, the nature of damage, etc. We clearly believe that without ureterography data, the use of bougienage and ureteroscopy methods is dangerous and contraindicated. Most experienced practicing urologists share this opinion.

The presence of discharge from the urethral canal, even in the anamnesis, if they are not visible at the time of examination (the patient, for example, could urinate, especially since the urge is frequent), requires a thorough examination. Urethritis can be of any etiology - from a banal infection to a specific (venereal), and recently the advantage of microflora associations has been noted. Not only purulent contents of the urethra are taken on glass with a glass rod, but also an epithelial scraping: But this is not enough. Given the ascending nature of the inflammation, the prostate should be examined in men, and in the chronic process - prostate juice obtained by massage. A three-glass urine test or a routine analysis with a study of the microflora should be carried out. If a venereal pathology is detected, an undoubted condition is the referral of such patients to a venereologist.

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