Bladder neck Y-V plasty

Severe bladder neck obstruction is ineffective with transurethral resection of the bladder neck, often combined with bladder neck wedge resection. Treatment of diseases: bladder neck obstruction in elderly women with bladder neck obstruction Indication Severe bladder neck obstruction is ineffective with transurethral resection of the bladder neck, often combined with bladder neck wedge resection. Contraindications (1) bladder neck obstruction complicated by severe urinary tract infection. (2) bladder neck obstruction complicated by severe renal insufficiency. The above two points are relative contraindications, and surgery should be performed after the condition is improved. Preoperative preparation 1, concurrent urinary tract infection should be placed in the catheter to drain urine, and systemic and topical application of antibiotics to control infection. 2, complicated renal insufficiency should be placed in the catheter to drain urine, until the renal function is restored before surgery. Surgical procedure (1) Incision: a midline incision in the lower abdomen. (2) Free bladder neck: lower the patient's head, press the bladder down and hold it by hand, free the posterior pubic space, fully expose the bladder neck, and continue to free the front of the bladder neck. (3) Incision of the bladder neck: The prostate (male) or urethral (female) anterior wall about 1 cm distal to the bladder neck is marked with a No. 4 silk suture. In the proximal side of the marker point to the bladder neck, the anterior wall of the bladder is inverted Y-shaped, each arm is 2~3cm long, and the angle of intersection is just above the bladder neck. The bleeding point is sutured or electrocoagulated to stop bleeding. The bladder cavity and neck are exposed, and if the posterior lip is raised, a wedge-shaped resection is performed. If the neck of the bladder is only narrowed in a ring shape, it will be cut longitudinally. (4) Bladder neck suture: The inverted V-shaped bladder flap was sutured to the distal edge of the incision with a 2-0 absorbable line. Then, the bladder neck is sequentially inverted V-shaped. The marker line is sutured to the tip of the bladder flap in a second layer, and the suture does not pass through the mucosa. Suture with thread 1 in sequence. (5) Bladder stoma or transurethral indwelling balloon catheter: If the bladder stoma is performed, the flap is placed under the peritoneal reflex of the anterior wall of the bladder, and the F26 sputum catheter is placed. The needle-forming tube is fixed by sewing a needle with a 2-0 absorbable line at the upper and lower sides of the tube. 150 ml of isotonic saline was injected into the bladder to observe whether there was leakage in the bladder neck. If the bladder stoma is not available, the balloon catheter is placed through the urethra. (6) Place drainage: After flushing the wound, a rubber tube is placed in the posterior pubic space for drainage. The abdominal incision is sutured layer by layer. The skin suture is used to fix the bladder stoma. complication (1) Bleeding: When performing this operation, due to the rich blood circulation of the bladder neck and prostate, there are more venous plexus, so the bladder neck incision is more bleeding, and the surgical field is deeper, showing poor, and it is difficult to suture and stop bleeding. Electrocoagulation stops bleeding. The bleeding usually stops after the incision is sutured. If there is still bleeding, the balloon can be placed into the balloon catheter through the urethra, and the balloon can be inflated and pulled to suppress hemostasis. (2) Leakage: The main reason is that the bladder neck is not tightly sutured and the healing is poor after secondary infection. The precautionary measure is that the bladder neck needs to be tightly sutured and strengthened against infection. In order to maintain the bladder ostomy tube or indwelling catheter, the application of effective antibiotics, the wound can heal more, and the leakage of urine will stop by itself. (3) Wound infection: mainly due to the existence of urinary tract infection before the patient, and the preparation is not sufficient. Prevention is to take preoperative anti-infective measures. The treatment is to keep the circulation smooth and strengthen the application of antibiotics.