Bladder neck obstruction in women
Introduction
Introduction Female bladder neck obstruction is also known as bladder neck sclerosis (or Marion disease). The etiology and pathogenesis are complicated. At present, there is still a lack of unified understanding, which may be bladder neck fibrosis, bladder neck muscle hypertrophy, sclerosis caused by chronic inflammation, and glandular hyperplasia caused by imbalance of hormone balance in elderly women. Bladder neck obstruction is severely caused by dysuria or even urinary retention, which can cause hydronephrosis in the long term and produce the same symptoms and results as male prostate hyperplasia.
Cause
Cause
(1) Causes of the disease
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.
(two) 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.
Examine
an examination
Related inspection
Urine routine cystoscopy renal function test
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 urinary 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.
Diagnosis
Differential diagnosis
Urethral stricture
More history of urethritis and urethral trauma. Transvaginal examination can not touch the hypertrophic bladder neck tissue. Urethral angiography shows urethral stricture. Imaging urodynamics showed that the maximum urinary flow rate was prolonged at a low level, and the bladder neck was open when the urinary flow rate was close to maximum.
2. Neurogenic bladder
Both have dysuria, urinary retention, renal ureteral hydrops, and renal dysfunction. However, patients with neurogenic bladder are often associated with neurological disorders, often with bilateral lower extremity dyskinesia. The rectal finger showed anal sphincter relaxation. When increasing abdominal pressure to urinate, the urine flow can be lined up. Insertion of the catheter or urethral dilation can be successfully passed. The urodynamic examination showed no reflex of the bladder detrusor, and the pressure curve was a horizontal line.
3. Female urethral syndrome
More common in married young and middle-aged women. There are frequent urination, urgency, and dysuria symptoms, and some patients have difficulty urinating. Mucosal edema, urethral secretions can be seen at the outer urethra, and sometimes urethral meat mites, urethra hymen fusion and hymen umbrella can be seen. Urodynamic examination showed overactive bladder, bladder weakness, distal urethral constriction, and increased urethral pressure.
4. Urinary polyps
Larger urinary tract polyps, obstructing the urethra and causing dysuria. Both need to be identified. Urethral polyps often show a purplish red mass outside the urethra. The observation of the urethra is more obvious. A biopsy can confirm the diagnosis. There is a sense of blockage when the urethra expands. Cystoscopy showed no elevation of the bladder neck, no hypertrophy of the neck tissue.
5. Urethral stones
Have difficulty urinating. There is often a history of sudden urination or obstruction of urinary flow. The urethral X-ray film has an opaque shadow, and the vaginal palpation can touch the stone on the anterior wall of the vagina. When the urethra is dilated, it can touch stones, and it has a feeling of blocking or rubbing with stones.
