Monural for cystitis: scheme and order of administration.

Monural for cystitis is a medicine quite often prescribed by doctors.

There is nothing surprising in this, given the effectiveness and relative safety of the drug.

Doctors note that the drug has proven itself to be effective, not only as a single medication, but also as part of complex therapy.

The main thing is to know the indications for its use and remember the rules of use.

What is the use of Monural for cystitis, patients are interested in, and how to choose the correct dosage of the drug.

Can the medicine be used to treat children and the elderly, and is it an antibiotic?

What is cystitis

Before you learn how to use Monural cystitis powder, you need to understand what kind of disease it is – cystitis.

After all, if you don’t know the specifics of its development and which organ it affects, you won’t be able to understand the effect of the drug.

Cystitis in medical practice refers to inflammatory processes affecting the inner mucous membrane of the bladder.

The inflammatory process can be either aseptic, that is, without the participation of pathogenic microflora, or with the participation of pathogenic microorganisms.

Since the bladder is not sterile, cystitis is mainly a consequence of the uncontrolled proliferation of various pathogenic or opportunistic microorganisms.

The disease is accompanied by quite striking symptoms.

The patient may complain of pain in the abdomen, and more specifically, in the area of the projection of the bladder.

Often there are problems with urination of various types, and there is an admixture of pus in the urine.

Mostly the fairer sex, as well as young children, suffer from cystitis.

In men, inflammation in the bladder is rare, which is explained by the structure of the genitourinary system.

However, representatives of the stronger sex are also not immune from the disease.

Especially if there is a genitourinary tract infection in his body for a long time.

Classification of cystitis

There are several signs that form the basis for the classification of the disease.

By methods of manifestation

According to the methods of manifestation, there are two types of cystitis:

Spicy
Chronic

Acute cystitis in men can occur:

first;
no more than one case per year;
with a frequency of 2 or more times every 365 days.

For the occurrence of acute cystitis, there are unfavorable factors in the form of uncontrolled use of certain medications and thermochemical effects on a man. An infection that enters the body of men can also cause certain symptoms characteristic of acute stage cystitis.

The chronic form of the disease can be divided into the following subtypes:

Latent (symptoms of cystitis in men in this case are smoothed out). The frequency of occurrence of the disease is more than two cases per year, the disease is stable or with rare periods of exacerbations.
Persistent. The process of inflammation and development of cystitis is diagnosed twice a year or more often.
Interstitial. This is the most severe form of the disease. Cystitis progresses and can lead to serious complications.

According to the etiology of occurrence

Based on this characteristic, doctors distinguish such forms of cystitis in men as primary and secondary. Primary cystitis is in no way associated with other pathologies of men. This is an independent disease. The secondary form may be the result of problems in the genitourinary system and other organs of the patient. Men with prostate adenoma, diseases of the spinal column, abnormal development of the bladder, or ingestion of foreign fragments should be prepared for this kind of disease.

By localization of inflammation

Cervical, diffuse, trigonitis, focal form of cystitis - this diagnosis is made depending on the location of the source of the disease. Each type of disease is characterized by its own symptoms: with cervical cystitis, urine cannot be retained, the patient often “runs” to the toilet; the diffuse form is characterized by the extensive spread of inflammation; With trigonitis, clots of blood and pus appear in the urine.

Properties of Monural and the active ingredient of the drug

Often patients faced with the disease wonder how Monural works for cystitis, which ensures its effectiveness.

Everything is very simple.

The main active ingredient of the drug is fosfomycin.

The substance has strong antibacterial activity, essentially belonging to the class of antibiotics.

The action of fosfomycin is quite transparent.

The substance blocks a number of transformations in the body.

Because of this, bacterial cells are unable to properly absorb nutrients.

The drug also interferes with the normal synthesis of cell membranes of microbial cells.

As a result, their natural death occurs.

The effectiveness of the drug with fosfomycin has been proven against Klebsiella, Haemophilus influenzae, staphylococci and enterococci.

Also a number of other pathological and opportunistic microorganisms.

It also happens that Monural does not help with cystitis.

A natural question arises as to why this happened.

The fact is that, like any antibiotic, the medicine can only act on certain microorganisms.

If the inflammatory process is triggered by a bacterium that is resistant to fosfomycin, then the therapy will have no effect.

The situation will be similar if the disease is caused by a virus or fungus.

pharmachologic effect

Monural is a good antibiotic with broad therapeutic activity. It is considered a phosphonic acid derivative and is structurally similar to pyruvate phosphoenol. It has excellent bactericidal properties and prevents the further development of pathogenic microorganisms. Effective against gram-negative and gram-positive bacteria. In particular, it helps fight streptococci, staphylococci, Proteus, Klebsiella, enterobacteria and other pathogenic pathogens.

After ingestion, it is instantly absorbed into the digestive organs and bloodstream. The highest concentration of the drug is observed after 2-2.5 hours.

Excretion occurs in most cases by the kidneys and a small part is metabolized in bile.

Indications for the use of Monural

Many patients are concerned about the indications for using the medication.

First of all, of course, the remedy is prescribed if the patient suffers from symptoms of cystitis.

Moreover, as doctors note, the drug performed best in acute infectious processes of bacterial origin.

Monural for chronic cystitis, on the contrary, has not proven itself as an effective remedy.

Therefore, it is practically not used in practice if the inflammation has become permanent.

However, as doctors note, the matter is not limited to inflammatory processes in the bladder.

The medicine may be additionally prescribed in the following cases:

the urinary tract is involved in an acute infectious process
urethritis (inflammatory reaction in the urethral tract) has developed in an acute form
the patient suffers from urethral syndrome, which is accompanied by problems with urination, which reduces the patient’s quality of life
infectious complications have developed in the genitourinary system after surgical intervention in the body

The drug is also often recommended for use if surgery is planned on the genital area.

Or any invasive research that poses a risk of infection.

In this case, the prescription plays a preventive role.

The doctor works proactively, trying to prevent the development of pathology.

Monural dosage regimen for cystitis and other pathologies

Instructions for using Monural for cystitis are quite simple.

If the infection was caught at an early stage of development, before it progresses, you can drink one sachet of the drug only once.

This is enough to stop the proliferation of pathogenic microorganisms and achieve a cure.

However, in some cases, a single use of the product is not enough.

If a relapse occurs, the medication is taken according to a strictly defined regimen, following the instructions.

For example:

for recurrent pathology, you should drink 1 sachet once a day for 2 days (the recommended interval between uses is 24 hours, which allows you to achieve optimal concentration of the drug in the blood)
during planned surgical or invasive diagnostic intervention, the first sachet is drunk before the procedure 2.5-3 hours, and the second 24 hours after the intervention

The optimal time to take is evening.

It is best if the powder is drunk on an empty stomach, a few hours after dinner.

The contents of the sachet are dissolved in cold water and then quickly drunk in one gulp.

It is important to remember that the drug is not prepared in advance.

It is necessary to prepare a new remedy each time for each subsequent appointment.

Otherwise, there is a chance that the solution will not work or cause more adverse reactions than it should.

Composition and release form

The drug is dispensed in the form of homogeneous granules for further preparation of parenteral solution. White powder with a pleasant fruity aroma. Packaged in multi-layer bags and a secondary paper pack with attached instructions for use. One package contains 1-2 packets of various volumes of product:

Laminated sachets containing 3.7 g trometamol fosfomycin and 2 g fosfomycin.
Laminated packets containing 5.6 g of fosfomycin trometamol and 3 g of fosfomycin alone.

The active ingredients of the drug are fosfomycin trometamol and fosfomycin in its pure form.

Additional components: sucrose, orange and tangerine flavors, saccharin.

The drug is dispensed only with a doctor's prescription.

Recommendations for using Monural for children

Monural for children with cystitis is prescribed in pediatric practice.

Moreover, the drug is used quite often, since children are at risk for developing bladder infections.

True, there is a limitation: if the child is less than 5 full years old, it is not prescribed.

Since its effect on such crumbs has not been fully studied.

A separate type of product is available for children.

In addition to the main active ingredient, sucrose and flavorings are added to the composition to make it easier for the child to use the medication.

Thanks to its pleasant taste, it’s not difficult to get your baby to drink the powder.

The pattern of use in children is not much different from that in adult patients.

For example, in case of an acute infectious process, 1 sachet is recommended for 1 day.

The course is 24 hours.

Naturally, the doctor can adjust the treatment regimen at his own discretion if he considers it necessary.

In most cases, parents who treated their children with Monural were satisfied with the effectiveness.

By following medical recommendations, it was possible to achieve a cure for the disease and eliminate symptoms.

Relapses with proper therapy are the exception rather than the usual, which is also a positive thing.

Contraindications to the use of Monural

Monural and analogues for cystitis, despite frequent use, should be used with great caution.

The drugs, like any other antibacterial agents, have a number of serious contraindications.

First of all, you will have to stop using this group of drugs if you have problems with your kidneys.

Kidney function is assessed using an indicator called creatinine clearance.

And if this indicator drops below 10 ml/min., the products are strictly prohibited.

This is due to the fact that medications will only worsen the already poor condition of the renal system in this case.

Such medications are always prescribed with caution for various liver pathologies.

Despite the fact that most of it is excreted by the kidneys, some still undergo metabolization in this organ, which is primarily used to neutralize toxic substances.

In case of liver pathologies, use is carried out with caution, as there is a possibility of aggravating liver disease.

Another serious contraindication that should always be taken into account.

This is the presence of individual intolerance to either the main component or additional substances included in the powder.

For patients who develop signs of intolerance after the first use, the drug regimen is reviewed.

It is strictly forbidden to remain silent about intolerance if it has developed.

You should tell your doctor about it, and immediately!

Possible side effects of Monural

If a doctor prescribes a medication, he usually takes into account the likelihood that side effects of Monural may develop.

It is usually practically impossible to predict their formation with 100% probability.

However, it is always necessary to remember that there is a risk of their development.

If you do not take it into account, there is a high probability of encountering serious problems in the future.

Among the side effects, doctors call:

attacks of nausea and vomiting
heartburn
stool disorders such as diarrhea
abdominal pain
the appearance of red rashes on the skin
Patient complaints of itching, burning of the skin
other options for allergic reactions and intolerances

If one or more side effects develop after using the medicine, be sure to report this to your doctor.

The doctor decides whether to stop the medication and whether it will do more harm than good.

Often, if adverse reactions do not greatly affect the patient’s life, Monural is not removed from the treatment regimen.

Since the expected benefit is higher than the expected harm in the long term.

However, if side effects greatly affect the quality of life, this is a reason to discontinue the medicine and remember that the patient has an intolerance.

Monural for cystitis in men

Treatment of representatives of the stronger sex can also be used in clinical practice.

At the same time, medicine is rarely used directly for inflammatory processes in the bladder, since cystitis practically does not occur among men.

After all, their urethra is too long for infection to easily get from it to the bladder area.

However, you should not exclude such a development of events, as well as refuse to use the medication for symptoms of urethritis.

Monural is used in the same way as in the case of women.

Most representatives of the stronger sex need to drink one sachet of medication to cope with the disease.

This is due to the strength of the active substance.

In exceptional cases, double dosage may be required.

Then the dose is repeated at intervals of 1 full day to achieve recovery.

In representatives of the stronger sex, especially when it comes to an uncomplicated course of the process, the therapy is well tolerated.

Caution should be exercised when prescribing this medication to older men.

Since during this period the performance of the kidneys and liver may be reduced, which will delay the active substance of the medication in the body.

Symptoms of male cystitis

The most common symptoms of cystitis in men are:

Frequent (often with difficulty and pain) urination.
Change in urine odor.
Presence of pus and bloody discharge in the urine.
Burning and itching when urinating.

Specific symptoms may be accompanied by general negative signs: weakness, decreased ability to perform usual work, painful manifestations in the groin, scrotum, bladder, increased body temperature. A man with cystitis becomes nervous, irritable, vulnerable to other diseases - the presence of these symptoms varies from person to person. The intensity of the signs of the disease increases along with the neglect and progression of cystitis.

What tests are used to prescribe Monural?

Patients often ask questions about what tests are needed before Monural.

To make sure that the drug will work fully and will be effective in combating inflammatory processes.

The question is quite logical, since in modern medicine it is practically not practiced to prescribe medications without first undergoing a series of tests.

First, you should make sure that the inflammatory process in the bladder is caused by bacteria.

To do this, a urine test is performed, which evaluates the activity of bacterial cells, the presence of blood or pus in the urine, which also indicates pathology.

Urine can be sown on nutrient media to understand which microflora predominates.

Secondly, a culture test for sensitivity to antibiotics is required.

Only after it should Monural be prescribed if the identified bacteria are sensitive to the main active substance.

If there is no sensitivity to the drug, prescribing treatment with Monural is simply impractical.

Only the attending physician can decide what to do if Monural does not help with cystitis!

Which doctor can recommend Monural

Another pressing question among patients is: which doctor to contact for an appointment.

You shouldn't be surprised by this interest.

After all, patients are often embarrassed about their problem when it comes to diseases of the genitourinary system.

They don't even try to find out which doctor can help with certain symptoms.

First of all, of course, Monural is a urological drug.

It is urologists who deal with diseases of the urinary system in both men and women.

Therefore, they often resort to prescribing this drug.

In addition to the urologist, a gynecologist can also prescribe a woman, although this happens quite rarely.

This purpose is explained by the fact that the genitourinary system in women is closely connected.

A gynecologist is often a specialist not only in the organs of the reproductive system, but also in the urinary organs.

If we are talking about a small child, the medicine can be prescribed to him by the attending pediatrician.

Also, the baby can be examined by a specialized doctor, and then the prescription of therapy will be received from him.

In rare cases, Monural is recommended by doctors of other specialties, including dermatovenerologists.

special instructions

It is recommended to avoid simultaneous intake of food and the drug during the course of therapy. Because food interferes with the normal absorption of the latter. Therefore, you need to drink the solution 2 hours before or after meals.

Particular caution should be exercised when prescribing a pharmacological agent to patients with diabetes mellitus. Because one pack of the drug contains sucrose.

It is not recommended to use the antibiotic for persons suffering from severe forms of kidney failure. In milder conditions, administration is possible, but a mandatory adjustment of the therapeutic dose is required.

Women during pregnancy and breastfeeding are prescribed a drug in extreme cases, if the benefit to the health of the mother greatly outweighs the threat to the fetus.

Features of using Monural during pregnancy

Pregnancy is a special period in the life of every woman.

What is meant here is not only the joy and happiness of expecting a new addition to the family, but also natural health problems that a rare pregnant woman can happily avoid.

So, for example, cystitis in pregnant women is aggravated much more often than in ordinary women on average.

This is due to the fact that the enlarged uterus prevents the normal outflow of urine from the bladder.

This contributes to the reverse flow of urine, causing an exacerbation of infectious processes.

Naturally, it is necessary to treat cystitis if it makes itself known during pregnancy.

Monural is approved for use during pregnancy and cystitis.

Although the main active ingredient penetrates the placenta, in a number of studies doctors have proven that its effect on the child is so insignificant that it can be neglected.

Naturally, one of the main conditions is the woman’s lack of individual intolerance to the medication.

If there is intolerance, you will have to abandon Monural and look for alternative medications.

Emergency care for urological diseases

Acute prostatitis is a nonspecific acute inflammation of the prostate gland.

Acute prostatitis develops as a result of a pathogenic infectious agent (E. coli, other Enterobacteria, Pseudomonas, Enterococcus and Staphylococcus) entering the prostate gland.

Ways of infection entering the prostate:

canalicular - through the excretory ducts of the prostate (the source of infection is the posterior urethra);
hematogenous - with congestion in the gland from hypothermia, constipation, prolonged sexual abstinence or excess, etc. (the source of infection is purulent foci in other organs);
lymphogenous.

Acute prostatitis is divided into catarrhal, follicular, parenchymal.

The disease begins with frequent (5-7 times per night), painful at the end, difficult urination in small portions, with continued urge and pain in the perineum, which intensifies with defecation. In some cases, terminal hematuria appears, caused by the involvement of the mucous membrane of the neck and bottom of the bladder in the inflammatory process. Body temperature is high.

Possible complications of acute prostatitis:

acute urinary retention;
prostate abscess;
paraprostatitis;
phlebitis of the paraprostatic venous plexus.

Diagnostics

During the survey they find out:

presence of chronic prostatitis;
whether hypothermia occurred (swimming in cold water, etc.).

With prostatitis, urine reflux from the posterior urethra into the prostate occurs in response to increased intraurethral pressure.

A digital rectal examination reveals an enlarged, sharply painful prostate gland, sometimes with signs of fluctuation in one of the lobes. This study is performed very carefully; it requires sufficient experience from the doctor.

Laboratory diagnostics. A blood test (leukocytosis, band shift, increased ESR) gives grounds to judge the degree of the inflammatory process and purulent-inflammatory intoxication. Urinalysis reveals pyuria and bacteriuria, and it is especially important to examine the first portion of urine.

Acute prostatitis should be differentiated from various diseases that occur with fever, and primarily from paraproctitis. In differential diagnosis, the main role belongs to digital rectal examination.

Main directions of therapy

Broad-spectrum antibiotics:
cephalosporins of the II, III generations - cefotaxime (Talcef, Ceftax) 1.0 g 2 times a day IM, ceftazidime (Cefadim, Fortum) 1 g 2 times a day IM), ceftriaxone (Medaxone, Oframax, Rocephin) 1 –2 g once a day IM and IV, cefoperazone (medocef, cefobid) 1–2 g 2 times a day IM, cefuroxime (Axetin, Zinnat, Supero) 750–1500 mg 3–4 times a day day IM and IV;
parenteral fluoroquinolones (ciprofloxacin - medociprin, siflox, ciprolet) 50 ml of 0.2% solution 2 times a day i.v.), ofloxacin (geoflox, ofloxin) 200 mg in 5% glucose solution i.v., pefloxacin (abactal, perti) 250 ml in 5% glucose solution;
in mild cases - fluoroquinolones orally: ciprofloxacin 0.5 g 2 times a day, ofloxacin 0.2 g 2 times a day, lomefloxacin (lomflox, maxaquin, xenaquin) 0.4 g 1 time a day, pefloxacin 400 mg 2 times a day day).The duration of antibacterial therapy should be at least 14 days.
If there is no positive dynamics within 1–2 days, a cystostomy is performed to drain urine from the bladder (Fig. 1).

Clinical pharmacology of individual drugs

III generation cephalosporins (cefoperazone, cefotaxime, ceftazidime, ceftriaxone, etc.) are active against gram-positive and gram-negative bacteria. The drugs are prescribed 1–2 g 2 times a day parenterally.

Common therapy errors:

Installation of a urethral catheter and other manipulations on the urethra - with the development of acute urinary retention, an emergency epicystostomy is necessary.
Reducing the duration of antibacterial therapy increases the likelihood of recurrence of the disease and its transition to a chronic form.

Acute prostatitis, especially in elderly and senile people, as well as in the presence of severe hyperthermia with chills, requires urgent hospitalization in a urological hospital.

Analysis of clinical cases

Patient R., 19 years old. Complaints of frequent and painful urination, pain in the perineum, fever up to 38.5°C with chills. History: the day before I bathed in cold running water. In the evening of the same day, he noted an increase in temperature against the background of frequent and painful urination. On examination: the abdomen is soft and painless. Pasternatsky's symptom is negative on both sides. On digital rectal examination, the prostate is slightly enlarged in size, sharply painful, with areas of hardening and softening. Diagnosis: acute prostatitis. The patient was hospitalized in the urological hospital. Treatment: intensive antibacterial therapy.

Patient Z., 65 years old. Complaints of sharp pain in the anus and perineum, aggravated by defecation, frequent and painful urination, fever up to 39°C with chills. History: complaints appeared 5 days ago and grew progressively. Periodically, body temperature rose to 39.5°C with chills, then decreased, with increased sweating. On examination: the patient is pale, breathing heavily, heart rate 95 beats/min. Rectally, an enlarged prostate is detected, which protrudes into the intestinal lumen, is sharply painful and asymmetrical due to the right lobe, where fluctuation is determined. Diagnosis: acute prostatitis; prostate abscess. The patient was hospitalized in the urological hospital. Treatment: surgical drainage of the prostate abscess, antibacterial and detoxification therapy.

Acute epididymitis is an acute inflammation of the epididymis that can involve the testicle (epididymo-orchitis).

The causative agents of acute epididymitis are Chlamydia trachomatis, N. gonorrhoeae (in patients under 35 years of age) and E. coli, P. aeruginosa (in older patients).

Routes of infection:

retrograde (from the urethra due to its bougienage, catheterization, endoscopic manipulation, etc.);
from the prostate gland;
hematogenous.

There are specific epididymitis (gonorrheal, chlamydial, trichomoniasis, tuberculous) and nonspecific.

The disease usually begins acutely, less often develops slowly. Fever appears, pain is localized in the testicular area, intensifying and radiating along the spermatic cord, due to swelling, the scrotum increases in size.

Possible complications of acute epididymitis:

suppuration with the formation of an abscess of the epididymis and phlegmon of the scrotum;
an increase in intoxication phenomena with the development of bacteriotoxic shock or urosepsis;
fertility disorders, especially with a bilateral process.

Diagnostics

On examination, swelling and redness of the skin of the scrotum are noted. On palpation, the appendage is enlarged, compacted, and sharply painful. As the inflammatory process progresses and exudate accumulates in the membranes of the testicle, the testicle itself and the epididymis form a single conglomerate.

Laboratory diagnostics. A general blood test reveals leukocytosis and band shift with an increase in ESR; in some patients, leukocyturia and bacteriuria. Before starting antibiotic therapy, a urethral smear and midstream urine should be obtained for microbiological examination.

Acute epididymitis is differentiated:

with torsion of the spermatic cord, in which the testicle is usually located above its normal position and is often turned transversely, the onset of the disease is sudden and is not accompanied by an increase in temperature;
hydrocele;
testicular injury;
strangulated hernia.

Main directions of therapy

Ice and a suspension are applied to the scrotum.
Prescribe suppositories with diclofenac.
Antibiotic therapy:
in severe cases and in older patients - aminoglycosides (amikacin, gentamicin) and fluoroquinolones parenterally (see acute prostatitis), then fluoroquinolones (for example, ciprofloxacin 500 mg 2 times a day) orally.

The duration of the course of antibacterial therapy should be at least 14 days.

When an epididymal abscess forms, surgical treatment is indicated.

Common therapy errors:

Discontinuation of antibacterial therapy after fever and pain have decreased.
Continuation of antibiotic therapy as the only method of treatment despite the lack of effect for more than 3 days without additional diagnostics.

Hospitalization to a urological hospital is indicated for most patients with moderate to severe acute epididymitis, especially with signs of chronic prostatitis. Only young patients with mild epididymitis are treated outpatiently.

Analysis of clinical cases

Patient K., 25 years old. Complaints of sharp pain in the testicular area, fever up to 38.5°C. History: bruised scrotum a week ago while riding a bicycle. About 5 days ago I discovered a lump in the scrotum area, which was progressively increasing in size. The day before treatment, the temperature increased to 38°C. He suffers from focal pulmonary tuberculosis, for which he receives treatment irregularly. On examination: the right half of the scrotum is increased in size and moderately hyperemic. Palpation reveals an enlargement and thickening of the right testicular epididymis; examination is sharply painful. Diagnosis: acute right-sided epididymitis, possibly of tuberculous etiology. The patient was hospitalized in the urological hospital. Treatment: antibacterial therapy with broad-spectrum antibiotics. If the tuberculosis etiology of the process is confirmed, the patient is transferred to a specialized medical institution.

Patient D., 82 years old. Complaints of pain in the area of the right half of the scrotum, increased body temperature to 38°C, severe general weakness. History: 8 days ago there was pain in the right half of the scrotum and its enlargement. The pain progressively increased, weakness appeared, and the day before treatment the temperature was 38°C. On examination: the patient's condition is serious. The right half of the scrotum is significantly increased in size and is sharply painful on palpation. Palpation reveals a single conglomerate with foci of softening; it is impossible to differentiate the testicle and epididymis. Diagnosis: acute epididymo-orchitis; purulent melting of the testicle and epididymis. The patient was hospitalized in the urological hospital.

Acute urinary retention (AUR) is the accumulation of urine in the bladder due to the inability to urinate independently with a painful urge to urinate.

The causes of AUR can be different.

Mechanical:
acute prostatitis;
sclerosis of the bladder neck;
foreign body;
stone and urethral rupture;
neoplasm of the lower urinary tract;
uterine prolapse.
Diseases and damage to the central nervous system (tumor, injury, etc.).
Reflex dysfunction of the bladder.
Poisoning with psychoactive substances (hypnotics, narcotic analgesics).

Mechanical and dynamic mechanisms are involved in the pathogenesis of AUR.

In elderly men, in response to gradually increasing bladder outlet obstruction (mechanical factor), nervous regulation changes - the tone of the smooth muscle cells of the detrusor increases and the detrusor hypertrophies. The histomorphological structure of the bladder wall gradually changes: muscle elements are replaced by connective tissue, trabecularity develops. The volume of the bladder increases. The process enters the stage of decompensation - hypotension of detrusor smooth muscle cells develops (dynamic factor). In such a situation, any provoking factor (hypothermia, alcohol intake, spicy food, prolonged sitting position, constipation) causes venous stagnation in the pelvis, the veins of the bladder neck dilate, swelling of the prostate occurs, which, in turn, leads to deformation and compression of the prostatic parts of the urethra (mechanical component). Against the background of existing pathological changes in the detrusor, AUR develops.

Often, AUR in older people occurs after injection of atropine or its derivatives due to a decrease in detrusor tone, more often with an existing urological disease (for example, prostate adenoma).

Reflex AUR is more often observed after operations, especially in children, due to disruption of the nervous regulation of the detrusor and striated sphincter of the bladder. In addition, it can occur with trauma to the perineum, pelvis and lower extremities, with severe emotional shock, alcohol intoxication, fear, hysteria.

Clinical picture: the patient is restless, experiences severe pain in the suprapubic region, a painful urge to urinate, and a feeling of fullness in the lower abdomen.

In older men, AUR often becomes chronic and causes:

inflammation in the urinary tract (infectious agents can be introduced during bladder catheterization);
chronic cystitis and pyelonephritis;
stone formation.

With a hypotrophied bladder wall, vesicoureteral-pelvic reflux develops, leading to bilateral urethrohydronephrosis and chronic renal failure.

Diagnostics

During the survey they find out:

how the patient urinated before AUR;
what color was the urine;
whether he took drugs that promote AUR.

When examining patients with asthenic physique, the symptom of a “ball” in the suprapubic region is determined. Percussion - a dull sound above the bladder. Palpation is painful due to a strong urge to urinate.

Ultrasound allows you to determine the volume of urine in the bladder and the condition of the upper urinary tract.

Laboratory diagnostics. Clinical tests of blood and urine (obtained during catheterization) in new-onset AUR are usually normal.

In patients with severe cystitis, pyelonephritis, signs of inflammation are detected in a blood test, and an increase in leukocytes and fresh red blood cells in the urine.

In chronic renal failure, hemoglobin levels and the number of red blood cells in the blood are reduced, and the level of urea and creatinine in the blood serum is increased.

Acute urinary retention is differentiated from anuria: with anuria there is no urge to urinate, palpation of the suprapubic area is not painful.

With paradoxical ischuria, the bladder is full, the patient cannot urinate on his own, but urine is involuntarily released in drops. Once the urethral catheter releases urine, urine leakage stops until the bladder becomes full again.

Main directions of therapy

Urgent emptying of the bladder by inserting an elastic catheter.
Contraindications to bladder catheterization:
- acute urethritis and epididymitis (orchitis);
urethral injury.

In this case, it is necessary to resort to puncture of the bladder, which is performed only in a urological or surgical hospital.

If AUR lasts more than 2 days, a permanent urethral catheter is installed in the bladder.
Antibiotics are prescribed to prevent inflammatory diseases of the scrotal organs and drugs from the α-blocker group (Table).

Drugs from the group of α-adrenergic blockers tamsulosin (omnic), doxazosin (zoxon, cardura, magurol), terazosin (setegis, hytrin, cornam), alfuzosin (dalfaz):

relax the smooth muscle elements of the prostate (mechanical component of the prostate);
improve blood microcirculation in the wall of the bladder, restoring the contractility of the detrusor (the dynamic component of the bladder).

Side effects of α-blockers:

blocking α1-adrenergic receptors located in the stroma, prostate capsule, bladder neck, urethra;
vascular dilatation;
reduction of peripheral vascular resistance;
decrease in blood pressure.

Common therapy errors:

Self-medication, taking diuretics.
Incorrect, inept catheterization and formation of false urethral passages. A metal catheter should not be used in the prehospital setting.

Urgent hospitalization to the urology department is indicated in the following cases:

difficult first catheterization;
urethrorrhagia, acute inflammation of the urethra, scrotal and prostate organs, urethral trauma;
impossibility of inserting a catheter (you cannot make more than two attempts);
unsuccessful repeated catheterizations of the bladder.

Analysis of clinical cases

Patient M., 77 years old. Complaints of sharp pain in the lower abdomen, inability to urinate independently. History: I took alcohol the day before. He did not urinate for about 12 hours. For 5 years he noted a deterioration in urination: a sluggish stream of urine, the need to strain when urinating, nocturia up to 2 times. I did not see a urologist. On examination: the patient is restless, holding his lower abdomen with his hands. The “ball” symptom is determined in the suprapubic region. Percussion - dull sound. On digital rectal examination: the prostate is enlarged 1.5 times, has a tight-elastic consistency, the median groove is smoothed. The rectal mucosa above the prostate is mobile. Diagnosis: benign prostatic hyperplasia, AUR. Treatment: catheterization of the bladder with a Nelaton catheter. It is recommended to take α-blockers, anti-inflammatory therapy, examination and observation by a urologist.

Patient Yu., 68 years old. Absence of urination for more than a day with the urge to urinate, no pain. History: three cases of acute urinary retention, which resolved after catheterization. During the last catheterization (6 months ago), the patient accidentally removed the catheter with an inflated balloon, after which he noted painful urination with blood at the beginning of urination. He has been suffering from benign prostatic hyperplasia for about 7 years. I took α-blockers, which had no effect in the last six months. On examination: the bladder is at the level of the navel, percussion - 10 cm above the womb. Palpation is sensitive, but does not cause sharp pain. On digital rectal examination: the prostate is enlarged 2–2.5 times, has a tight-elastic consistency, the median groove is smoothed. The rectal mucosa above the prostate gland is mobile. Diagnosis: benign prostatic hyperplasia, post-traumatic urethral stricture, AUR. The patient is indicated for hospitalization in a urological hospital to decide on the tactics of further treatment (if it is impossible to install a urethral catheter, perform a trocar cystostomy).

Patient T., 20 years old. Complaints about the inability to urinate independently, pain in the lower abdomen. History: the patient has not urinated for more than 20 hours. She experienced emotional stress, felt a strong urge to urinate, but was unable to visit the toilet, after which she was unable to urinate. On examination: the “ball” symptom is determined in the suprapubic region. Percussion reveals the bladder 8 cm above the pubis. Diagnosis: AUR of a neurogenic nature. Treatment: bladder catheterization. Further examination by a urologist and neurologist is recommended.

Anuria is the absence of urine in the bladder.

Risk factors for the development of prerenal anuria:

decreased cardiac output (cardiogenic shock - cardiac infarction);
systemic vasodilation (sepsis, neurogenic shock);
hypovolemia and a sharp decrease in circulating blood volume: - blood loss; -plasma loss (with extensive burns); -dehydration (with vomiting, diarrhea, forced diuresis); -the emergence of a “third space” (with sequestration of fluid into the abdominal cavity - ascites, into the subcutaneous tissue - edema), etc.

Violation of general hemodynamics and circulation with a sharp depletion of renal blood circulation leads to renal ischemia; when it worsens, ischemic necrosis of the epithelium of the renal convoluted tubules occurs and prerenal anuria can develop into renal anuria.

Risk factors for the development of renal anuria:

acute tubular necrosis, the most common causes of which can be:
nephrotoxic factors: - iodine-containing radiocontrast agents during angiography; - salts of heavy metals (lead, mercury, copper, barium, arsenic, gold); -antibiotics (aminoglycosides, amphotericin B); -organic solvents (glycols, dichloroethane, carbon tetrachloride); -uricuric crises - intrarenal occlusion of tubules by uric acid crystals during gout, chemotherapy for myelo- and lymphocytic leukemia, treatment with sulfonamides, etc.;
acute and chronic end-stage renal failure due to glomerulonephritis, malignant arterial hypertension, hemorrhagic fever with renal syndrome, etc.

Postrenal anuria is an acute violation of the outflow of urine from the kidneys to the bladder, resulting from occlusion of the upper urinary tract on both sides.

Causes of postrenal anuria:

urolithiasis, mainly in the form of ureteral stones;
external compression of the urinary tract due to retroperitoneal fibrosis;
cancer of the uterus, ovaries, etc.;
obstruction of the ureter of a single kidney.

There are four forms of anuria:

arenal anuria (renoprival) - with congenital aplasia of both kidneys, accidental or intentional removal of both kidneys or the only functioning one;
prerenal anuria (hemodynamic) - caused by acute disruption of the blood supply to the kidneys;
renal anuria (parenchymal) - caused by damage to the renal parenchyma;
postrenal anuria (obstructive) - resulting from an acute violation of the outflow of urine.

Early symptoms of anuria are always associated with its cause.

With anuria the following are noted:

disturbance of water-electrolyte metabolism, hyperkalemia;
acid-base imbalance;
damage to the central nervous system (uremic intoxication), Kussmaul breathing;
increasing azotemia;
uremic pulmonary edema;
acute bacterial and non-bacterial inflammation of organs.

Possible complications of anuria:

cardiovascular disorders (arrhythmias, pulmonary edema, pericarditis, hypertension);
metabolic disorders (hyperuricemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, hyperkalemia, hyponatremia);
neurological disorders (convulsions, somnolence, coma);
gastrointestinal disorders (nausea, vomiting);
hematological disorders (normocytic normochromic anemia, disorders in the hemocoagulation system and vascular platelet insufficiency with the development of hemorrhagic rashes, ecchymosis, gastrointestinal bleeding);
infectious complications (pneumonia, urinary tract infections, septicemia, wound infections).

Diagnostics

During the survey you need to find out:

whether there was exposure to nephrotoxic factors;
whether the patient has diseases leading to anuria (urolithiasis, prostate disease, gynecological diseases, heart disease, etc.);
whether there were episodes of renal colic.

When examining a patient, you need to pay attention to:

presence of free fluid;
the presence of massive edema;
skin turgor;
condition of mucous membranes;
muscle tone;
presence or absence of neurological symptoms;
the patient's consciousness.

The patient needs to measure blood pressure (if blood pressure is <70 mm Hg, prerenal anuria may develop).

Auscultation in the case of uremic pulmonary edema reveals moist rales of various sizes over the entire surface of the lungs.

Radiologically, anuria is characterized by multiple cloud-like infiltrates in both lungs; in other cases, edema of the airways of the lungs is localized in the hilar zones, forming homogeneous butterfly-type opacities, while the peripheral parts of the lungs are free from edema.

An ECG can reveal hyperkalemia by tall, narrow, pointed positive T waves, gradual shortening of the QT interval, with possible slowing of atrioventricular and intraventricular conduction and a tendency to sinus bradycardia.

Laboratory diagnostics. A biochemical blood test is performed and the following is assessed:

level of creatinine, urea;
ionogram;
acid-base status of blood:
level of creatinine and sodium in daily urine;
osmolarity of urine and blood.

The leading role in identifying hyperkalemia and monitoring potassium levels belongs to biochemical monitoring.

If necessary (if the patient’s consciousness is confused, the memory is clouded, the explanations of the patient’s relatives are sufficient), the presence of urine in the bladder is determined by installing a urethral catheter.

Anuria is differentiated from acute urinary retention. For this:

perform a detailed history taking;
perform catheterization of the bladder with a catheter with a balloon (No. 14-16.18 according to Charrière);
the catheter is left in the urinary tract to monitor the possible appearance of urine.

Catheterization is performed delicately, wearing sterile gloves, since any trauma to the urethra during infection can lead to resorptive fever and urethritis.

Main directions of therapy

Therapy directly depends on the cause and clinical manifestations of anuria.

In case of prerenal anuria resulting from cardiogenic shock or collapse, it is necessary:

maintain cardiac activity;
stabilize or even increase blood pressure;
reopolyglucin, reoglukin 400–1000 ml intravenous drip, albumin 150–200 ml 10–20% solution intravenous drip, native or fresh frozen plasma 400 ml, glucose 400–800 ml 5% solution intravenous drip.

In case of postrenal anuria it is necessary:

determine the level of urinary tract obstruction;
restore their patency, especially in patients with sepsis.

In case of renal anuria due to poisoning, it is necessary:

urgently rinse the stomach through a tube or give the patient to drink 2-3 liters of water, then induce vomiting, repeat the manipulation several times;
if a toxic substance is clearly identified, administer antidotes;
carry out detoxification therapy;
correct acidosis and water-electrolyte balance.

The treatment algorithm is presented in Figure 2.

Clinical pharmacology of individual drugs

Reopolyglucin reduces the aggregation of blood cells, promotes the movement of fluid from tissues into the bloodstream, increases the volume of circulating blood, has a detoxification effect, improves the microcirculation system, and helps restore blood flow in small capillaries. It is necessary to administer 400–1000 ml intravenously.

Dopamine (dopmin, dopamine Solvay 50) increases myocardial contractility, increases renal blood flow and has a diuretic effect (at an infusion rate of 2–4 mcg/kg/min). 200 mg of dopamine is dissolved in 400 ml of 5% glucose solution (1 ml of solution contains 500 mcg, and 1 drop - 25 mcg of dopamine), for a patient weighing up to 70 kg, the infusion is carried out at a rate of 3 mcg/kg/min, more than 70 kg - 10 mcg/kg/min.

Mannitol increases osmotic pressure in the renal tubules, reduces water reabsorption, eliminates spasm of afferent arterioles and thus increases glomerular filtration. The drug also increases renal blood flow, but is ineffective in cases of already developed renal failure and tubular necrosis. Apply 10–20% mannitol solution intravenously by drip or slow stream at a dose of 1 g/kg. Mannitol is dissolved in 5% glucose solution.

Common therapy errors:

The use of Lasix and osmotic diuretics for postrenal anuria.
The administration of large amounts of fluid (more than 600–800 ml) is dangerous due to the high risk of developing severe extracellular hyperhydration.

For any form of anuria, emergency hospitalization to the urology department is indicated.

Analysis of clinical cases

Patient K., 68 years old. Complaints of lack of urine for 18 hours, chills. History: benign prostatic hyperplasia for 15 years, takes adrenergic blockers, but periodically experiences difficulty urinating, and in the last 24 hours he noted the inability to urinate independently. On examination: no signs of dehydration were detected, no pathology in the organs, the per rectum gland was significantly enlarged, densely elastic in consistency, the median sulcus was smoothed. A physical examination revealed no abnormalities; body temperature was 38.9°C. The patient was taken to the urology department. Treatment: a urethral catheter was inserted into the bladder cavity, 680 ml of urine was obtained, after which the catheter was clamped. Over the next 3 hours, 2000 ml of urine was obtained, in which a large number of gram-negative microorganisms were found, 15–20 leukocytes in the field of view. Antibacterial and anti-inflammatory therapy was prescribed, which led to an improvement in the condition. Over the next 9 hours, the patient excreted about 2500 ml of urine, and 1000 ml of saline was administered. Over the next 3 days, diuresis decreased to normal, serum creatinine was 14 mg/l.

E. B. Mazo , Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Medical Sciences, Russian State Medical University, Moscow