Лікування циститу – клініка гендерної медицини Andros

Лікування циститу – клініка гендерної медицини Andros

Лікування циститу

Що таке цистит, хто і як часто хворіє циститом?

Цистит – запальне захворювання сечового міхура. Не ускладнений цистит – цистит, що розвивається у пацієнтів без фізіологічних і анатомічних порушень сечостатевої системи, при відсутності перенесених раніше урологічних операцій або інструментальних обстежень.

циститу хворіють і чоловіки, і жінки. На першому році життя частота інфекції сечової системи вище у хлопчиків. В цілому частота народження інфекції сечових шляхів у новонароджених становить близько 1%. У віці від 1 до 5 років частота виявлення інфекції в сечовий системі у дівчаток зростає щорічно на 4,5%, у хлопчиків щорічно знижується приблизно на 0.5%. Наявність інфекції у хлопчиків часто пов’язано з вродженими порушенням розвитку сечової системи або фимозом. Приблизно 30-50% випадків наявності інфекції в сечовий системі в перші 5 років життя пов’язані з наявністю у дитини міхурово-сечовідного рефлюксу. У шкільному восрасте наявність сечовий інфекції у девочекв середньому 1,2%, у хлопчиків-школярів сечова інфеція зустрічається набагато рідше.

По досягненні періоду статевого дозрівання ймовірність сечової інфекції у жінок зростає в 50 разів. У літньому віці частота народження інфекції сечових шляхів приблизно однакова у чоловіків і жінок.

У США щорічно реєструється 4-6 мільйонів випадків гострого бактеріального циститу у жінок. Приблизно 25-30% жінок у віці 20-40 років щорічно переносять хоча б один випадок циститу. У той же час, гострий цистит у чоловіків без структурних та функціональних змін сечостатевого тракту розвивається набагато рідше, ніж у жінок.

Які фактори ризику розвитку циститу?

До факторів ризику розвитку захворювання відносяться:

    Використання контрацептивних діафрагм. Чи не обрізана крайня плоть статевого члена або фімоз у чоловіка. Активне статеве життя. СНІД. Вроджені та набуті аномалії сечостатевої системи

Які фактори привертають до розвитку ускладнень циститу?

    Пол. Літній вік. Госпітальна інфекція. Вагітність. Наявність сечового катетера. Наявність інфекції сечової системи. Недавнє інструментальне обстеження сечової системи. Недавнє застосування антибактеріальних препаратів. Функціональні та анатомічні порушення в сечовий системі. Наявність скарг більше 7 днів. Цукровий діабет. Імунодефіцит.

Як проявляється цистит?

Гострий не ускладнений цистит викликає запальний процес в сечовому міхурі і уретрі. Захворювання характеризується наступними ознаками:

    Болезеннимі сечовипусканнями. Частими сечовипусканнями. нестерпно позивами до сечовипускання. Виділенням невеликої кількості сечі. Болями над лоном, в низу живота. Домішки крові в сечі. Каламутна та або смердюча сеча.

Як діагностується цистит?

Основними методами діагностики циститу є мікроскопія осаду сечі і посів на мікрофлору середній порції сечі. У нормі вміст лейкоцитів в осаді сечі не повинно перевищувати 5 в полі зору, кількість бактерій в посіві сечі lt; 103 КУО / мл.

Які захворювання можуть проявлятися як цистит?

Цистит повинен бути віддиференціювати від інших можливих інфекційних станів, що призводять до прискорене, хворобливе сечовипускання – вагініт, інфекції, що передаються статевим шляхом, простатит і незапальних причин – стриктури уретри. травми уретри, дивертикулів сечового міхура і уретри, гіперактивного сечового міхура, ургентного нетримання сечі. доброякісних і злоякісних утворень сечового міхура. матки, шийки матки, піхви, каменів сечового міхура. хімічних і алергічних реакцій на контрацептиви.

Чим і як довго лікують цистит?

Бактеріальні цистити лікуються антибактеріальними препаратами, які призначаються лікарем після очної консультації. У сучасній фармакології є достатній вибір препаратів для успішного лікування циститу.

Безліччю досліджень було доведено, що для лікування неускладнених циститів у жінок достатньо прийому антибактеріальних препаратів протягом трьох днів і ефективність триденного прийому препаратів порівнянна з результатами семідневго лікування цими ж препаратами, тільки з меншою кількістю побічних ефектів і меншою вартістю лікування (Warren et al, 1999). Лікування одноразовим прийомом антибактеріальних препаратів може бути застосоване, однак, в цілому, при застосуванні деяких антибактеріальних препаратів, при такому лікуванні частіше відзначається поновлення захворювання і менший відсоток вилікуваних.

Для лікування неускладнених циститів у молодих чоловіків достатньо застосування антибактеріальних препаратів протягом 7 днів.

Чи може Заболеваеніе поновитися після лікування?

Так, в деяких випадках може. Найбільш часто відновлення захворювання викликане бактеріями, які потрапили в сечову систему ззовні. Наприклад, у жінок причинами реинфекции може бути підвищена чутливість рецептороного апарату слизової піхви до бактерій або закид в піхву і уретру мікроорганізмів з кишечника. У чоловіків, в основному, повторне інфікування пов’язано з наявністю анатомічних змін сечової системи (стриктур уретри). У випадках повторного частого рецидивування циститу потрібно поглиблений індивідуальний підхід до подальшої діагностики, виключення таких захворювань як сечоміхурово-ректальний свищ, сечоміхурово-вагінальний свищ, дивертикул сечового міхура або уретри, камені сечового міхура і т. д. Крім того, причиною рецидивуючого (возобновляющегося) циститу може бути раніше перенесена променева терапія, операція на органах малого таза.

У жінок в постменопаузі з пролапсом тазових органів і у літніх чоловіків з доброякісну гіперплазію простати або раком простати відзначаються більш часті рецидиви захворювання, що може бути обумовлено наявністю значно кількості залишкової сечі після сечовипускання. Крім цього, зниження концентрації естрогенів у жінок суттєво впливає на влагалищную мікрофлору, скорочуючи кількість лактобактерій іспособствуя росту кишкової палички (E. coli) – провідному мікроогранізмов у розвитку інфекції сечових шляхів.

Чи існує профілактика циститів?

Так. Ефективність профілактичної антибактеріальної терапії неодноразово задокументована у жінок з рецидивуючими інфекціями сечової системи, відзначено зниження рецидивів на 95% в порівнянні з жінками, що не проходили профілактичну терапію.

1.Профілактіческая терапія має на увазі постійний пріемнебольшіх доз антибактеріальних препаратів перед сном протягом 6-12 месяцев. В разі якщо на тлі профілактики жінка відзначає значне посилення скарг, може знадобитися прийом повних доз антибактеріального препарату з наступною зміною препарату профілактики.

2.Посткоітальная профілактика – статевий акт визнаний одним з факторів ризику розвитку гострого бактеріально циститу у жінок. Використання контрацептивних вагінальних діафрагм значно підвищує цей ризик. Одноразовий прийом антибактеріального препарату після статевого акту ефективно і достовірно знижує ризик повторного інфікування.

3.Періодіческая самостійна профілактика – може застосовуватися у випадках, коли пацієнт не бажає постійно приймати малі дози антибактеріальних препаратів. У подібних випадках жінка за власним відчуттю появи ознак раніше перенесеного циститу приймає запропонований їй препарат.

Кому і коли потрібен нагляд?

Повторний візит, контрольні аналізи мікроскопії осаду сечі і посів сечі після перенесеного циститу рекомендований жінкам похилого віку та чоловікам з потенційним ризиком рецидивування захворювання і при поновленні скарг після лікування і вагітним .

У випадках доброї відповіді на проведене лікування, якщо скарги відсутні і немає відновлення скарг після лікування молодим жінкам і чоловікам повторний візит необов’язковий.

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