Bladder neck obstruction in women
Introduction
Introduction to female bladder neck obstruction Female bladder neck obstruction (bladderneckobstruction), also known as bladder neck sclerosis (or Marion disease), the etiology, pathogenesis is complex, there is still a lack of unified understanding, may be bladder neck fibrous tissue hyperplasia, bladder neck muscle hypertrophy, chronic inflammation The hardening and the imbalance of hormonal glands around the urethra caused by the imbalance of hormones in the elderly women. The bladder neck obstruction is serious and causes dysuria or even urinary retention. It will cause hydronephrosis in the long term and produce the same symptoms and results as male prostate hyperplasia. basic knowledge The proportion of illness: 0.003% Susceptible people: middle-aged women Mode of infection: non-infectious Complications: kidney damage
Cause
Female bladder neck obstruction
Causes:
The cause of the disease is still inconclusive, and there are roughly the following observations: inflammation, non-inflammation or aging, fibrous tissue hardening of the sphincter and its adjacent tissues, long-term bladder neck; due to the formation of collagen in the structure of local tissues Fibroblasts are presumed to be connective tissue diseases; congenital malformations, especially bladder neck nerves, poor muscle structure: early nerve damage; vaginal, urethral, bladder neck surgery secondary to bladder neck sclerosis.
Pathogenesis:
The pathological changes of female bladder neck obstruction are more complicated, mainly as follows:
1. In many cases, the specimen of bladder neck resection has smooth muscle fiber hypertrophy, resulting in muscle hypertrophy at the inner mouth, similar to congenital pyloric hypertrophy.
2. Bodian et al found that the smooth muscle tissue of the bladder neck was largely replaced by elastic fiber tissue, and there was hyperplasia of fibrous elastic tissue.
3. In some cases of bladder neck pathological sections, hyperplastic glands can be seen. Morphologically, these glands are very similar to the male prostate.
4. Submucosal inflammatory infiltration and edema thickening in the bladder neck, and a large proportion of squamous metaplasia.
Prevention
Female bladder neck obstruction prevention
The disease occurs mostly in middle-aged and elderly women, and may be associated with decreased estrogen levels and reduced urethral vaginal epithelial atrophy resistance. Therefore, a small amount of long-acting estrogen should be taken for a long time. Pay attention to the cleansing of the perineum. The depth of the posterior lip of the bladder neck should be cut to the level of the triangle. Avoid excessive electrocautery to avoid post-surgical scarring. Do not cut the neck sphincter too deeply. Urinary incontinence, regular urethra expansion after surgery until the urinary line is coarse and stable.
Complication
Female bladder neck obstruction complications Complications kidney damage
If the obstruction of the neck of the bladder is not diagnosed and properly treated, it may cause the upper urinary tract to expand and accumulate water and affect the kidney function. The severe or combined infection may cause serious damage to renal function damage.
Symptom
Female bladder neck obstruction symptoms Common symptoms Urinary dysfunction dysuria and urinary retention urinary incontinence Urinary flow thinning or interrupted urination is not smooth Postpartum urination frequency or...
1. Symptoms: mainly for progressive dysuria, manifested as delayed urination, fine urine flow, urinary dying, urine drip, and gradually appear residual urine, urinary retention and overflow incontinence.
2. Palpation of the bladder neck: The neck of the bladder can be felt through the vagina, and the neck tissue can be thickened to varying degrees. Especially when the catheter is indwelled in the urethra, the thickening of the neck tissue is more obvious.
Women with middle-aged or older patients with unexplained dysuria should consider bladder neck sclerosis and should be further examined.
Examine
Female bladder neck obstruction
1. Urine routine: visible white blood cells or pus cells.
2. Renal function test and blood biochemical examination: If the kidney function is obviously impaired, there will be azotemia (blood non-protein nitrogen, urea nitrogen, creatinine, etc.), so the examination can not reveal the renal damage, phenol The red (phenol sulfon phthalein PSP) excretion test can promptly remind the hydronephrosis and renal function. Patients who have suffered damage to the kidney should also measure the binding of potassium, sodium, chlorine and carbon dioxide to determine the presence or absence of electrolytes. Balance imbalance, with or without acidosis.
3. Cystoscopy: is the most important and most intuitive method of examination. Under the microscope, the bladder neck mucosa is stiff and edematous, the posterior lip is elevated, the neck is contracted, the open movement is weakened or disappeared, and the trabecular, small chamber and ureter are visible in the bladder. Chronic obstructive changes such as bulging.
4. Urinary bladder urethra angiography: visible bladder neck stiffness, during the urination process, the neck is open or incomplete, neck narrow, and the bladder wall is uneven, and sometimes diverticulum formation.
5. Residual urine measurement: According to the amount of residual urine to determine the degree of obstruction, choose effective treatment, but also can be used to observe the effect of treatment.
6. Urodynamic examination: In the early stage of obstruction, the intravesical pressure during urination is higher than normal, and the maximum urinary flow rate is normal. When the obstruction is further aggravated and the detrusor decompensation, the intravesical pressure during urination can be reduced to normal. There was residual urine, and the maximum urinary flow rate was reduced. The imaging urodynamics showed that the synchronous image showed a poor openness of the bladder neck when the urine flow rate was close to the maximum.
Diagnosis
Diagnosis and diagnosis of female bladder neck obstruction
1. Urethral stenosis: more history of urethritis and urethral trauma, vaginal examination can not touch the hypertrophic bladder neck tissue, urethra urethral urethral stricture, imaging urodynamics showed that the maximum urinary flow rate is prolonged, urine flow When the rate is close to the maximum, the bladder neck is open.
2. Neurogenic bladder: Both have dysuria, urinary retention, renal ureteral hydrops, renal dysfunction, but patients with neurogenic bladder are often associated with neurological disorders, often with lower extremity dyskinesia, digital rectal examination The anal sphincter relaxation is shown. When the abdominal pressure is increased, the urine flow can be lined up, the catheter can be inserted into the catheter or the urethral dilation can pass smoothly, and the urodynamic examination shows that the bladder detrusor has no reflection, and the pressure measurement curve is a horizontal line.
3. Female urethral syndrome: more common in married young and middle-aged women, frequent urination, urgency, urinary pain symptoms, some patients have dysuria, mucosal edema at the outer urethra, urethral secretions, and sometimes urethra meat Hemorrhoids, urethra hymen fusion and hymen umbrella, etc., urodynamic examination showed overactive bladder, bladder weakness, distal urethral constriction and increased urethral pressure.
4. Urinary polyps: relatively large urethral polyps, obstruction of the urethra caused by dysuria, both need to be identified, urethral polyps often seen in the urethra outside the mouth showed a purple-red mass, the urethral opening is more obvious, take the living tissue The examination can be clearly diagnosed, and there is a sense of blockage when the urethra is dilated. The cystoscopy shows that the bladder neck does not rise, and the neck tissue is not hypertrophic and hypertrophic.
5. Urinary calculi: dysuria, often have a history of dysuria or urinary obstruction, urethra X-ray film has opaque shadows, vaginal palpation examination can touch the stone in the anterior wall of the vagina, when the urethra expands Can touch the stone, have a sense of blocking or rubbing with the stone.
