Cowperitis is an inflammation of the exocrine glands located in the urethra in men. Pathology often accompanies infectious and inflammatory diseases: prostatitis, urethritis, prostatovesiculitis. Symptoms depend on the severity of the process: at advanced stages, there is pain in the perineum, dysuria. Diagnostics is aimed at identifying the main pathology of the genitourinary system, including palpation of the prostate, cooper glands, trans-rectal ultrasound, urethrocystoscopy, urethrography. From laboratory tests, a study of the separated urethra, urine, and prostate juice is carried out. Treatment involves antibacterial therapy, NSAIDs, immunomodulators, physiotherapeutic effects.
ICD 10
N34.0 N34 N34.1
Meaning
Cowperitis is an inflammatory process in the bulbourethral (Cowper’s) glands, named after the English surgeon-anatomist William Cowper, who described them in 1684. These are some of the smallest exocrine glands of the male reproductive system. They are identical to the bartholin glands in women. Pathology is mainly faced by sexually active men of reproductive age who practice casual sexual intercourse without a condom. With age, there is a natural atrophy of Cooper’s glandules. In the autumn-winter period, the disease is more common, which is associated with hypothermia. It is noted that in most observations, cuperite is one-sided and develops on the left side.
Causes
Bulbourethral glands are located directly under the prostate, in the bulbous part of the urethra at the base of the penis, enclosed in transverse fibers of the muscles of the external sphincter of the urethra. The main role is the production of lubricant that protects the penis during sexual intercourse from injury, facilitates the movement of sperm, protects the urethral mucosa from the aggressive effects of urine. The conditions that can cause cowperitis include:
- Venereal diseases. The main sexually transmitted infections that are complicated by inflammation of the bulbourethral glandules are gonorrhea and trichomoniasis. The use of modern antibiotics has led to a decrease in morbidity. Cowperitis occurs in every tenth patient with an STI. Pathology can be caused by untreated chlamydia, mycoplasmosis, urogenital candidiasis.
- Inflammatory diseases. Long-term cystitis, prostatitis, urethritis with contributing factors associated with the weakening of the immune system, can provoke the development of cowperitis. The tuberculous etiology of the process is described. Phimosis in an adult male is often complicated by chronic urethritis with cowperitis, especially if concomitant diabetes mellitus is diagnosed.
- Sexual excesses. Excessively prolonged sexual intercourse, lack of regular sexual activity (ejaculation) disrupt the work of the bulbourethral glands. In the first case, the process manifests itself due to excessive load on the glandules, in the second – against the background of stagnation and reproduction of bacteria. Congestions are also promoted by constipation, varicose veins of the pelvis, sedentary lifestyle with obesity.
- Traumatization. Some medical manipulations (catheterization, augmentation), diagnostic measures can lead to damage to the urethral mucosa or the excretory ducts of the glands. The addition of secondary microflora initiates cuperite. Cases of self-introduction of foreign bodies into the urethra during masturbation, which resulted in generalized inflammation, are described.
Pathogenesis
In pathogenesis, the main role belongs to infection with microbial flora (specific or non-specific) against the background of reduced immune protection. Microorganisms enter Cooper’s glands by urinogenic or hematogenic route, mainly from inflammatory foci located in the pelvis. Sometimes the source of pathogenic microflora becomes tonsillitis, caries, pharyngitis. A cascade of inflammatory reactions is triggered, which is accompanied by trophic disruption, melting of normal functioning tissue with the death of secreting cells, phagocytosis processes with the production of pus. The more pronounced the swelling and inflammatory reaction, the stronger the pain syndrome, since there are a large number of nerve endings in this area.
Secretory dysfunction with the development of inflammation leads to the need to produce an increased amount of secretions during prolonged sexual arousal without ejaculation. A rush of blood to the genitals is accompanied by acute venous stagnation in the pelvis. If the situation repeats repeatedly, pathogenic microflora joins the initially abacterial (aseptic) inflammation associated with glandular overload, which provokes cowperitis. Arterioles surrounding the excretory ducts spasm, this interferes with drainage function and causes blockage of acinuses.
Classification
Cowperitis can be unilateral or bilateral, acute or chronic. More often, the inflammatory process of the bulbourethral gland is secondary, i.e. it appears due to the dissemination of pathogens from other organs. In clinical urology , there are four forms of cowperitis:
- Catarrhal. The inflammatory reaction is superficial, there are no clinical manifestations. A slight hyperemia with an increase in Cooper’s glands is visualized when performing a urethrocystoscopic examination for another pathology: cystitis, tumors, diverticula, etc. In secret, the number of white blood cells is normal or slightly increased.
- Follicular. It is characterized by the appearance of inflammatory changes. In a man with a follicular form of cuperitis, the symptoms are erased, the general condition does not suffer. During cystoscopy, when pressing on the glandula, soreness appears, changes in the form of bullous edema, hyperemia, pseudoabcesses are visible. In secret, the number of white blood cells has increased.
- Parenchymal. The whole parenchyma is involved in the process. Edema, redness, dilation of arterioles, micro-hemorrhages are expressed significantly. The glandula is enlarged in size, purulent discharge appears when pressed. There are numerous complaints, the temperature rises. The juice of the gland contains a lot of leukocytes (80-100 in n / a), bacteria.
- Paracuperite. The most unfavorable variant of the disease. Inflammation spreads not only to the glandula itself, but also to the surrounding fiber. Clinical manifestations are vivid. General well-being suffers. Pus is discovered in secret. Urethrocystoscopy is not performed due to the high risk of dissemination of the process.
Symptoms
Clinical signs correlate with the stage and depend on the course of inflammation. In the initial stages, the symptoms are absent or erased. The chronic process is more often latent. With parenchymal form and paracup, the patient complains of pain in the perineum, which increases in a sitting position, frequent urination with cuts, uncomfortable sensations during sex or at the time of defecation. Typically, fever, weakness, depressed mood.
If, for some reason, adequate therapy is not carried out, the inflammatory process is generalized with the spread to the nearby fiber. In the perineum, you can see a slight swelling, sometimes with redness of the skin and fluctuation. This is due to inflammatory edema and the likely formation of an abscess. The pain is strong, the pain radiates into the rectum, penis, lower abdomen. The temperature is 38-39 ° C, with chills. Urination is frequent, with cuts, in small portions. Secretion increases after sleep and physical exertion, purulent discharge from the urethra appears.
Complications
With timely treatment, there are no complications, in advanced cases and with tuberculous genesis of pathology, an abscess of the bulbous-urethral gland develops, which can spontaneously break into the perianal region or urethra with the formation of a fistula. An untreated acute process takes a chronic form or a recurrent course, inflammatory infiltrates and retention cysts containing pathogenic flora form in the glandula. Prolonged cuperitis in some cases is complicated by the development of urethral stricture.
Untreated primary cuperitis caused by trauma, combined with background conditions associated with immunosuppression, leads to prostatitis, cystitis, vesiculitis. Often, after undergoing bilateral inflammation, erectile dysfunction occurs in men, expressed to one degree or another, the amount of lubricant produced decreases at the time of sexual arousal. Generalization of the process leads to a decrease in fertility, in severe cases infertility develops.
Diagnostics
Given that cuperitis often occurs without specific objective or subjective symptoms, it is difficult to confirm the pathology. Visualization of bulging (infiltration) in the perineum slightly to the left or right of the median line makes the consulting urologist assume cuperitis. Initially, the patient is interviewed and complaints are evaluated. The further examination algorithm is as follows:
- Transrectal palpation. In patients without obesity, palpation of Cooper’s glandules through the rectum is possible. The study is performed in the patient’s supine position. The inflamed glandula is larger than a pea, dense, painful, sedentary. After her massage, the resulting secret is sent for microscopic examination.
- Instrumental visualization. With transrectal ultrasound examination, parenchymal cuperitis and paracuper are visualized quite well, the diagnostician examines the prostate, seminal vesicles, and other structures. Urethroscopy, urethrography is performed in questionable situations, if there is no effect from therapy, if the tumor nature of the disease is suspected.
- Laboratory diagnostics. To exclude venereal infections, PCR tests for STIs, microscopy of the urethra, secretions of the cooper glands, and prostate are prescribed. In a 3-cup urine sample collected after the massage, an increased number of white blood cells in the second portion indicates in favor of cuperitol. In the general blood test, changes are recorded only at advanced stages. Culture sowing helps to determine the causative agent of infection, sensitivity to drugs.
Differential diagnosis is carried out with cystitis, prostatitis, vesiculitis. Similar clinical manifestations in colliculitis and urethritis. Practicing urologists do not always consider it necessary to isolate cuperitis, but no one disputes the identification and treatment of the main etiological factor that supports inflammation in the male reproductive organs.
Treatment
First-line treatment involves etiotropic antibacterial, anti-inflammatory therapy. Hospitalization in a hospital with an uncomplicated course is not required. The duration of therapy is variable, is 10-14 days, in combination with chronic prostatitis, treatment can last up to 28 days. After the therapeutic course, if there are complaints of decreased potency, lethargy of erection, decreased orgasmic sensations, an andrologist’s consultation is needed. To stop the inflammatory process , it is carried out:
- Drug therapy. Antibiotics with sensitivity, NSAIDs, immunomodulators, multivitamins in complex use lead to an improvement in the patient’s condition within 2-3 days. At the same time, a man is recommended to give up spicy, sour, salty dishes, exclude alcohol intake. Pronounced acute inflammation dictates the need to refrain from sexual contact, with catarrhal / follicular form of cowperitis, regular ejaculation will contribute to the elimination of pathogens, purification of acinuses.
- Physiotherapy and local treatment. Laser magnetotherapy, electrophoresis with anti-inflammatory and resorbing drugs, thermal effects, vibration massage – physiotherapy measures that help to relieve inflammation, edema, normalization of secretory function of the gland. The patient is recommended warm sedentary baths, warming compresses on the perineum area (not applicable for abscess), prostate massage, bulbous glandules. Solutions with an anti-inflammatory effect are poured into the urethra.
- Surgical intervention. In most patients, there is no need for surgical care, removal of the bulbourethral glandula is performed with tuberculosis infection in the absence of positive dynamics from treatment, with its suppuration. If the cuperitis is complicated by an abscess, the abscess is opened, which prevents the formation of a fistula. Subsequently, antibacterial therapy is prescribed.
Prognosis and prevention
The outcome with timely medical care is favorable, with a tuberculosis lesion, treatment is prolonged, and the prognosis is individual. Prevention involves the use of a condom during casual sex, the regularity of sexual contacts, avoiding too prolonged sexual acts. Adherence to monogamous relationships, proper hygiene, sports can reduce the risk of developing pathology. All adverse symptoms, even if they are poorly expressed, are a good reason to make an appointment with a urologist.