cystocele
Introduction
Introduction to bladder bulging Bladder bulging refers to a type of female reproductive system injury, and the bladder bulges toward the anterior wall of the vagina. The most common cause is that the birth injury causes damage to the pelvic floor fascia and muscles that maintain the normal position of the bladder and is not repaired in time. In severe cases, the urethra also bulges. Light asymptomatic, severe cases often feel backache, consciously have something from the vagina, the tumor will shrink after urination. Often accompanied by dysuria and urinary sensation. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: Bladder dysplasia and hypoplasia Repeated bladder Bladder diverticula Bladder valgus
Cause
Bladder bulging cause
Childbirth factor (50%):
Bladder bulging occurs mainly during the delivery process. When the fetal head passes through the vagina, the bladder fascia of the pubic bladder and the anterior wall of the vagina are overstretched and even torn. Especially in the second stage of labor due to the opening of the cervix, bladder filling, childbirth or vaginal surgery, such as forceps, fetal head aspiration, breech traction, etc. can aggravate the supporting tissue at the bottom of the bladder.
Premature labor factor (38%):
The supporting tissue of the anterior vaginal wall is mainly the cervical fascia of the pubic bladder. The puerperal period is too early to participate in manual labor, so that the vaginal support tissue cannot return to normal. Therefore, bladder bulging often occurs in women who are maternal, and unmarried women are extremely rare.
Prevention
Bladder bulging prevention
Delivery should be handled correctly. Where the head basin is not called early cesarean section, the uterus is not open when the whole woman is not allowed to force down the breath, when the cervix has been opened all the time in the perineal incision, if necessary, the surgical midwifery ends the delivery to avoid the second stage of labor Prolonged, if the perineal tear occurs, it should be repaired immediately, avoiding premature physical labor after childbirth, and postpartum health exercises can help restore the pelvic floor muscles and fascia tension.
Complication
Bladder bulging complications Complications Bladder dysplasia and hypoplasia repeat bladder bladder diverticulum bladder valgus
(1) Bladder dysplasia and hypoplasia
Bladder development is often accompanied by renal dysplasia, so there are few survivors, and a group of 19,046 cases of autopsy data have 7 cases. There are 25 cases in the literature. Bladder hypoplasia means retention of the cloaca, which is caused by the separation of the urinary rectal septum. The ureter terminates in the rectum.
(two) repeated bladder
As a result of embryonic developmental disorders, a portion of the embryo's tail is caused by a pair of births, often accompanied by a repeat of the hindgut. Can be divided into left and right, front and rear or upper and lower bladder, gourd-shaped or multi-atrial bladder. A group of 18 patients with 50% had a lower gastrointestinal repeat deformity, and a group of 20 patients with a posterior intestinal repeat deformity had a repeat bladder. The incidence of genital recurrence is also high. Urinary tract obstruction and infection symptoms can occur, after a thorough examination, according to the bladder disease and other organs congenital anomalies specific treatment plans, including the removal of urinary tract obstruction, retention of bladder function, external genital plastic surgery and correction digestion Road deformity and so on.
(three) bladder diverticulum
Because of the confines weakness of the congenital bladder wall, there is an obstruction factor in the lower urinary tract during the fetal period, which causes the intravesical pressure to rise, which causes the bladder wall to protrude from the separated detrusor bundle to form a diverticulum. However, there are also anatomical obstructions in the bladder neck and urethra. Therefore, its formation is related to the abnormal arrangement of bladder muscle fibers. More common in men, often single, mostly located near the ureteral orifice. After the diverticulum is formed, each time it urinates, it fills and gradually increases. After a long period of time, the ureter is brought into the sputum, and the ureteral submucosa and interwall segments of the oblique ureter disappear and the ureteral reflux occurs. The bladder diverticulum is often found for further urinary examination due to urinary tract infection or dysuria. The diagnosis relies mainly on urography, which can show the shape and location of the bladder diverticulum. If necessary, supplemented with cystoscopy. Treatment is mainly to relieve lower urinary tract obstruction, control infection, use diverticulum resection, or add anti-reflux ureteral bladder re-anastomosis.
(four) bladder valgus
Bladder valgus urethral fissure complex malformation is caused by abnormal development at the 4th to 10th week of the embryo. Due to the excessive development of the cloaca membrane, the migration of the interstitial tissue and the normal development of the inferior abdominal wall are prevented, and the time and location of the cloaca membrane perforation are different, resulting in a series of malformations ranging from glans urethra to cloaca eversion. Bladder valgus is only a part of this type of malformation, accounting for about 50%, the incidence rate is about 1 / 1 ~ 50,000 in the birth of a baby, twice more men than women, the risk of valgus in their offspring The normal population is 500 times higher, but the genetic type has not yet been determined.
Symptom
Bladder bulging symptoms Common symptoms Poor urination, backache, incontinence, vulva
Light can be asymptomatic, or have a slight sense of falling, backache, aggravation after a long time, and shrink after bed rest. In addition to the sense of falling, the severe person often has difficulty in urinating, and often has more residual urine, and more complicated urinary tract infections, such as urethral sphincter relaxation, can increase the abdominal pressure in the case of laughing, coughing, exerting force, etc. There is urine overflow, called tension incontinence.
I degree means that the bulged bladder is still in the vagina and moves down from the normal anatomy.
II degree means that the bladder bulge is exposed outside the vaginal opening when force is applied.
III degree means that the bulging part of the bladder is exposed outside the vaginal opening at rest.
IV degree means that the anterior wall of the vagina completely bulges out of the vaginal opening, even beyond the labia majora.
Examine
Examination of bladder bulging
Vaginal palpation, colposcopy, transvaginal ultrasound.
Colposcopy is the use of a microscope that magnifies the cervix or genital epidermal tissue, combined with the role of the light source and the filter, to clearly examine the cervix and genitals, so that the doctor can observe changes in the cervical epithelium and blood vessels to diagnose whether there is abnormality. Produce lesions and determine the severity of the lesion.
Diagnosis
Diagnosis of bladder bulging
diagnosis
Mainly rely on vaginal inspection and palpation. The vaginal opening is wide when inspected, accompanied by old perineal laceration. Vaginal mouth protrusions may increase during breath holding. At the time of palpation, the protruding mass is the anterior vaginal wall, soft and the boundary is unclear. If a metal catheter is inserted into the bladder of the urethra, the metal catheter can be touched in the narrowed mass, which can be diagnosed as bulging of the bladder or urethra, and may also exclude other masses in the vagina, such as submucosal uterine fibroids, vagina. Wall cysts, vaginal fistula, hypertrophy of the cervix and uterine prolapse (can exist simultaneously).
Need to be differentiated from the following diseases
(a) vaginal anterior wall tumor
The tumor can make the anterior wall of the vagina prominent, much like vaginal prolapse and bladder bulging. During gynecological examination, the tumor can be cystic or solid, with a certain degree of tension. The boundary of the tumor is clear, does not increase with the increase of abdominal pressure, and is not easy to be returned to the vagina. When the bladder bulges, the bulge is soft and has no clear boundary and increases with increasing abdominal pressure. It can be returned to the original position when pushed by hand. When a metal catheter is inserted into the bladder for examination, the catheter cannot enter the mass.
(two) uterine prolapse
Often there is vulva or vaginal bulging sensation, something protruding from the vagina, standing for a long time, labor aggravation, bed rest, the symptoms disappear. Gynecological examination can be seen in the center of the lower end of the prolapse, the probe can penetrate into the uterine cavity through this hole. The bladder is swollen out of the protrusion to reach the cervix, and the uterus is in a normal position.
(3) Tension urinary incontinence
The disease has similar symptoms to bladder bulging, but the pathogenesis of the two is completely different and can coexist. In bladder urethrography, tension urinary incontinence manifests as the disappearance of the posterior urethra and the urethral tilt angle is greater than normal. When the bladder bulges, the urethral tilt angle and the posterior urethral angle are within the normal range.
(4) hymen atresia
Early asymptomatic, periodic abdominal pain after puberty, and urinary retention. The gynecological examination showed that the hymen was bulging and it was purple-blue. The anus is diagnosed with a tense cystic mass in front of the rectum.
