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"lead": "Во время полового возбуждения из полового члена может выделяться предэякулят – бесцветная прозрачная вязкая жидкость, которая вырабатывается железами Литтре и железами Купера (бульбоуретральными железами), и поэтому ее также называют Куперовой жидкостью. Этот секрет необходим не только для того, чтобы поддерживать уретру увлажненной, но также для того, чтобы рН в ней был щелочной – наиболее благоприятный для сперматозоидов.Объем предэякулята может доходить до 4 мл. В среднем в 40% случаев, по данным исследования 2010 года, проведенного врачами из Hull York Medical School при University of Hull, в предэякуляте можно обнаружить живых и активных сперматозоидов.Нормальными также являются выделения, получившие название «смегма» – в переводе с древнегреческого это означает «кожное сало». Это действительно секрет препуциальных сальных желез, находящихся в крайней плоти, смешанный с остатками отмершего эпителия. Он нужен телу мужчины для смазки, чтобы нежная ткань головки не стиралась о крайнюю плоть. В норме в смегме обитают разнообразные бактерии, которых ученые относят к категории комменсалов - так называют организмы, получающие пользу от совместного обитания и при этом не причиняющие организму-партнеру вреда. К таким бактериями относятся: некоторые виды энтерококков, коринебактерии, Mycobacterium smegmatis и др. Под крайней плотью могут обитать более 40 видов микробов.\r\n\r\nПри регулярной гигиене половых органов смегма не накапливается и не доставляет никаких неудобств. В противном случае она откладывается в препуциальном мешке (крайней плоти) и может становиться отличным «пастбищем» для разнообразных микроорганизмов, которые начинают бурно размножаться и, в свою очередь, приводят к воспалению кожи головки пениса и крайней плоти. И вот уже на этом фоне могут развиваться баланит и баланопостит, кондиломы и папилломы (которые в худшем случае трансформируются в рак полового члена)По сути, это воспаление головки пениса. А воспаление крайней плоти называется поститом. Если же воспалительный процесс охватил и то, и другое – говорят о баланопостите. Цепочка баланит-постит-баланопостит часто наблюдается у необрезанных представителей мужского пола.\r\n\r\nВ перечень симптомов баланита, постита и их комбинации входят покраснение в области головки пениса и тканей крайней плоти, неприятный запах и зуд в области половых органов, боль.\r\n\r\nБаланит развивается у каждого 25-го мальчика и у каждого 30-го взрослого необрезанного мужчины. В категорию высокого риска входят мальчики младше 4 лет и мужчины, не проходившие процедуру обрезания (у обрезанных представителей сильного пола баланит развивается на 68% реже). При этом следует помнить, что на фоне баланита в 3,8 раза возрастают риски развития рака полового члена.\r\n\r\nВ группу повышенного риска указанных болезней также входят пациенты с сахарным диабетом и с фимозом (в последнем случае заболевание развивается из-за невозможности проведения полноценных гигиенических процедур и активного развития анаэробных бактерий). Баланит может также развиваться при экземе, грибковых и бактериальных инфекциях, при раздражении из-за использования агрессивных для кожи моющих средств.\r\n\r\nВ свою очередь, на фоне баланопостита увеличивается вероятность развития таких патологий, как фимоз, парафимоз, ксеротический облитерирующих баланит и злокачественные опухоли полового члена.",
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"description": "<p><span id=\"docs-internal-guid-ccd66d15-7fff-691a-db9f-5050257a4ff2\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Баланопостит - воспалительное заболевание, которое поражает головку полового члена и внутренний листок крайней плоти. </span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Баланопостит – воспалительное заболевание, причиной которого выступают микроорганизмы. Возбудителями патологии могут быть как бактерии, которые в норме присутствуют в области головки полового члена (стафилококки, стрептококки, кишечная палочка), так и специфические патогены (бледные трепонемы, трихомонады, грибки).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У детей и подростков болезнь чаще обусловлена несоблюдением правил интимной гигиены и анатомическими особенностями строения крайней плоти. У детей ее листки довольно плотно прилегают друг к другу, что затрудняет полноценное вымывание остатков секрета (смегмы) из тканевого кармана. Взрослые же заражаются преимущественно во время незащищенного полового контакта.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Немаловажным фактором, который влияет на риск развития болезни, является снижение иммунитета. Такое состояние может быть следствием:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">обострения хронических соматических заболеваний;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">частых стрессов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сахарного диабета и/или метаболического синдрома;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">приема медикаментов, угнетающих функцию иммунитета (глюкокортикостероиды, цитостатики).</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Агенты, вызывающие баланопостит, делятся на инфекционные (патогенные, условно-патогенные микроорганизмы) и неинфекционные (травма, ожог, контакт с химическими веществами и пр.). В области гениталий чрезвычайно развиты кровеносная и лимфатическая сети, что проявляется выраженной экссудацией при воспалении, вплоть до развития фимоза и парафимоза. Повышенная температура и влажность в препуции, щелочная реакция смегмы (а при сахарном диабете еще и глюкоза) способствуют усиленному размножению аэробных и анаэробных микроорганизмов и вирусов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение правил гигиены, равно как и частый контакт с агрессивными средами, приводят к реализации патогенных свойств у условных возбудителей или к преобладанию патогенной микрофлоры над условно-патогенной. У детей баланопостит часто развивается после грубой ретракции крайней плоти при фимозе, длительном нахождении в памперсах или при генерализации какой-либо инфекционной болезни.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика баланопостита – это в первую очередь клинический осмотр больного урологом. Врач визуально осматривает половой член, оценивает жалобы пациента, собирает анамнез. Изучив возможные пути заражения, уролог может предложить лечение также половому партнеру.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для более детальной оценки степени тяжести заболевания может проводиться:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общий анализ крови;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общий анализ мочи;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">биохимический анализ крови;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">бактериологическое исследование выделений из крайней плоти.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для выбора оптимального антибактериального средства выполняется антибиотикограмма.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В 60-70% случаев лечение воспаления головки полового члена и крайней плоти проводится консервативным путем. Суть терапии сводится к эрадикации (уничтожению) возбудителя и устранению неприятных симптомов заболевания.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В рамках этиотропной терапии (направлена на устранение причины заболевания) уролог назначает антибактериальные или противогрибковые препараты. Выбор конкретного медикамента зависит от результатов лабораторных исследований, предполагающих определение возбудителя. Из антибактериальных препаратов чаще всего используются производные имидазола, макролиды, фторхинолоны. Противогрибковые препараты показаны только при доказанной причинной роли грибков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В составе комплексной терапии могут также назначаться:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нестероидные противовоспалительные средства;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">уросептики;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">иммуномодуляторы, повышающие активность естественной защиты организма.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При частом рецидивировании баланопостита может выполняться хирургическое вмешательство. Оптимальной операцией является циркумизация. Процедура предусматривает обрезание крайней плоти с оголением головки полового члена. За счет такого вмешательства устраняется субстрат для развития воспаления, пропадает проблема застоя секрета. Рецидивы болезни после оперативного лечения встречаются менее чем в 1-2% случаев.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для уменьшения рисков развития болезни нужно соблюдать правила интимной гигиены, избегать хаотичных половых связей, своевременно лечить заболевания мочеполовой системы.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эффективным методом профилактики патологии считают операцию циркумизации, которую проводят детям в раннем возрасте. </span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от степени тяжести и особенностей клинической картины баланопостит делится на 3 формы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Простой. Патология проявляется покраснением и отечностью головки полового члена и крайней плоти. Наблюдается мацерация кожи с образованием ограниченных эрозий, которые вызывают зуд и жжение у пациента.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Эрозивный. Более сложная форма заболевания, которая характеризуется образованием болезненных эрозий, окруженных ободком мацерации. Эти элементы чередуются с отекшими участками полностью отмершего эпителия. Такая форма болезни в 40-60% случаев сопровождается фимозом (сужение отверстия крайней плоти) и воспалением близлежащих лимфатических узлов (лимфаденит).</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гангренозный. Наиболее тяжелая форма заболевания. На головке пениса и крайней плоти образуются гнойные язвы, которые могут прорывать (перфорировать). Пациент страдает от общего интоксикационного синдрома, который проявляется лихорадкой, выраженной общей слабостью. Болезнь сопровождается фимозом и требует максимально быстрого оказания медицинской помощи.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от характера течения баланопостит может быть острым и хроническим. Чем раньше начато лечение заболевания, тем ниже риск его прогрессирования и последующего развития осложнений.Также снижается вероятность перехода острого воспаления в хроническое.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выраженность симптомов зависит от вида возбудителя заболевания, индивидуальных особенностей организма пациента и состояния иммунитета. Кроме указанных выше симптомов, баланопостит сопровождается следующими признаками:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">зуд и жжение в патологическом участке;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">появление налета на головке пениса;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">преждевременное семяизвержение и дискомфорт во время полового контакта;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">серозные или гнойные выделения с неприятным запахом при обнажении крайней плоти;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">образование язв и мацерация кожи в патологическом участке;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">частое и болезненное мочеиспускание.</span></li>\r\n</ul>",
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