Urethritis
Introduction
Introduction to urethritis Urethritis refers to the inflammation of the urethral mucosa. It is a common disease and is more common in women. It is clinically divided into acute and chronic, non-specific urethritis and gonococcal urethritis. The latter two clinical manifestations are similar and must be based on medical history. Identification with bacteriological examination. Mostly caused by retrograde invasion of the urethra by pathogenic bacteria. The clinical manifestations are urinary frequency, dysuria, urgency and hematuria. In the acute phase, men may have urethral secretions, which are initially mucoid and have a lot of purulent secretions. Females have few secretions. When they are chronic, they show urinary tract irritation and urination discomfort. The urethral secretions are reduced and they are thin and serous. In the acute episode, there is dull pain in the suprapubic area and perineum, and the urethral opening is red. Secretion. At present, there are many kinds of drugs for treatment, and it is necessary to select two or three kinds of drugs according to the types of pathogenic bacteria and the sensitivity to drugs, and the curative effect is good. After the symptoms have completely disappeared, the urine test is normal, and the bacterial culture is negative, the drug should last for 7 to 10 days before stopping the drug. basic knowledge The proportion of illness: 0.12% Susceptible people: more common in women Mode of infection: non-infectious Complications: prostatitis urethral stricture cystitis
Cause
Cause of urethritis
Causes
The common causes of urethritis are as follows:
Urethral injury (25%):
It is the most vulnerable part of the urinary system. It mainly occurs in male youth. There are very few women, only 3%. Male urethra is divided into two parts by genital warts. The anterior urethra is the cavernous urethra, especially the ball is more damaged, mainly caused by riding a cross injury. Urethral mucosal abrasion caused by urethral instrument examination can destroy the urinary tract mucosal defense function and cause bacterial infection.
Urethral obstruction (20%):
Such as stenosis of the foreskin, urethral stricture, urethral stricture, posterior urethral valve, urethral tumor, female hymen umbrella, urethra hymen fusion, etc., due to poor urination, urine accumulation in the urethra can be secondary urinary tract infection.
Foreign body in the urethra (10%):
A foreign body placed in the outside world or a stone in the urethra may cause a urinary tract infection if it is stopped for a long time.
Adjacent organ inflammation (8%):
Such as prostatitis, seminal vesiculitis, vaginitis or cervicitis can spread to the urethra, which is often a stubborn lesion of chronic posterior urethritis.
Often related to sex life (5%):
Unclean sex can easily cause urinary tract infections.
Pathogenesis
There are ascending infections and descending infections in the infection route. According to the different pathogens, they can be divided into:
1. Non-specific urethritis, pathogenic bacteria are most common in Escherichia coli, Streptococcus and Staphylococcus.
2, specific urethritis, also known as gonorrheal urethritis (gonorrheal urethritis), referred to as gonorrhea (gonorrhea), the pathogen is Neisseria gonorrhoeae.
3, non-gonococcal urethritis (non-gonococcal urethritis), the pathogens are Chlamydia trachomatis, Ureaplasma urealyticum, Brevibacterium haemophilus, fungi, Trichomonas vaginalis, condyloma acuminata and herpes simplex virus.
Acute inflammation of the urethra, redness and swelling of the external urethra, marginal valgus, mucosal surface often adhered by serous or purulent secretions, sometimes superficial ulcers, mucosal edema seen under the microscope, including white blood cells, plasma cells and lymphocytes infiltration The capillaries are obviously dilated, and the paraurethral glands are hyperemia or filled with piles of pus cells.
Chronic urethritis lesions mainly in the posterior urethra, bladder neck and bladder triangle, sometimes spread throughout the urethra, the surface of the urethra mucosa is dark red granules, due to scar contraction, the external urethra is smaller than normal, lymphocytes, pulp can be seen under the microscope Cells and a few white blood cells, fibroblasts increase.
Prevention
Urethitis prevention
Male prevention
1. Patients with paralysis avoid sexual behavior before they are cured, prohibit alcohol, do not eat spicy food, and drink more water.
2, do the necessary isolation in the family, bath towels, washbasins, bathtubs, toilets, etc., or disinfect after use.
3. Tell the patient what is safe sex, what is dangerous behavior, and how to avoid dangerous behavior.
4. Encourage the use of condoms.
Female prevention
When urgency, do not delay going to the toilet. When you are thirsty, you should drink plenty of water or other beverages. After sexual intercourse, you should urinate and wash. After the big solution, clean it with clean water.
Complication
Urethitis complications Complications Prostatitis Urethral stricture Cystitis
Complications in male patients: epididymitis, prostatitis, seminal vesiculitis, etc.
Complications of women with endometritis: endometritis, salpingitis, pelvic inflammatory disease, peritonitis, etc.
Intraurethral infection can spread directly to the bladder or prostate causing cystitis or prostatitis. If the acute urethritis is improperly treated, it can be accompanied by paraurethral abscess. Abscess can penetrate the penis skin and become urethral fistula. Fibrosis can cause urethral stricture during the healing of urethral inflammation.
Symptom
Symptoms of urinary tract symptoms Common symptoms Urinary pain, urinary urination, urinary weakness, fever, frequent urination, urine... Hematuria, white mucus, urinary fever, glans, odor, urinary tract, diffuse infiltration
Urinary frequency, urinary burning pain and hematuria, acute men may have urethral secretions, beginning with mucus, after a lot of purulent secretions, women have few secretions, when converted to chronic urethral tingling and urination discomfort, The secretion of urethra is reduced, and it is in the form of a thin serous fluid. There is dull pain in the suprapubic area and perineum in the acute attack. It can be seen that the urethra is red and has secretions.
Examine
Examination of urethritis
1, urine routine examination see leukocytosis or pyuria, accompanied by erythrocytosis, a small number of gross hematuria, urine three cup test, you can find a large number of pus cells in the first cup, red blood cells, and the second cup, the third cup Basically normal, the number of urinary cell culture bacteria in the initial stage is significantly more than the mid-stage urine, urethra or vaginal secretion smear examination, gonococcal urethritis can be seen intracellular or extracellular gonorrhea, non-specific urethritis can be used secretion or anterior urethra swab Culture, see a large number of bacterial growth, secretion smear and culture have not found bacteria, that is, there is the possibility of mycoplasma, chlamydia infection, special methods can be cultured or PCR.
2, chronic urethritis need to undergo urethroscopic cystoscopy to determine the cause of the disease, sometimes metal urethral probes can be used to test the presence or absence of stenosis in the urethra, if necessary, urethral angiography, acute urethra avoidance of equipment examination.
Diagnosis
Diagnosis and diagnosis of urethritis
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
1, acute cystitis: mainly manifested as frequent urination, urgency, dysuria and other bladder irritation symptoms, but cystitis patients mainly mainly due to urinary terminal pain, middle-stage urine culture has bacterial growth.
2, acute pyelonephritis: mainly manifested as sudden urinary frequency, urgency, dysuria and other urinary tract irritation symptoms, often accompanied by low back pain and chills, fever and other symptoms, physical examination has kidney sputum pain, urine routine examination has pus cell.
3, acute prostatitis: also manifested as frequent urination, urgency and dysuria, but prostatitis has genital discomfort, dysuria and fever, rectal examination revealed prostate enlargement with tenderness.
4, gonococcal urethritis: also manifested as frequent urination, urgency and dysuria, urethral orifice also redness, there are thin or purulent secretions, often have a history of unclean sexual intercourse, urethral secretion smear can be seen gonococcal, can be Clear diagnosis.
5, bladder tuberculosis: also manifested as frequent urination, urgency, dysuria, pus cells found in the urine, often have a history of urinary tuberculosis, and urinary acid-fast staining can be found acid-fast bacilli.
6, trichomonas urethritis: also manifested as frequent urination, urgency and urinary tract burning pain and itching, tract secretion can be found in urethra secretions.
