{"id":8722,"date":"2021-08-03T11:38:20","year":"2021","link":"https:\/\/rigasveseliba.lv\/lv\/aktualitates\/zenu-veseliba-prieksadinas-sasaurinajums\/","type":"aktualitates","slug":"zenu-veseliba-prieksadinas-sasaurinajums","featured_image":"https:\/\/rigasveseliba.lv\/wp-content\/uploads\/2021\/08\/1-1.jpg","title":"Z\u0113nu vesel\u012bba \u2013 priek\u0161\u0101di\u0146as sa\u0161aurin\u0101jums","content":"

<\/p>\n

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Konsult\u0113 “R\u012bgas vesel\u012bbas centra” b\u0113rnu \u0137irurgs Juris \u0160veklis un RSU studente El\u012bna \u0160uta.<\/h3>\n<\/div>\n

Fimoze ir dzimumlocek\u013ca priek\u0161\u0101di\u0146as sa\u0161aurin\u0101jums<\/strong>, kura d\u0113\u013c nav iesp\u0113jams norm\u0101li atbr\u012bvot dzimumlocek\u013ca galvi\u0146u. Z\u0113niem augot, priek\u0161\u0101di\u0146a no dzimumlocek\u013ca atb\u012bd\u0101s pak\u0101peniski. Par probl\u0113mu fimoze k\u013c\u016bst tad, kad t\u0101 s\u0101k ietekm\u0113t pacienta dz\u012bves kvalit\u0101ti un izraisa rakstur\u012bgo kl\u012bnisko ainu.<\/span><\/p>\n

Anatomija<\/strong><\/span><\/h5>\n

Lai var\u0113tu s\u012bk\u0101k apskat\u012bt fimozi k\u0101 patolo\u0123iju, ir b\u016btiski g\u016bt nelielu ieskatu anatomij\u0101 par dzimumlocek\u013ca uzb\u016bvi (1. att\u0113ls).<\/span><\/p>\n

Priek\u0161\u0101di\u0146a (preputium<\/em>) ir \u0101das kroka, kura ap\u0146em un nosedz dzimumlocek\u013ca galvi\u0146u (glans penis)<\/em>. Sprauga starp dzimumlocekli un priek\u0161\u0101di\u0146u veido prepuci\u0101lo telpu. Prepuci\u0101lais gredzens ir atvere, pa kuru prepuci\u0101l\u0101 telpa atveras uz \u0101ru. Norm\u0101 gredzens ir elast\u012bgs. Tas nodro\u0161ina priek\u0161\u0101di\u0146as br\u012bvu kust\u012bbu p\u0101ri dzimumlocek\u013ca galvi\u0146ai, gan veicot manu\u0101lu kust\u012bbu, gan ar\u012b erekcijas laik\u0101. Fimoze ir prepuci\u0101l\u0101 gredzena r\u0113taina stenoze jeb sa\u0161aurin\u0101jums, kas ne\u013cauj atbr\u012bvot galvi\u0146u.<\/span><\/p>\n

\"\"<\/p>\n

\u00a0<\/p>\n

1. att\u0113ls. Dzimumlocek\u013ca uzb\u016bve<\/em><\/p>\n

Klasifik\u0101cija<\/strong><\/h3>\n

Iz\u0161\u0137ir fiziolo\u0123isku un ieg\u016btu jeb patolo\u0123isku fimozi. Fiziolo\u0123iska fimoze ir tad, kad b\u0113rnam l\u012bdz tr\u012bs gadu vecumam dzimumlocek\u013ca galvi\u0146u nevar atbr\u012bvot no priek\u0161\u0101di\u0146as, tom\u0113r fimoze var b\u016bt fiziolo\u0123iska l\u012bdz pat pubert\u0101tes vecumam. \u0160is st\u0101voklis ir izskaidrojams ar l\u0113no attiec\u012bbu pret garo priek\u0161\u0101du un t\u0101s iek\u0161\u0113j\u0101s lapi\u0146as pieaug\u0161anu dzimumlocek\u013ca galvi\u0146ai, veidojot sinehijas jeb saaugumus. P\u0113c tr\u012bs gadu vecuma z\u0113niem dzimumlocek\u013ca galvi\u0146a s\u0101k strauji augt un sinehijas atdal\u0101s no galvi\u0146as, l\u012bdz ar to priek\u0161\u0101di\u0146a pamaz\u0101m k\u013c\u016bst kust\u012bga. B\u016btiski ir atcer\u0113ties, ka priek\u0161\u0101di\u0146as kust\u012bgums uzlabosies ar laiku, nevis uzreiz p\u0113c tr\u012bs gadu dzim\u0161anas dienas, l\u012bdz ar to nevien\u0101 br\u012bd\u012b nevar tikt pielietots sp\u0113ks, m\u0113\u0123inot priek\u0161\u0101di\u0146u kustin\u0101t. Parasti piln\u012bb\u0101 fiziolo\u0123isk\u0101 fimoze p\u0101riet 5\u20137 gadu vecum\u0101, bet ir situ\u0101cijas, kad b\u0113rns var b\u016bt vec\u0101ks un sasniegt pubert\u0101tes vecumu. Kl\u012bnisk\u0101 aina ir individu\u0101la, t\u0101p\u0113c ir svar\u012bgi regul\u0101ri sekot l\u012bdzi izmai\u0146\u0101m un atr\u0101d\u012bties \u0101rstam, lai izvair\u012btos no nev\u0113lam\u0101m blakn\u0113m.<\/span><\/p>\n

Lai nov\u0113rt\u0113tu situ\u0101ciju, ir b\u016btiski saprast, par k\u0101du fimozes veidu ir runa. Fimozes veids tiek noteikts \u0101rsta viz\u012btes laik\u0101. Fiziolo\u0123iskas fimozes gad\u012bjum\u0101 priek\u0161\u0101di\u0146a ir bez r\u0113taudiem, vienm\u0113r\u012bg\u0101 kr\u0101s\u0101, turkl\u0101t piln\u012bb\u0101 nosedz dzimumlocek\u013ca galvi\u0146u, iz\u0146\u0113mums ir, ja priek\u0161\u0101di\u0146a nedaudz tiek pavilkta va\u013c\u0101, tad dzimumlocek\u013ca galvi\u0146u ir iesp\u0113jams ieraudz\u012bt (2. att\u0113ls).<\/span><\/p>\n

\"\"<\/p>\n

2. att\u0113ls. Fiziolo\u0123iska fimoze \u00a0<\/em><\/p>\n

Ieg\u016bta fimoze bie\u017e\u0101k ir sastopama pusaud\u017eiem un pieaugu\u0161iem v\u012brie\u0161iem. T\u0101s c\u0113lonis var b\u016bt da\u017e\u0101das dzimumlocek\u013ca galvi\u0146as traumas un iekaisuma procesi priek\u0161\u0101di\u0146\u0101. Ir situ\u0101cijas, kad ieg\u016bta fimoze var b\u016bt neiz\u0101rst\u0113tas fiziolo\u0123iskas fimozes sekas situ\u0101cij\u0101s, kad priek\u0161\u0101di\u0146\u0101 ir radu\u0161\u0101s r\u0113tainas izmai\u0146as, kuru d\u0113\u013c priek\u0161\u0101di\u0146a vairs nav tik elast\u012bga un veido \u0161auru fibrozu gredzenu (3. att\u0113ls).<\/span><\/p>\n

\"\"<\/p>\n

3. att\u0113ls. Patolo\u0123iska fimoze\u00a0<\/em><\/p>\n

Riska faktori<\/strong><\/span><\/h5>\n

Ieg\u016btas fimozes gad\u012bjum\u0101 pacientam ir vair\u0101ki riska faktori \u2013 slikta person\u012bg\u0101 higi\u0113na, r\u0113to\u0161an\u0101s procesi priek\u0161\u0101di\u0146\u0101, dzimumlocek\u013ca galvi\u0146as traumas, iekaisuma procesi, dzimumlocek\u013ca galvi\u0146as un priek\u0161\u0101di\u0146as iek\u0161\u0113j\u0101s virsmas iekaisumi, nepiln\u012bga priek\u0161\u0101di\u0146as apgraiz\u012b\u0161ana, k\u0101 ar\u012b t\u0101di patolo\u0123iski st\u0101vok\u013ci k\u0101 cukura diab\u0113ts, kas var veicin\u0101t infekcijas ra\u0161an\u0101s risku.<\/span><\/p>\n

Kl\u012bnisk\u0101 aina<\/strong><\/span><\/h5>\n
    \n
  • S\u0101p\u012bga priek\u0161\u0101di\u0146as p\u0101rvilk\u0161ana p\u0101ri dzimumlocek\u013ca galvi\u0146ai.<\/span><\/li>\n
  • Dzimumlocek\u013ca priek\u0161\u0101di\u0146as balonveida papla\u0161in\u0101\u0161an\u0101s urin\u0113\u0161anas laik\u0101.<\/span><\/li>\n
  • V\u0101ja ur\u012bna str\u016bkla, kura atg\u0101dina pilienus, ak\u016bta ur\u012bna aizture.<\/span><\/li>\n
  • Izmain\u012bta dzimumlocek\u013ca galvi\u0146as kr\u0101sa, iekaisuma aina.<\/span><\/li>\n
  • Diz\u016brija jeb s\u0101p\u012bga urin\u0101cija.<\/span><\/li>\n
  • Hemat\u016brija jeb asinis ur\u012bn\u0101.<\/span><\/li>\n
  • Enur\u0113ze jeb slapin\u0101\u0161ana gult\u0101 nakts laik\u0101.<\/span><\/li>\n<\/ul>\n

    Komplik\u0101cijas<\/strong><\/span><\/h4>\n

    Savlaic\u012bgi ne\u0101rst\u0113ta fimoze var izrais\u012bt sekund\u0101ru hronisku nieres b\u013codi\u0146as iekaisumu. Fimoze var b\u016bt ur\u012bna nesatur\u0113\u0161anas iemesls. Smegmas (biezpienveida masa, kas sast\u0101v no atmiru\u0161\u0101m \u0101das \u0161\u016bn\u0101m, taukiem un bakt\u0113rij\u0101m) un ur\u012bna kr\u0101\u0161an\u0101s priek\u0161\u0101di\u0146as \u201cmais\u0101\u201d var izrais\u012bt dzimumlocek\u013ca galvi\u0146as iekaisumu (balan\u012btu), kas izveidojas vien\u0101 laik\u0101 ar ak\u016btu post\u012btu jeb priek\u0161\u0101di\u0146as iek\u0161\u0113j\u0101s lapas iekaisumu, radot dzimumlocek\u013ca galvi\u0146as un priek\u0161\u0101di\u0146as iek\u0161\u0113j\u0101s virsmas iekaisumu (balanopost\u012btu). \u0160ajos gad\u012bjumos gados jaunais pacients var s\u016bdz\u0113ties par past\u0101v\u012bgu niezi un s\u0101p\u0113m dzimumlocek\u013ca galvi\u0146as rajon\u0101. Tom\u0113r, \u0146emot v\u0113r\u0101, ka probl\u0113ma ir pietiekami int\u012bma, var b\u016bt situ\u0101cijas, kad b\u0113rns cie\u0161as l\u012bdz p\u0113d\u0113jam un neko nesaka vec\u0101kiem, t\u0101p\u0113c j\u0101\u0146em v\u0113r\u0101, ka ir j\u0101seko l\u012bdzi izmai\u0146\u0101m b\u0113rna \u0137ermen\u012b un j\u0101radina vi\u0146\u0161 run\u0101t par jebkur\u0101m, ar\u012b nepat\u012bkam\u0101m, izmai\u0146\u0101m, nekautr\u0113joties par to.<\/span><\/p>\n

    Reta, bet b\u012bstama komplik\u0101cija ir parafimoze\u00a0t\u0101 ir dzimumlocek\u013ca sa\u017e\u0146aug\u0161ana ar sa\u0161aurin\u0101tas priek\u0161\u0101das gredzenu (ja ir izdevies atbr\u012bvot dzimumlocek\u013ca galvi\u0146u), kas rada dzimumlocek\u013ca asinsrites trauc\u0113jumus, t\u0101p\u0113c var notikt dzimumlocek\u013ca galvi\u0146as atmir\u0161ana. Parafimozi var\u0113tu defin\u0113t k\u0101 pret\u0113ju st\u0101vokli fimozei. Parafimozes gad\u012bjum\u0101 ir nepiecie\u0161ama neatliekama medic\u012bnisk\u0101 pal\u012bdz\u012bba, jo tas ir ak\u016bts st\u0101voklis (4. att\u0113ls).<\/span><\/p>\n

    Vec\u0101kiem b\u0113rniem fimoze var izrais\u012bt s\u0101p\u012bgu erekciju un attiec\u012bgi noteiktus kompleksus un trauksmi par to.<\/span><\/p>\n

    \"\"<\/p>\n

    4. att\u0113ls. Parafimoze\u00a0<\/em><\/p>\n

    Diagnostika<\/strong><\/span><\/h5>\n

    Diagnostika ir sal\u012bdzino\u0161i vienk\u0101r\u0161a \u2013 pietiek ar dzimumlocek\u013ca apskati un priek\u0161\u0101das atvilk\u0161anu. Fimozes gad\u012bjum\u0101 priek\u0161\u0101da urin\u0113\u0161anas laik\u0101 var piep\u016bsties, t\u0101p\u0113c diagnostic\u0113t var pal\u012bdz\u0113t ar\u012b ur\u012bna str\u016bklas nov\u0113rt\u0113jums. Ur\u012bna str\u016bkla b\u016bs \u0161aura, pacients urin\u0113s ar p\u0101rtraukumiem. Diagnostikas etap\u0101 \u013coti b\u016btiska ir vec\u0101ku un \u0123imenes \u0101rsta sadarb\u012bba. V\u0113l b\u016btisk\u0101ka ir t\u0113va loma aug\u0161anas proces\u0101, jo tie\u0161i t\u0113vs \u2013 z\u0113na autorit\u0101te \u2013 var\u0113tu b\u016bt tas cilv\u0113ks, kur\u0161 iedro\u0161in\u0101s z\u0113nu nebaid\u012bties un run\u0101t par sav\u0101m izj\u016bt\u0101m noteiktu probl\u0113mu gad\u012bjum\u0101. J\u0101saprot, ka b\u0113rnam nav j\u0101rauj nost bikses pie katras iesp\u0113jas, tom\u0113r vi\u0146\u0161 ir j\u0101izgl\u012bto un p\u0113c iesp\u0113jas j\u0101veicina tas, ka vi\u0146\u0161 nekautr\u0113jas run\u0101t ar vec\u0101kiem par tik int\u012bm\u0101m liet\u0101m. Iesp\u0113jams, vec\u0101ki jau ir paman\u012bju\u0161i k\u0101das z\u0113na probl\u0113mas ar ur\u012bna str\u016bklu vai priek\u0161\u0101di\u0146u, kura neatvelkas. T\u0101d\u0101s situ\u0101cij\u0101s b\u016btu j\u0101v\u0113r\u0161as pie sava \u0123imenes \u0101rsta, lai var\u0113tu nov\u0113rt\u0113t situ\u0101ciju un saprast, vai ir k\u0101das novirzes no normas, un neskaidr\u012bbu gad\u012bjum\u0101 \u0123imenes \u0101rsts var\u0113tu nos\u016bt\u012bt mazo pacientu t\u0101l\u0101k pie b\u0113rnu \u0137irurga vai urologa. Praks\u0113 diem\u017e\u0113l var nov\u0113rot, ka uz pie\u0146em\u0161anu ierodas jauns pacients, kur\u0161 jau ir sasniedzis pubert\u0101tes vecumu un kuram ir att\u012bst\u012bjies hronisks balan\u012bts, kas pier\u0101da to, ka sadarb\u012bbas posm\u0101 ir radies k\u0101ds caurums, kura d\u0113\u013c ne vec\u0101ki, ne ar\u012b \u0123imenes \u0101rsts \u0161o probl\u0113mu nav paman\u012bju\u0161i.<\/span><\/p>\n

    Profilakse<\/strong><\/span><\/h4>\n

    B\u016btisk\u0101kais ir iev\u0113rot person\u012bgo higi\u0113nu, kas sev\u012b ietver priek\u0161\u0101das atvilk\u0161anu un apmazg\u0101\u0161anos. Priek\u0161\u0101di\u0146as atvilk\u0161anai ir j\u0101b\u016bt nes\u0101p\u012bgai un bez diskomforta. Ja process rada s\u0101pes, tas ir j\u0101p\u0101rtrauc, jo past\u0101v risks, ka, atvelkot priek\u0161\u0101di\u0146u ar sp\u0113ku, var veidoties mazi, mikroskopiski pl\u012bsumi, kas dz\u012b\u0161anas laik\u0101 veido nelielas r\u0113tas, kuras ir neelast\u012bgas un laika gait\u0101 var rad\u012bt pret\u0113ju efektu \u2013 problem\u0101tisku priek\u0161\u0101di\u0146as atvilk\u0161anu. T\u0101pat, iev\u0113rojot vecuma interv\u0101lu \u2013 z\u0113nam augot, priek\u0161\u0101di\u0146a k\u013c\u016bst br\u012bv\u0101ka un viegl\u0101k kustin\u0101ma, savuk\u0101rt 2\u20133 gadu vecum\u0101 p\u0101rsl\u012bd p\u0101ri dzimumlocek\u013ca galvi\u0146ai.<\/span><\/p>\n

    Laika gait\u0101 z\u0113ns s\u0101ks iepaz\u012bt savu \u0137ermeni un, visdr\u012bz\u0101k, uzskat\u012bs savu dzimumlocekli par rota\u013clietu, l\u012bdz ar to ar\u012b pastiprin\u0101ti to aiztiks, piem\u0113ram, ejot mazg\u0101ties. Tas veicin\u0101s priek\u0161\u0101di\u0146as turpm\u0101ku stiep\u0161anos. V\u0113lams b\u0113rni\u0146am paskaidrot, kas tas ir, un mazg\u0101\u0161an\u0101s laik\u0101 iedro\u0161in\u0101t vi\u0146u priek\u0161\u0101di\u0146u atvilkt.<\/span><\/p>\n

    \"\"<\/p>\n

    5. att\u0113ls. Smegma\u00a0<\/em><\/p>\n

    \u0100rst\u0113\u0161ana<\/strong><\/span><\/h4>\n

    \u0100rst\u0113\u0161ana bez simptomiem nav nepiecie\u0161ama. Ja z\u0113nam pieaugot fimoze nesamazin\u0101s, ir gr\u016bt\u012bbas veikt person\u012bgo higi\u0113nu vai ar\u012b par\u0101d\u0101s simptomi, kas ietekm\u0113 dz\u012bves kvalit\u0101ti, tad noteikti b\u016btu j\u0101v\u0113r\u0161as pie \u0101rsta, lai izv\u0113rt\u0113tu situ\u0101ciju un piem\u0113rotu pacientam nepiecie\u0161amo \u0101rst\u0113\u0161anas terapiju.<\/span><\/p>\n

    \u0100rst\u0113\u0161ana balst\u0101s uz vair\u0101kiem metod\u0113m:<\/span><\/p>\n

      \n
    1. uzman\u012bga, regul\u0101ra priek\u0161\u0101di\u0146as atvilk\u0161ana,<\/span><\/li>\n
    2. lok\u0101la kortikostero\u012bdu ziedes lieto\u0161ana, piem\u0113ram, 2,5% hidrokortizons, 0,5% betametazons un 0,01% triamcinolons,<\/span><\/li>\n
    3. dorsumc\u012bzija (priek\u0161\u0101di\u0146\u0101 veic iegriezumu, lai to papla\u0161in\u0101tu).<\/span><\/li>\n
    4. cirkumc\u012bzija (priek\u0161\u0101das apgraiz\u012b\u0161ana),<\/span><\/li>\n<\/ol>\n

      Absol\u016bt\u0101 indik\u0101cija cirkumc\u012bzijai \u2013 patolo\u0123iska fimoze. Oper\u0101cija tiek veikta visp\u0101r\u0113j\u0101 narkoz\u0113.<\/span><\/p>\n

      Risinot probl\u0113mas, kuras saist\u012btas ar b\u0113rna vesel\u012bbu, nepiecie\u0161ama laba savstarp\u0113ja sadarb\u012bba starp \u0123imenes \u0101rstu un b\u0113rna vec\u0101kiem, jo tie\u0161i vec\u0101ki ir tie, kuri pirmie iev\u0113ros jebkuras izmai\u0146as b\u0113rna \u0137ermen\u012b. Tom\u0113r, lai \u0161\u012b sadarb\u012bba veidotos, tie\u0161i \u0123imenes \u0101rstam b\u016btu j\u0101b\u016bt tam cilv\u0113kam, kur\u0161 vec\u0101kus izgl\u012btos un sniegs rekomend\u0101cijas par b\u0113rna \u0137erme\u0146a anatomiju un fiziolo\u0123iju. Tikai kop\u012bgiem sp\u0113kiem ir iesp\u0113jams sasniegt lab\u0101ko rezult\u0101tu.<\/span><\/p>\n

      Foto: Priv\u0101ts arh\u012bvs, Shutterstock<\/p>\n

      Rakstu lasiet “\u0100rsts.lv” 2021. gada maija numur\u0101!<\/strong><\/p>\n

      P\u0101rpublic\u0113\u0161ana saska\u0146ota ar port\u0101la redakciju.<\/strong><\/p>\n

      <\/p>","tags":[],"cust_order":"9920210803","acf_order":null}