Huerta female. How do urethral diseases manifest in women?

Urethritis in women is quite common. This disease is an inflammatory process urethra, it can be acute or chronic, depending on the nature of the course. Women are more susceptible to the development of urethritis than men, which is explained by the anatomical features of the structure of the urethra - in females it is wider and shorter, which contributes to the rapid penetration of various bacterial agents.

Despite the fact that acute or chronic inflammation in urethritis in women does not pose a danger to the life of the patient, nevertheless, the disease delivers many unpleasant symptoms, disrupting the normal functioning of a person. In addition, if not adequately treated, the infection can spread through the urinary tract, causing the development of other diseases.

Causes of inflammation in urethritis in women

Many factors can provoke the development of the inflammatory process of the urethra in women. Experts call such causes of urethritis in women:

Hypothermia of the body, both general and local. As a result of spasm blood vessels, which occurs when the body is overcooled, its protective functions are reduced and it becomes vulnerable to the action of various infections.
STDs are sexually transmitted diseases. These are "classic" venereal diseases, the causative agents of which can be independent causes of the development of urethritis in women or cause the action of other pathogenic microorganisms.
Gynecological diseases - acute and chronic.
decline local immunity organism.
Urethral injury. A woman can get damage to the urethra during gynecological examination, as well as in the process of removing stones from the overlying sections of the urinary tract. Bladder catheterization and cystoscopy - methods necessary in the treatment of urethritis, also cause an exacerbation of this disease.
Beginning of sexual activity. During the first sexual intercourse, a "foreign" microflora inevitably enters the girl's body, which can cause the development of an inflammatory process.
Wrong nutrition. The inflammatory process of the mucous membrane of the urethra can be caused by the use of spicy, sour, salty, fatty, smoked, pickled, bitter, too sweet food, as well as alcoholic beverages. All these substances enter the urine and together with it, passing through the urinary tract, have irritant effect on the mucous membrane of the urethra.
Urolithiasis disease. With the development of urolithiasis, crystals and sand enter the urine, which injure the urethra.
Prolonged stress.

Common causes of urethritis in women are microorganisms such as chlamydia, ureaplasma and mycoplasma. Despite the fact that these microorganisms belong to the number of conditionally pathogenic microflora, they can provoke the development of an inflammatory process in urinary tract women.

Chlamydial and mycoplasmal urethritis is difficult to treat, often causing serious complications. It is chlamydia and mycoplasma that are one of the main causes of infertility in women of reproductive age.

Causes of urethritis in older women

Urethritis in older women is a fairly common phenomenon that requires mandatory monitoring by specialists. This is due to the fact that in most older women, the tissues of the urethra and bladder become significantly thinner and drier after menopause. This process is caused by the absence of the hormone estrogen in the female body, which ceases to be produced after menopause. This is the most common cause of urethritis.

General symptoms urethritis in women

Despite the fact that each form of the inflammatory process is characterized by its own specific manifestations, nevertheless, the following general symptoms of urethritis in women are known:

pain during urination;
the occurrence of discomfort during intercourse;
pain in the lower abdomen;
copious discharge from the urethra and vagina with a sharp bad smell, sometimes with impurities of pus.

Classification of urethritis in women

The manifestation of symptoms of urethritis in women depends on the form and type of the disease. That is why the causes and symptoms of urethritis in women are closely related.

In urology, such a classification of the inflammatory process is known, depending on the cause of its occurrence:

candidal;
allergic;
bacterial;
trichomonas;
gonorrheal;
herpetic.

According to the nature of the course, acute and chronic urethritis are distinguished.

Acute and chronic urethritis in women: symptoms and treatment

Acute urethritis in women makes itself felt with such symptoms:

pain in the process of urination;
burning and itching in the urethra;
increased urine output;
frequent urge to urinate, often false;
pain in the lower abdomen;
discharge from the genitals, which may have different character depending on the form of the disease - white, green, yellow, mucous, foamy.

At acute form inflammatory process in women, chills, fever, headaches and other non-specific signs of intoxication of the body can be observed. urethritis with such severe symptoms, as a rule, occurs in women with a significant decrease in immunity or with other infectious and inflammatory processes in genitourinary system.

Each of the forms of the disease in the acute course of urethritis in women is accompanied by its characteristic symptoms:

with gonorrhea - pain and cramps with long delay urination, profuse discharge from the genital tract, having a creamy character;
with trichomonas - itching and burning not only in the area of the urethra, but the skin of the labia, green discharge from the vagina is observed;
with candidiasis - severe itching and white curdled discharge from the vagina;
with mycoplasmosis and chlamydia, symptoms are practically not observed.

Chronic urethritis in women occurs in cases where the acute form of the disease was not noticed in time and adequate treatment was not carried out. Chronic urethritis has a less vivid clinical picture, most often the disease occurs in latent form. Main symptoms chronic urethritis in women - frequent urination and discomfort in the genital tract, which is uncertain. In the chronic form of the inflammatory process, itching, burning and discharge from the urethra may not be.

Body temperature during chronic infection also does not increase, the general condition of the woman remains unchanged. Chronic urethritis can be asymptomatic, and a woman often does not even know about the development of an inflammatory process in her body. They learn about the course of an infectious disease only during an examination of a completely different disease.

Treatment of chronic urethritis in women is carried out by specialists such as a gynecologist, venereologist and urologist. The therapy consists of the following steps:

restoration of the functional properties of the walls of the urethra;
restoration of healthy microflora of the vagina;
restoration of immunity.

Specialists should adhere to the following principles for the treatment of symptoms of chronic urethritis in women:

Reception antibacterial drugs is the basis of treatment. For antibiotic therapy to be effective, it is important to identify the causative agent of the infection.
The use of suppositories and ointments with anti-inflammatory action. Such complex therapy allows you to restore the natural microflora of the vagina and save the woman from distressing symptoms diseases.
An important role in the effectiveness of treatment is given to compliance with a sparing diet. Experts recommend that their patients exclude spicy, salty, smoked, sour, spicy foods, carbonated and alcoholic drinks from the diet.
In order to increase defensive forces the body is required to take multivitamin complexes.
The procedure for introducing drugs in the form of instillation into the urethra is effective. In case of damage to the bladder, when cystitis develops against the background of urethritis, drugs are also injected into it.

Candida urethritis in women: signs and treatment

Candidal urethritis in women develops as a result of the penetration of fungi of the genus Candida into the urinary tract. The incubation period lasts from two to three weeks. Usually this type of urethritis occurs against the background of long-term use antibiotics and more often than other types of the disease acquires chronic form. This is due to the fact that candidal urethritis mainly occurs in a latent form and is found already on late stage development.

The following signs of urethritis in women caused by the Candida fungus will help to suspect the development of the disease:

pain and burning in the urinary tract and anus;
mild pain during urination;
white discharge from the genitals;
dull pain in the lower abdomen.

Urologists also name other factors that cause the candidal form of the disease:

diabetes;
overweight or excessive thinness;
bad habits - smoking and alcohol abuse;
violation hormonal background and taking steroids.

There are two types of candidal urethritis - primary and secondary. Experts talk about the primary form in the case when the inflammatory process develops directly in the ureter. The secondary form is associated with the penetration of Candida fungi from other nearby organs.

Primary candidiasis is usually diagnosed in adolescent girls, and in most cases is accompanied by vulvovaginitis. Infection of women often occurs sexually. Anyone can become infected with the disease, but those who are promiscuous are at risk.

Candidal urethritis is dangerous for its complications. Suffer first digestive system, Candida fungi actively multiply in the intestines, disrupting its activity and reducing the protective functions of the body. In addition, this form of inflammation in the urethra can lead to the following consequences:

cystitis;
violation of the microflora of the vagina;
the formation of female balanoposthitis;
narrowing of the urethra;
other inflammatory diseases of the genitourinary system in women.

Treatment of candidal urethritis in women is carried out antifungal drugs in the form of tablets and vaginal suppositories. The duration of therapy depends on the stage of the disease, on average - 2-4 weeks. Most often, when diagnosing this disease, patients are prescribed Fluconazole and Clotrimazole. Antibiotic therapy for this form of the disease is ineffective.

Allergic urethritis in women

This form of urethritis in women occurs as a result of an allergic reaction of the body to certain medications, the use of personal care products, or the use of certain food products. Allergic urethritis is a serious complication in the form of severe inflammatory edema that affects the mucous and submucosal layers.

In the absence of treatment, edema can completely block the patient's urine output. Treatment of urethritis in women, which develops as a result of an allergic reaction, is carried out by prescribing antihistamines, decongestants and anti-inflammatory drugs.

Nonspecific bacterial urethritis in women

Bacterial urethritis in women develops as a result of the penetration of bacterial agents into the urinary tract. This is a nonspecific urethritis in women, caused by microorganisms such as streptococci, E. coli, enterococci, staphylococci entering the urethra.

These microorganisms constantly live on the mucous membrane of the urethra even healthy person, however, with a decrease in immunity, they actively multiply, being the cause of the inflammatory process. With this form of the disease pathogenic microorganisms are present not only in the urethra, but also in the woman's vagina, therefore, competent complex treatment is required.

Diagnosis of urethritis in women and how to treat the disease

You should consult a specialist if you experience pain during urination and sexual intercourse, as well as if purulent or mucopurulent discharge from the genitals is detected. How to treat urethritis in women can only be determined by a specialist after a diagnosis. The diagnosis of bacterial nonspecific urethritis usually does not cause problems, the clinical manifestations are enough for the specialist. However, to confirm a preliminary diagnosis, it is necessary to examine the urine under a microscope.

The following test results will help confirm the diagnosis:

increase in leukocytes in the blood;
the presence of bacteria;
the presence of protein in the urine of cellular origin - leukocytes and erythrocytes.

Treatment of bacterial nonspecific urethritis is carried out taking into account the most likely pathogens of the inflammatory process. The main method of treatment is antibiotic therapy, which is usually combined with the use of uroantiseptics.

Drugs for the treatment of bacterial urethritis in women

The use of these drugs in the treatment of symptoms of urethritis in women in the photo below:

Currently in urology in the treatment of the inflammatory process bacterial origin Monural is actively used.

The drug has a high efficiency, it is used once.

In addition to this drug, an antibiotic may be prescribed in the treatment of urethritis in women.

Azithromycin or Doxycycline.

Azithromycin is taken once at a dose of 1 mg, Doxycycline is prescribed for one week.

Among the drugs of the group of uroantiseptics, the following are mainly prescribed:

Kanefron and Phytolysin course for a month.

Trichomonas urethritis in women: symptoms and treatment

Among the inflammatory processes of the urethra, which are infectious nature, belongs to Trichomonas urethritis in women, caused by pathogens such as Trichomonas. Trichomonas infection is transmitted sexually. In this case, Trichomonas may be in the body for some time, but not make itself felt, and only 10-14 days after infection, the first symptoms appear.

Trichomonas urethritis is manifested by such symptoms:

itching and burning in the genital area;
foamy discharge from the urethra;
yellow-green vaginal discharge;
irritability, insomnia;
pain during intercourse.

With advanced forms of the disease, swelling of the labia becomes possible. If timely treatment is not carried out, this form of inflammatory disease acquires chronic which is very difficult to cure.

An infection can be cured from one day to several weeks, provided that the treatment tactics are chosen correctly. It is important to carry out the treatment of a permanent sexual partner of a woman, otherwise the infection will occur again.

The most effective today in the treatment of trichomonas are antibacterial drugs based on metronidazole. It can be used in several ways, but the most effective is the use of drugs in the form vaginal gel. When the first signs of Trichomonas urethritis are detected, a woman should immediately seek help from a specialist, since the disease can lead to infertility.

Forms of gonorrheal urethritis in women

Gonorrheal urethritis in women is another common sexually transmitted disease. It is caused by the gonococcus of the Neisseriae family. 10-40% of women with this form of the disease develop other inflammatory processes pelvic organs, which can cause ectopic pregnancy or infertility.

Depending on the prescription of the disease, two of its forms are distinguished:

fresh - if infection with gonococcal infection occurred no later than 2 months;
chronic - if the infection occurred more than 2 months ago.

According to the degree of intensity of fresh gonorrhea, its three variants are known:

acute - there are abundant discharge from the urethra with severe dysuria;
subacute - the same amount of discharge is noted, but there is practically no dysuria;
torpid - characteristic complete absence symptoms characteristic of this form of the disease, while minor discharge from the urethra is detected by chance.

Chronic gonorrhea can proceed in exactly the same way as the torpid form of the disease, and during the period of exacerbation it takes on the character of one of the types of fresh gonorrhea. Treatment of symptoms of urethritis in women of the gonorrheal type is carried out by the use of antibiotics of bactericidal and bacteriostatic action on gonococci.

Herpetic urethritis in women: symptoms and diagnosis

Herpetic urethritis in women is viral disease, which is manifested by a fairly large variety of symptoms. This urinary tract infection is caused by herpes simplex virus type 2.

The first signs of the disease appear only a week after infection with the virus. On the genitals, local erythema is formed, vesicles filled with fluid, which soon burst and turn into sores, with an inflammatory red border.

Herpetic urethritis is also manifested by other symptoms:

fever;
high body temperature;
swollen lymph nodes in the groin;
frequent painful urination, which is accompanied by pain in the urethra;
mucous discharge from the urethra;

Often a bacterial infection joins the virus, then the discharge becomes abundant and acquires a purulent character. When affected by the herpes virus, the urethra becomes inflamed, as a result of which patients are disturbed by a sensation of pain and tingling.

Diagnosis of urethritis in women caused by the herpes simplex virus type 2 is carried out by PCR or ELISA, during which a smear or scraping is examined. The treatment of the disease is antiviral drugs type Acyclovir, which have proven effective against the herpes virus. In order to stop the spread of the virus throughout the body and eliminate clinical manifestations for each patient, the urologist selects the most effective drug, its dosage and course of application.

In case of recurrence of the disease, immunomodulators are prescribed simultaneously with antiviral agents:

Roferon, Cycloferon other.

Treatment of urethritis and cystitis in women with effective methods

Often in women, urethritis occurs simultaneously with cystitis, with such a combination of inflammatory processes, their symptoms can be smoothed out. Inflammation of the bladder and urethra requires mandatory treatment of the most effective drugs. Cystitis almost always occurs as a complication of urethritis, when therapy has not been sufficiently effective or timely. That is why it is so important to detect the inflammatory process in the urethra in time in order to prevent it from developing into more dangerous disease. However, if it was not possible to avoid the development of cystitis, the urologist is faced with the task of choosing the most effective methods of treatment.

Most effective method treatment of cystitis and urethritis in women is medication, which comes down to taking antibacterial drugs. Such medicines are immediately absorbed into the tissues, which explains their rapid effect.

First, the specialist diagnoses, determines the form of the disease and the type of pathogenic agents that caused it. Then, based on the data obtained, a group of antibiotics is selected that are effective against bacteria that caused an inflammatory process in the urinary tract.

How to cure urethritis in women with drugs

How to cure urethritis in women, against which cystitis appeared as a complication? Most often, with the simultaneous occurrence of urethritis and cystitis in the female body, such antibacterial drugs are prescribed:

Ofloxacin;

doxycycline;

Ciprofloxacin;

Monural;Nitroxoline;

Palin;

Nolicin.

In addition to antibiotics, which are used in almost all forms of cystitis and urethritis, drugs from the group of immunomodulators are prescribed, as well as antiviral agents. If the infectious disease is viral in nature, and not fungal or bacterial, medications of the appropriate action are prescribed.

Treatment of urethritis in women at home with folk remedies

Treatment of urethritis in women at home, in addition to medications prescribed by a specialist, can be carried out using folk remedies. In order to eliminate the inflammatory process in the urethra, such folk remedies can be used:

Parsley tincture. This tool is considered the most effective in the treatment of urethritis at home. It is not difficult to prepare a medicine: you need 1 tbsp. l. parsley leaves pour 0.5 l warm water and leave overnight. It is necessary to take the infusion during the day in a small amount at regular intervals.

Blackcurrant leaf tea. Couple fresh leaves plants are flooded hot water in the amount of 1 liter, and drink during the day instead of tea.

Decoction lime blossom. This remedy relieves inflammation well and eliminates unpleasant symptoms in the form of burning and itching when urinating. To prepare a decoction, you need 2 tbsp. l. lime blossom pour two glasses of water and boil for 10-15 minutes. Cool the decoction and drink before going to bed in the amount of 1-2 glasses.

calamus, oak bark, St. John's wort flowers and leaves, chamomile flowers.

However, you should be aware that self-medication for urethritis is dangerous development many complications of the disease. Before use medical preparations and medicinal herbs you need to consult with a specialist.

Prevention of urethritis in women

Considering that infection with urethritis mainly occurs during sexual intercourse, a woman, in order to prevent the development of the disease, should take care of protection against STDs and STIs. It is desirable to have a constant sexual partner, if this is not possible, condoms must be used for casual sex.

The urethra (urethra) is the organ of the urinary system. It is a channel in the form of a tube through which urine is removed from the bladder to the outside.

The internal opening of the urethra is located in the wall of the bladder. The urinary canal passes through the urogenital diaphragm. At the end of it, on the eve of the vagina, there is an external opening. The latter is rounded in shape, and next to it are hard, roll-like edges. The lumen of the urethra is not the same in diameter along its entire length. The outer opening is relatively narrow, while the inner opening is wider and funnel-shaped.

The urethra in women is smaller in length compared to the male (up to 4 centimeters), but on the other hand, the width is much larger - up to 1.5 cm. The posterior surface of the urethra is fused with the wall of the vagina and is located strictly parallel to it. The urethra is surrounded by connective tissue. It is particularly dense in lower sections. The walls of the urethra are composed of a mucous membrane and muscle tissue.

The mucous membrane of the urethra is covered with several layers of prismatic epithelium. In some cases, this epithelium is flat, in others it is high.

The membrane is a series of longitudinal folds, and the transverse section of the urethra resembles a star in shape. Most large fold The canal is called the ridge and is located on its back wall, from the bladder to the outlet.

Throughout the urethra, there are periurethral glands that produce mucus. There are lacunae on the mucosa, and in lower areas the urethra are the mouths of the ductal glands.

The muscles of the urethra include the outer, inner, circular and longitudinal layers, as well as smooth muscles with elastic fibers. The connective tissue of the canal is supplied with veins.

The urethra in women is equipped with a pair of sphincters, external and internal. The purpose of these valves is to keep urine from flowing freely.

The external sphincter is a pair of muscles attached to the vagina. Internal - represents a stronger muscle in the bladder area.

Microflora of the urethra

Healthy microflora adult woman composed of epidermal and saprophytic staphylococci and lactobacilli. The maximum level of bifidobacteria - 10%, peptostreptococci - 5%. The totality of these microorganisms is called the Doderlein flora.

The composition and norms of the specific content of microorganisms in the microflora depend on the age of the woman.

Methods for studying microflora

Smear

The purpose of taking a smear is to detect and study the microflora in order to identify the microorganisms that caused the disease.

A smear is prescribed in the following cases:

risk of urinary tract infection;
pain in the canal area;
inflammatory process;
pregnancy.

An indication for taking a smear is also a preventive gynecological or urological examination.

Rules for preparing for a smear:

for a week, refuse to take medications and, first of all, antibiotics;
do not drink alcohol at least a day;
for 12 hours to refuse sexual contacts;
within an hour before the smear, do not empty the bladder;
do not douche;
do not use vaginal medications.

scraping

3 hours before scraping, you need to stop urinating. If there is abundant discharge, the external opening of the urethra is wiped with gauze soaked in saline.

When carrying out a scraping, the probe is inserted into the urethra for a couple of centimeters and held inside for about 5 seconds. In this case, the tool is rotated around its axis. The collected biological material is transferred to a test tube.

Pathologies

Inflammation of the lining of the urethra is called urethritis. Most often, the disease occurs in an acute form and is accompanied by colpitis and endocervicitis. Causes of the disease:

infection with viruses and bacteria, including mycoplasmas, chlamydia, Trichomonas, gonococci, mycotic and mixed infections;
trauma to the mucous membrane (usually as a result of catheterization);
metabolic disorder;
the influence of allergens;
stagnant processes.

Manifestations:

discharge from the canal;
discomfort, pain, cramps, itching.

Therapy of the disease consists in infusion of drugs into the urethra and oral intake chemotherapy drugs and antibiotics.

Urethral prolapse. Prolapse of the tissues of the urethra usually occurs in old age and may be accompanied by prolapse of the vagina. The cause of the pathology is damage to the muscles pelvic floor and perineum due to severe physical labor, prolonged labor, delivery, prolonged cough, constipation. If the prolapse is different strong fallout walls, circular tissue excision is used.

Polyps belong to benign tumors arising on the mucous membrane of the urethra. They are an enlarged area of connective fibers. The neoplasm is soft on palpation and grows rapidly in size. In the end, the polyps close the inner lumen of the canal. Causes of pathology:

chronic inflammatory process resulting from infection;
hormonal imbalance;
inflammatory process in the intestine.

AT initial stage the disease develops asymptomatically, but after a while, uncomfortable sensations appear. Polyps are identified using a ureteroscope. During diagnostic measures are held bacterial culture a smear from the urethra and a smear for microflora. Treatment consists of surgical removal neoplasms.

One of the varieties of polyps is caruncle. Its size is from 3 to 5 millimeters. A neoplasm may or may not have a pedicle. The color of the polyp is scarlet. Injury leads to bleeding, as the tumor contains many capillaries. At the beginning of their development, caruncles are soft, but with the age of a person they become more rigid.

Typically, these polyps are found in older women. Caruncles are infrequently multiple and located near the external opening of the urethra. The main signs of caruncles are bleeding and urinary incontinence. Often they are accompanied by inflammatory processes in the bladder and urethra. Treatment of caruncles is carried out surgically and with the help of electrocoagulation.

A manifestation of the papilloma virus are warts. The virus is transmitted sexually. The period of latent stay of the infection in the body can be any. Outwardly, warts are similar in shape to cauliflower.

Appearing for the first time, these formations can then spontaneously disappear. The degeneration of endourethral warts into malignant tumors is an extremely rare occurrence. Although this disease is more common in men, it can also occur in women.

Treatment of genital warts is carried out by cryotherapy and the drug Podophyllin. Moreover, the virus itself cannot be removed from the body. Prevention of recurrence of the disease consists in strengthening the immune system, a healthy lifestyle, the use of enough vitamins and minerals.

Cysts are glands filled with fluid. Cysts are located near the outer part of the canal and look like protruding anterior vaginal walls. Cysts are divided into 2 types:

associated with defects in the formation of the urinary organs;
appearing as a result of blockage of skin glands.

Most often, pathology occurs with weak immunity as a result of inflammation or injury.

Cysts are characterized by difficulty urinating. Bulges appear near the external opening of the urethra. If suppuration occurs in the cyst, the patient experiences pain, her temperature rises. Cyst treatment is surgical under local anesthesia.

Cancer in the urethra is a rare disease. However, in women this type of tumor is found about 10 times more often than in men. The location of the tumor in the canal can be anything, but most often occurs near the external opening - between the urethra and the vulva. Disease manifestations:

pain syndrome, ;
pain during sexual contact;
urinary incontinence;
bleeding.

Diagnostics is carried out by the following methods:

inspection and probing;
smear cytology;
histology;
cystography, cystoscopy.

The main methods of treatment are surgery and radiation.

Myomas, fibromas, angiomas are benign hormone-dependent neoplasms. Consists of muscle and connective tissue. Treatment is only surgical.

Thermal burns are most often characterized by a small area, rapid scarring, and usually heal without therapeutic procedures. Chemical burns cause inflammation and death of mucosal tissues.

The main symptom of a chemical burn is pain when the drug is injected. If this symptom occurs, it is necessary to determine the temperature of the agent injected into the urethra. You also need to make sure that exactly the drug that is prescribed is injected into the urethra.

At chemical burn it is recommended to wash the urethra with a liquid that softens the effect of the irritant. For example, if acid enters the mucous membrane, it is necessary to wash with a solution baking soda. Alkali should be neutralized with a solution citric acid or vinegar. Following washing, the canal is treated with synthomycin ointment. The patient is recommended plentiful drink. For severe burns, a drain is installed.

Prevention of diseases of the urethra consists in observing the rules of personal hygiene, refraining from eating foods that irritate the mucous membranes. During sexual intercourse, the use of condoms is recommended. In the event of pain, cutting sensations, discharge or other symptoms described above, you should consult a doctor to find out the cause and, if necessary, treatment.

Urethra (urethra)- is a part urinary system women and the urinary and reproductive systems of men.

In men, the urethra, 20 cm long, is located both in the pelvis and inside the penis, and opens with an external opening on its head. Anatomically, the following sections of the male urethra are distinguished:
(1) outer hole;
(2) navicular fossa;
(3) penile;
(4) bulbous;
(5) membranous;
(6) prostatic (proximal and distal sections).

Figure taken from www.urologyhealth.org

The prostatic urethra passes through the prostate and is divided into proximal and distal parts at the level seed tubercle. In the proximal part of the prostatic urethra, along the posterolateral surfaces, they open with mouths excretory ducts prostatic glands. On the sides of the seminal tubercle are the mouths of the right and left ejaculatory ducts, through which sperm enters the lumen of the urethra from the seminal vesicles and vas deferens. In the distal part of the prostatic part and in the membranous part of the urethra, elements of the urethral sphincter are located. Starting from the bulbar region, the urethra passes inside the spongy body of the penis. The bulbar region is located inside the bulb of the spongy body. In the membranous and bulbar sections, the urethra bends anteriorly upwards. In the penile region, the urethra is located medially along the ventral surface of the penis downward from cavernous bodies. The capitate part of the urethra is located inside the head of the penis. Inner surface the male and female urethra are covered with a mucous membrane (transitional epithelium, with the exception of a non-extended area near the external opening, where there is a squamous non-keratinized epithelium).

The main functions of the urethra in a man

passing urine out of the bladder
carrying semen out during ejaculation (ejaculation);
participation in the mechanism of urinary retention.

The most common diseases of the urethra

Urethritis (inflammation of the urethra), often due to sexually transmitted infections (gonococci, chlamydia, ureoplasma, etc.);
(narrowing of the lumen) of the urethra in its various departments (due to education: congenital, traumatic and inflammatory origin);
Anomalies in the development of the urethra: the most common is hypospadias (the location of the external opening of the urethra on the ventral surface of the penis is more proximal than the top of the head).

The urethra, or in professional language - the urethra is a tube that serves to exit urine from the bladder. The urethra in the female and male half is very different. Due to differences in the structure of the urethra, the female part of the population is more susceptible to various diseases than the male. An important role in the normal functioning of the urethra in both sexes is played by the microflora present in it. The microorganisms that inhabit the female and male urethra also differ from each other.

The urinary canal in men and women is similar to a soft elastic tube, the walls of which are represented by 3 layers: the outer connective, muscular (middle layer) and mucous membrane. The male urethra performs not only the function of urination, but also serves to eject the male seed.

The length of the urethra averages from 18 to 25 cm (depending on individual features each person). The urethra in the male half can be conditionally divided into 2 parts: anterior and posterior, which are represented by 3 sections:

Prostatic- has a length of about 3 cm. It includes tubules for ejection of sperm and 2 ducts (prostate and for excretion of sperm).
Membranous- has a length of about 2 cm. It extends through the urogenital diaphragm, which has a muscular sphincter.
Spongy- is considered the longest section of the urethra and has a length of about 20 cm. The ducts of the bulbourethral glands (numerous small canals) go to the spongy section.

The urethra of men originates from the urinary sac, then smoothly passes into the area prostate. The urethra ends at the head of the penis, from where urine and ejaculatory fluid (sperm) are ejected.

You can also watch a video about the male urethra.

Anatomy and functions of the female urethra

The female urethra is arranged in this way:

The urethra of a woman is much shorter than that of a man, no more than 5 cm long and about 1.8 cm wide.
The urethra in women is directed forward, passes next to the elastic wall of the vagina and the pubic bone.
At the end of the urethra, just below the clitoris, is its external opening.
Inside the urethra there is a mucous membrane, which has the form of folds (longitudinal). Due to these folds, the lumen of the urethra looks smaller.
Thanks to connective tissue, consisting of various vessels, veins and special elastic threads, an obstructing pad is formed, which is able to close the canal duct.

The urethra serves a woman only for the exit of urine from the body. It does not perform other functions. Due to the short and wide urethra, located next to anus and vagina, women are more susceptible to various infections urinary organs.

You can look at the genitourinary system in women in this video.

Microflora in the urethra

At the time of a person's birth on his skin covering various microorganisms enter, which then penetrate the body and settle on internal organs and their mucous membranes.

Microbes are fixed on the mucous membranes, since they cannot spread further (they are prevented by the internal secretion of the body and urine). In addition, ciliated epithelium provides additional protection against bacteria. Those microbes that remain on the mucous membranes are the innate microflora of the body.

Among women on the mucous membrane of the urethra, there are much more various microorganisms than in men:

In the urethra of the weaker sex, lactobacilli and bifidobacteria predominate, which secrete acid, thereby forming an acidic environment in the body.
If for some reason these bacteria become insufficient, the acidic environment is replaced by an alkaline one, resulting in inflammatory processes.
As the female body matures, beneficial microflora changes to coccus.

The male urethra contains:

Staphylococci and streptococci, corynebacteria.
In men normal microflora remains unchanged throughout life.
The composition of the microflora can change from frequent shift sexual partners, therefore, dangerous microorganisms that can cause serious diseases can also enter the human body.
Normally, the presence of Pseudomonas aeruginosa in the urethra is also considered, Staphylococcus aureus, Neisseria.
In small quantities, ureaplasma, chlamydia, fungi of the genus Candida, mycoplasma can occur.

Diseases in women and men

The process of excretion of urine in a healthy person is painless, without causing any inconvenience. If pathogenic microflora penetrates into the urethra, an inflammatory process develops, and the act of excretion of urine begins to be accompanied by pain, burning, itching and other unpleasant symptoms.

Inflammatory processes in the urethra can be:

specific. These include those diseases that were obtained sexually (chlamydia, trichomoniasis, gonorrhea, mycoplasmosis, ureaplasmosis.
Nonspecific. The second include those diseases that have arisen due to the large (pathogenic) reproduction of streptococci, fungi, staphylococci and Escherichia coli.

The most common cause of infection in the genital tract is a decrease in protective functions organism, simply speaking human immunity. In addition, the following reasons also affect the likelihood of the formation of inflammatory processes:

hypothermia;
urolithiasis disease;
injuries in the urinary tract;
unbalanced diet;
inflammatory processes occurring in chronic forms;
frequent urinary retention;
unsanitary conditions during medical manipulations(taking a smear, setting a catheter).

Urethritis

Inflammation in the urethra is called urethritis. The disease can have several types:

Spicy. It occurs as a result of ingestion of pathogens such as Trichomonas and gonococcus. AT rare cases the cause of acute urethritis can be called trauma or a chemical irritant that has entered the urethra.
Chronic. It is also formed as a result of the penetration of pathogenic microorganisms (gonococcus or Trichomonas), sometimes it can occur after birth trauma or if the urethra is damaged during intercourse.
Granular. The most common type of urethritis. It is formed as a result of inflammatory processes occurring in the genital organs.
Senile. Most often, they suffer from menopausal women. Causes of urethritis are hormonal changes occurring in a woman's body.
Premenstrual. Occurs before the onset of menstruation and is caused by jump hormones in the body.
Allergic. May bother a person who is prone to allergic reactions to some medicines or food products.

polyps

They are considered benign formations that develop on the mucous membrane of the urethra. May occur with hormonal imbalance, chronic infectious inflammations, bowel diseases:

Cancer of the urethra

A rare disease of the urethra, it mainly affects the female part of the population. It is formed in any part of the urethra, but most often cancer affects the external outlet of the urethra, located near the vulva.

Rupture of the urethra

It is observed mainly in men. Occurs due to injury to the penis (fracture, bruise). The rupture of the urethra can be complete or partial. At complete break urine cannot come out on its own male body, which may result in serious complications.

Signs of disease

Depending on the pathogen and the incubation period of the disease, the first signs may appear after a few days or months. The patient feels pain during urination, strong cramps, itching. Soreness can spread not only to the lower abdomen and pubis, but also to the back or lower back.

Typical symptoms of inflammation of the urethra are:

The infectious process eventually spreads to the entire mucous membrane of the canal and over time can move to other organs. The symptoms will only get worse. If inflammation is not fought, there is a risk of serious health complications: for men, it is inflammation of the testicles or prostate gland, for women, etc. Untreated inflammatory processes can cause infertility in both women and men.

Treatment

For successful treatment inflammatory process in the urethra, it is necessary to accurately establish the cause that provoked the disease:

The course of antibiotic therapy can take about a week.
In addition to antibiotics, the patient may need painkillers and anti-inflammatory drugs, uroantiseptics.
It is recommended to take vitamin and mineral complexes and immunomodulators.
If a polyp is found in the urethra, treatment can only be surgical.
If condylomas are the cause of the pathology of the urethra, cryotherapy is used and further healthy lifestyle life.
Cancers in the urethra are treated with radiation and surgery. With an incomplete rupture of the urethra, it is sometimes enough to take a course of antibiotic therapy, and certain time observe bed rest.
A complete rupture may require catheterization to remove urine, as well as surgery.

In order to avoid inflammatory processes in the urethra, you need to follow simple rules:

Since most diseases of the urethra occur due to promiscuity, you need to have a permanent partner who does not have health problems. Otherwise, protection methods such as a condom must be used.
It is important to monitor the personal hygiene of the genitals. After intercourse, you need to urinate, as urine helps flush out bacteria from the urethra.
A person should also take care of his health: do not get cold, empty the full bladder in time, eat right, drink plenty of water and herbal teas.

When carrying out any medical manipulations in the urethra (scraping, smear, catheterization), sanitary standards must be observed. Therefore, it is important to trust only an experienced specialist, otherwise you can get injured in the urethra. In addition, it is necessary to timely identify and treat various diseases that can form inflammatory processes in the urethra.

Urethritis - inflammatory disease, localized in the mucous membrane of the urethra (urethra). The disease is equally widespread in both men and women, but in women it is much less often diagnosed in isolation from another inflammatory pathology of the urinary system.

Danger late diagnosis urethritis in women lies in the possibility of ascending infection of the urinary organs and the transition of inflammation to a chronic relapsing form.

Urethritis in women, in more than half of the cases, is combined with symptoms of cystitis and is caused by the presence of a genital tract infection. It is almost impossible to make a differential diagnosis and separate the symptoms of cystitis and urethritis in women from each other, based solely on clinical data.

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1. Features of the development of urethritis in women

Since the disease is based on the development of inflammation in the wall of the urethra, it anatomical features underlie clinical picture pathology.

The clinical manifestations and symptoms of urethritis in women are usually less pronounced than in men. This is due to the fact that the urethra in women has a shorter length (about 1-2 cm) and a greater width.

It creates good conditions for the migration of pathogens from the urethra of a woman and their reproduction in the overlying sections of the urinary tract, while in the urethra itself the conditions for their attachment and reproduction are not particularly favorable (rapid urine flow, absence of anatomical bends and significant narrowing).

Figure 1 - Where is the opening of the urethra in women

Even with the development of severe inflammation, with significant swelling of the mucous membrane, which happens infrequently, urethritis in women is not accompanied by a violation of the outflow of urine.

In men, the exact opposite is true, the urethra is long, narrow, and has several anatomically significant curves and constrictions.

The listed anatomical features allow pathogenic pathogens to gain a foothold and multiply, being localized precisely in the urethral mucosa, without significant migration to the overlying sections.

In connection with the above, the symptoms of urethritis in women are erased, masked or combined with the clinic acute cystitis, whereas inflammation of the urethra in men has a vivid and specific clinical picture.

2. Classification

Depending on the type of pathogen that causes an inflammatory reaction, all types of urethritis can be divided into two types - nonspecific and specific.

The etiological factor of specific urethritis are genital infections (STDs).

Among the pathologies of this group:

Gonorrheal urethritis is caused by specific pathogen Neisseria gonorrhoeae. The disease has a specific clinical picture, a feature of which is whitish-purulent urethral and vaginal discharge.

In women, the disease can be erased, which makes them dangerous as a carrier of infection. Gonococcal urethritis is one of the most studied types of urethritis associated with genital infections, which allowed all other types of specific lesions of the urethra to be placed in a separate group - non-gonococcal;

Chlamydial urethritis - caused, which is one of the most common forms of STDs.

Often in the first place with symptoms of inflammation of the genital organs (vaginitis, salpingitis, endometritis, oophoritis, etc.), while the manifestations of urethritis are mild.

In the absence of timely treatment, the symptoms of urethritis and lesions of the genital organs may be accompanied by damage to the joints and eyes.

Mycoplasma and ureaplasma urethritis - caused by M. hominis or genitalium, U. urealyticum. The clinical picture is erased, the phenomena are weakly expressed, which makes it difficult to diagnose and treat this condition.
Trichomonas urethritis - caused. In addition to the urethra, the vaginal mucosa and glands of the vestibule of the vagina are affected, which provides a vivid clinical picture of infection with pain during urination, vaginal itching and yellow, foamy vaginal discharge.

If, according to the results of the survey, STIs were not detected, then urethritis is called nonspecific. Nonspecific urethritis is based on active reproduction in the urethral lumen of pathogenic and opportunistic flora, such as staphylococci, streptococci, gardnerella, Candida fungi and E. coli.

This type of disease most often develops in connection with sexual contact, during which the listed microorganisms are actively thrown into the urethra.

Predisposing factors are the location of the urethra close to the vagina, the presence of bacterial vaginosis, disorders of carbohydrate metabolism and a decrease in local immunity.

Most frequent view nonspecific urethritis in women is precisely postcoital (associated with sexual intercourse). In 50-60% of cases, the described pathology proceeds under the guise of chronic recurrent cystitis, which creates certain difficulties in diagnosis and therapy.

T.I. Derevyanko suggests that the main reason for the development of postcoital urethritis and cystitis in women is precisely the abnormal structure and location of the urethra - its location near the vestibule of the vagina or along its front wall.

All of the above creates a favorable environment for migration vaginal microflora through the meatus (external urethral opening) into the urethra, and then to the bladder mucosa.

In the vast majority of women, the debut of urethritis and cystitis coincides precisely with the onset of sexual activity, and exacerbations are somehow associated with sexual intercourse.

However, recent studies have shown that this species inflammation of the urethra in 60% of cases can be associated with incoming mycoplasmal or chlamydial infection, which makes standard therapeutic regimens ineffective and leads to the development of chronic urethritis.

3. Predisposing factors

As presented above, the etiological factor in the development of inflammation in the urethra is an infectious agent, however, the severity inflammatory response depends not only on the type of pathogen, but also on general condition macroorganism.

Factors predisposing to development and progression infectious process are:

1 Systematic (even short-term) hypothermia, especially local.
2 Violations of microbiocenosis in the vagina, a decrease in the level of functioning lactobacilli, as well as the growth of pathogenic and opportunistic flora.
3 Taking hormonal contraceptives.
4 Violation of carbohydrate metabolism, which leads to a decrease in both local and general immunity, and creates a more positive environment for the reproduction of bacteria.
Non-compliance with personal hygiene, washing in the direction from the anus to the vagina, passion for frequent douching;
disruption of local and general immunity.
6 Low-protein nutrition, hypo- and beriberi.
7 Casual sex, lack of sexual culture, neglect of barrier contraception.
8 The presence of confirmed urolithiasis, which leads to permanent trauma to the surface of the mucous membrane passing "sand" and the formation of a chronic non-specific inflammatory process.
9 Violation of the pH of urine, which is one of the main protective factors preventing the growth of pathogenic bacteria.
10 Eating a large number sweet, spicy, pickles, which causes irritation of the walls of the bladder and urethra.
11 Insufficient drinking regimen, rare urination, the need to constantly "endure", leading to not enough frequent washing out of bacteria from the walls of the urethra.

4. Main symptoms

Symptoms of urethritis in women, especially non-specific, are usually mild and may go unnoticed for a long time.

Urethritis in women almost never occurs in isolation only with damage to the urethral canal. With a specific infection, the symptoms of urethritis in women are combined with symptoms of vaginitis, endometritis, salpingitis or bartholinitis. With nonspecific - with signs of acute cystitis.

Patients are concerned about pain and cramps during urination, itching and burning in the urethra or in the perineum, discomfort and pain in the urethra. Patients are concerned about increased urination, false urge to urinate.

On examination, you can notice the redness of the meatus, possible discharge from the urethra. Discharge from the urethra in a woman is more often observed with a specific infection. With specific urethritis, reddening of the labia can also be detected, abnormal discharge from the vagina and traces of scratching on the genitals.

The disease proceeds cyclically with periods of exacerbation and remission, sometimes the symptoms may disappear altogether. Even with a large amount of damage to the urethral canal, a woman can feel relatively healthy for a long time until the inflammation affects the walls of the bladder.

Each successive exacerbation usually captures more and more volumes of the urethral mucosa, the disease is steadily progressing.

Pathological complications include the development of ascending cystitis and pyelonephritis. Systemic reaction organism for inflammation, as a rule, is absent.

Due to the poor and low-specific clinical picture of the pathology differential diagnosis urethritis or cystitis in women may be difficult.

The hallmarks of urethritis in women are:

1 Burning and pain during the entire act of urination, while with cystitis there is an increase in burning at the end.
2 Rezi may last several minutes after the end of urination.
3 Mandatory swelling and redness of the external urethral opening during examination.
4 In favor of urethritis, the woman has discharge from urinary canal, itching of the urethra, vagina and genitals.
5 If available vaginal discharge, urethritis due to sexual infection should be suspected.

5. Diagnostics

The main task of diagnosing urethritis is the identification of the causative agent of infection (identification etiological factor), which completely determines the further management of the patient. Since there are two types of urethritis, one of which is caused by a sexual infection, and the other by non-specific pathogenic flora, the definition of the pathogen is extremely important for choosing a treatment regimen for the patient.

For the diagnosis of urethritis are used:

1 Urinalysis (urinalysis, urine culture to determine sensitivity to antibiotics);
2 Taking smears from the urethral canal and vagina with further bacteriological and microscopic examination;
3 Ureteroscopy is an endoscopic invasive method of examination that allows visually determining the degree of morphological changes in the urethra. In women, it is practically not carried out.

B can be determined by an increased number of leukocytes and desquamated epithelium, as well as bacteriuria varying degrees expressiveness.

If necessary, it is possible to conduct a three-glass urine sample, where the largest number epithelial cells and leukocytes will be observed in the first portion.

It must be remembered that the three-glass sample method is low sensitive and directly depends on the correct collection of material for research.

When deviations are found general analysis urine from the norm, especially in the presence of massive bacteriuria, urine bakposev is indicated with a further determination of the sensitivity of the pathogen to antibiotics.

5.1. Examination of vaginal and urethral swabs

One of the most precise methods diagnosis of urethritis is the collection of specific smears using a special urethral brush, slightly peeling off the surface epithelium of the urethra.

The high accuracy of the method is due to the fact that the material is taken directly from the focus of inflammation, and the study of desquamated particles of the epithelium makes it possible to detect mycoplasmas and ureaplasmas living intracellularly in the smear.

There are several types of urethral swabs that are necessarily duplicated with vaginal swabs:

1 General smear for visual examination microscopic examination. The material is collected from the urethra and vagina. The described method allows you to assess the state of the vaginal microflora, the level of leukocytes and visually detect pathogens such as gonococci, trichomonas, gardnerella and fungi of the genus Candida. The disadvantage of the method is its low sensitivity (40%).
2 Swab from the urethra and vagina for bacteriological research(sowing) and diagnosis of genital infections by PCR.

It is necessary to strictly monitor compliance with all rules for the collection and transportation of material, since the pathogens of genital infections are very sensitive to ultraviolet radiation, temperature fluctuations and drying, which can lead to false negative results.

Rules for taking swabs from the urethra:

1 For 12 hours from the proposed sampling of the test material, it is recommended to limit sexual activity;
2 Research should be carried out before antibiotic therapy;
3 Before taking the material, it is recommended not to urinate for 2-3 hours, so as not to wash off pathogenic microorganisms, discharge from the urethra.

6. Treatment of specific urethritis

The choice of treatment regimen for specific urethritis in women directly depends on the type of pathogen that caused it. Antibacterial therapy includes the appointment of the following drugs:

1 The antibiotic of choice for gonococcal urethritis is ceftriaxone 250 mg IM once (A). An alternative is cefixime 400 mg once orally, spectinomycin 2 g IM once;
2 Chlamydial urethritis - first-line antibiotic - azithromycin 1.0 g once. Alternative drugs- doxycycline 100 mg 2 times a day or josamycin 500-1000 mg 2 times a day for 7 days;
3 Mycoplasma and ureaplasma urethritis - drugs are used for treatment: doxycycline 100 mg 2 times a day, ofloxacin 300 mg 3 times a day, josamycin 500 mg 3 times a day for 7-10 days;
4 Trichomonas urethritis - first-line drug metronidazole 500 mg 2 r/s (A), ornidazole 500 mg 2 r/s (B), tinidazole 500 mg 2 r/s for 5 days. Alternative means- metronidazole 2.0, ornidazole 1.5 or tinidazole 2.0 once.

Be sure to prescribe treatment to the sexual partner, even if he does not have signs of inflammation, to exclude reinfection. After the completion of antibiotic therapy, it is mandatory to monitor its effectiveness and control the eradication of the pathogen.

7. Therapy of nonspecific urethritis

In the absence of STDs, the choice of treatment regimen for urethritis in women depends on the severity of the clinical picture of inflammation and the sensitivity of the pathogen to antimicrobial therapy.

1 The first-line drug is fosfomycin (orally in the form of packets, 3.0 grams once).
2 Alternative drugs are nitroxoline, azithromycin, ofloxacin, ciprofloxacin (tablets and other oral forms) in standard dosages for 3-5 days. Before prescribing these funds, it is desirable to determine the sensitivity of pathogens to them.
3 Fungal infection of the urethra with white discharge from the urethra (urethral candidiasis) is eliminated by taking fluconazole (Flucostat), itraconazole (Orungal, Orungamine), ketoconazole, natamycin (Pimafucin). It should be remembered that the presence of a fungal infection may indicate a decrease in overall immunity, intestinal and vaginal dysbiosis.

In addition to drug therapy diet is prescribed. It is advisable to reduce the consumption of spicy, sour and salty foods, as well as drink at least 1.5 liters of water during the day.

For amplification clinical effect with inflammation of the urethra, it is possible to use herbal preparations and berries with diuretic properties (lingonberries, cranberries), as well as herbal uroantiseptics (Canephron, Cyston, Fitolizin, etc.).