Cavernitis is an inflammatory process that occurs in the cavernous (cavernous) bodies of the penis. Cavernitis is accompanied by the appearance of painful compaction of the penis, its swelling, hyperemia of the skin, spontaneous erection, increased body temperature, intoxication syndrome. It is possible to form an abscess of the cavernous body with the subsequent breakthrough of the abscess into the urethra. Diagnosis of cavernitis includes ultrasound of the penis, PCR examination and bacteriological seeding of the discharge from the urethra, if necessary, urethroscopy. In the treatment of acute cavernitis, antibiotic therapy and physiotherapy are used. With suppuration, an opening of the abscess is shown; with fibrous deformation of the penis, falloprosthetics.
General information
Cavernitis is an infectious and inflammatory disease of the penis, characterized by lesions of the cavernous (cavernous) bodies. In urology and andrology, cavernitis is much less common than other inflammatory diseases of the male genital area (urethritis, prostatitis, orchitis, epididymitis, balanoposthitis, etc.). Nevertheless, cavernitis is a very dangerous pathology, the consequences of which can affect the quality of sexual life and male fertility. Therefore, every man should be aware of the possible causes, signs and complications of cavernitis.
The penis is formed by two cavernous (cavernous) bodies and one spongy (spongy) body, which are covered with easily displaced skin from above. The right and left cavernous bodies have a cylindrical shape; in their structure, the distal part (apex, apex), the middle part and the proximal part (pedicle) are distinguished. Parallel to the ventral surface of the cavernous bodies is the spongy body of the penis, in the thickness of which the urethra passes. With cavernitis, not only cavernous bodies, but also the spongy body of the penis can be involved in the inflammatory process. The main functional purpose of the cavernous bodies is to provide and maintain an erection. Therefore, the danger of cavernitis is that the disease can contribute to the development of erectile dysfunction.
Causes
Cavernitis can be a consequence of direct traumatization or the spread of infection to the cavernous bodies of the penis. In the first case, the development of cavernitis is preceded by penile injuries or surgical operations accompanied by damage to the cavernous bodies. Post-injection cavernitis occurs as a result of intracavernous administration of drugs or other chemicals. Bilateral cavernitis can be a complication of prolonged catheterization of the bladder with a permanent Foley catheter.
Infectious cavernitis in most cases is a complication of acute nonspecific or specific urethritis (usually gonorrheic etiology). In this case, pathogens can penetrate into the cavernous bodies, both hematogenically and with microtraumatization of the urethral mucosa during smear sampling. Lymphogenic spread of infection to cavernous bodies is observed in the presence of common purulent-inflammatory diseases (carbuncle, sore throat, caries, sinusitis, osteomyelitis, sepsis, etc.). syphilitic cavernitis serves as a special form of inflammation of cavernous bodies.
Classification
Depending on the course of the inflammatory process, cavernitis can be acute and chronic (spongiositis). At the same time, acute inflammation of the cavernous bodies can be limited or diffuse, single- or bilateral in nature.
Taking into account the origin, two forms of cavernitis are distinguished – pereloic and syphilitic. With a cavernous fracture, the inflammatory process from the urethral mucosa spreads to the submucosal tissue, and then to the spongy and cavernous body. The consequence of these processes is the formation of painful nodules, which, under the influence of treatment, can dissolve without a trace or remain in place, leading to the desolation of cavernous bodies and deformation of the penis. It is also possible to abscess the node with the subsequent breakthrough of pus into the urethra or out.
Syphilitic cavernitis is observed in patients in the tertiary period of syphilis. Inflammatory nodules (gummas) primarily occur in the cavernous bodies of the penis, are difficult to treat, but usually do not disappear at all.
Symptoms
The clinic of acute cavernitis is pronounced; at the same time, the symptoms of inflammation occur suddenly and develop at lightning speed. Acute cavernitis usually manifests with febrile fever (38-39 ° C), chills, weakness, headache, inguinal lymphadenitis. There is a sharp pain in the penis; prolonged, almost non–subsiding spontaneous erection causes difficulty urinating, sometimes acute urinary retention. With unilateral inflammation of the cavernous body, the penis bends towards the lesion. Even with a decrease in erection, swelling and thickening of the penis, hyperemia of the skin remains. When palpating the penis, a dense infiltrate is felt along the course of the cavernous bodies, touching which causes sharp pain.
The next stage in the development of acute cavernitis is the formation of an abscess, which is most often opened into the lumen of the urethra. The breakthrough of the abscess is accompanied by an improvement in general well-being, a decrease in pain and swelling of the penis, the release of a large amount of fetid pus from the urethra. Together with pus, the necrotic connective tissue partitions of the cavernous bodies are rejected, which is further accompanied by a violation of the blood filling of the caverns and leads to erectile dysfunction.
After the opening of the abscess, the stage of sclerosis begins: scar tissue forms in place of the emptied abscess, causing curvature of the penis during erection (Peyronie’s disease). It also significantly complicates sexual intercourse or makes it impossible. Chronic cavernitis occurs with erased symptoms – mild pain in the penis, painful erections, the formation of foci of compaction in the penis of various shapes and lengths, erectile dysfunction.
Diagnostics
If a painful seal appears in the penis area, you should immediately contact a urologist or andrologist. After clarifying the complaints and circumstances of the disease, examination and palpation of the external genitalia, the specialist directs the patient to additional studies necessary for the correct diagnosis.
The laboratory stage of the diagnosis of cavernitis includes an overview smear microscopy, bacteriological seeding of urine and the urethra; PCR and REEF scrapings from the urogenital tract, seeding for the presence of gonorrhea, RPR test and other analyzes. A patient with gonorrhea or syphilitic cavernitis should be consulted by a venereologist. The most important method of instrumental diagnosis of cavernitis is ultrasound of the penis. With chronic cavernitis, urethroscopy, cavernosography may be indicated.
Treatment
Patients with diagnosed cavernitis should be treated and monitored in a urological hospital. In the initial (infiltrative) stage of acute cavernitis, conservative therapy is prescribed, including antibacterial drugs (macrolides, aminoglycosides, penicillins, nitrofurans), immunostimulants, anti-inflammatory drugs. Instillations of antiseptic solutions into the urethra, physiotherapy procedures (magnetotherapy, laser therapy, ultrasound therapy, UHF, electrophoresis) are carried out. In chronic cavernitis, anti-inflammatory, immunostimulating therapy and local physiotherapy are prescribed.
At the stage of abscessing, surgical intervention is indicated – deep longitudinal dissection of the cavernous bodies and drainage of the purulent cavity. In case of gangrene, an emergency amputation of the genital organ is indicated. When fibrotic deformity is formed, surgical correction of penile curvature is performed; with erectile dysfunction, penile endoprosthetics (falloprosthetics) may be required.
Prognosis and prevention
Timely referral to a urologist-andrologist and adequate therapy, undertaken at the initial stage, allow to cure cavernitis without long-term consequences. In the case of a complicated course, cavernitis can lead to organic impotence and male infertility. Restoration of sexual function in this case will be possible only with the help of methods of falloprosthetics.
Prevention of cavernitis consists in preventing penile injuries, timely treatment of urethritis, as well as inflammatory and infectious processes of other localization. An important role is played by the prevention of STIs, the rejection of casual sexual relations, the use of barrier contraception.