Increased residual urine volume in the bladder

Introduction Residual urine measurement is one of the important diagnostic tools for benign prostatic hyperplasia. Due to prostatic hyperplasia, the patient has difficulty urinating. As the obstruction increases, the urine in the bladder cannot be completely emptied during each urination and remains in the bladder. These urine remaining in the bladder are called "residual urine." The appearance and amount of residual urine reflect the urinary dysfunction of the bladder. In the process of diagnosis and treatment of benign prostatic hyperplasia, the determination of residual urine is an indispensable step. There are three methods for determination: transabdominal B-ultrasound, guide Urine and intravenous urography.

Cause

The cause is unknown and may be related to hormonal changes caused by age. Multiple fibrous adenoma-like nodules that appear in the area around the prostatic urethra may originate from the glands surrounding the urethra, rather than in the true fibromuscular prostate (surgical envelope), which is squeezed aside by growing nodules . Hyperplasia may involve the prostate lateral wall (lateral lobular hyperplasia) or the bladder neck lower margin tissue (middle lobular hyperplasia). Histologically, the tissue is glandular with a different proportion of fibrous matrix.

When the urethral lumen of the prostate is damaged, the urine outflow is gradually blocked, and there is a bladder detrusor hypertrophy, trabecular formation, small chamber formation and diverticulum. Bladder emptying does not completely cause urinary siltation, infection is easy, and there are secondary inflammatory changes in the bladder and upper urinary tract. Urinary siltation is easy to form stones. Long-term obstruction, even incomplete obstruction, can cause hydronephrosis and impair kidney function.

an examination

Related inspection

Urine routine urine volume urinary flow rate determination of vesicoureteral reflux imaging

1. Physical examination: If the patient is weak, pale, lethargic, high blood pressure, fast pulse, and deep breathing, the possibility of uremia should be considered. Abdominal examination may reveal an enlarged kidney with tenderness of the rib angle, indicating that hydronephrosis has been secondary. The pubic bone should be examined for inflated bladder. The bladder surface of the urinary retention is smooth, soft, and no nodular. Patients with a long history must pay attention to whether there is a combination of cancer, hemorrhoids, stenosis of the foreskin, and normal urethra.

Digital rectal examination: First understand the anal sphincter tension, the anal canal relaxation should be thought of the neurogenic bladder. The prostate enlarges, the middle groove disappears, the surface is smooth, and the hyperplastic nodules seen by histology are usually no nodular changes due to the pseudo-envelope formed by the outer peripheral zone. The enlargement of the two sides of the prostate can be asymmetrical. If the enlarged part of the prostate protrudes into the bladder, the rectal examination may not reach the upper edge of the prostate. The texture of the prostate can be softer or harder, depending on the proportion of glandular components and fiber smooth muscle. If the prostate enlarges irregularly, there are nodules and even hard as stones, the possibility of prostate cancer should be considered. During the physical examination, the ball sponge muscle reflex, lower limb movement and perception should be monitored for normality, and possible neuropathy is found.

2. Perform blood and urine tests to assess the patient's kidney function and to rule out the possibility of urinary tract infections. Because infections in the male reproductive system or any part of the urinary system can cause dysuria, some symptoms of benign prostatic hyperplasia resemble prostatitis, which can easily lead to misdiagnosis.

3. Ultrasound examination (also used for the diagnosis of prostate cancer) can monitor the size of the prostate for the patient. In addition, through a pressure-sensitive sensing device, the doctor can measure the urinary flow force when the patient urinates urinarily. The decrease in urinary flow force often indicates that the patient may have benign prostatic hyperplasia.

4. Renal angiography (intravenous injection of contrast agent for urinary X-ray examination) is mainly used for the diagnosis of kidney and ureteral diseases, but it also has a certain diagnostic value for benign prostatic hyperplasia. Through pyelography, the doctor can find out whether the patient has occlusion or abnormal stenosis in the entire urinary tract. Prostate urethral stricture will highly suggest the presence of benign prostatic hyperplasia.

5. Through cystoscopy, we can directly find the stenosis or blockage in the patient's urethra. Before performing cystoscopy, we should first inject a certain amount of anesthetic into the urethra through the urethral orifice, and then insert the probe with the probe into the patient's urethra, so that we can search for the stenosis in the patient's urethra through the monitor. .

Differential diagnosis

Differential diagnosis

Bladder capacity reduction: Bladder capacity refers to the amount of urine in the bladder when there is urinary urgency and urgency. Under normal circumstances, the amount of urine discharged at one time is the bladder capacity. Residual urine refers to the amount of residual urine that cannot be discharged from the bladder after urination. When there is residual urine, the amount of urine discharged is not equal to the bladder capacity. At this time, the bladder capacity = the amount of urine discharged at one time. The normal bladder has a capacity of about 400 m1. When the bladder is inflamed, the bladder capacity is below 200 m1. The capacity of tuberculous bladder can be as small as 10m1.

Bladder emptying: Normal adult males have a volume of about 250 ml when they are full, and about 300 ml for women; after urine, they should be below 10%. If the urinary function is abnormal, resulting in excessive residual urine, or even unable to urinate at all, it is urinary retention. According to the emergency of symptoms, it can be divided into acute and chronic urinary retention. There are symptoms of urination.

Acute urinary retention: Suddenly unable to urinate at all, the bladder continues to rise and must be catheterized immediately. For example, maternal occasional urinary retention after childbirth, indwelling the catheter for one to two weeks to reclamation. Another example is patients with benign prostatic hyperplasia. It is very difficult to urinate. If you take drugs that affect bladder contraction (such as anti-histamines commonly used in colds and nasal congestion), it may cause bladder strikes. Some patients are also blocked because of nerve pathways, such as stroke or sacral injury.

diagnosis

1. Physical examination: If the patient is weak, pale, lethargic, high blood pressure, fast pulse, and deep breathing, the possibility of uremia should be considered. Abdominal examination may reveal an enlarged kidney with tenderness of the rib angle, indicating that hydronephrosis has been secondary. The pubic bone should be examined for inflated bladder. The bladder surface of the urinary retention is smooth, soft, and no nodular. Patients with a long history must pay attention to whether there is a combination of cancer, hemorrhoids, stenosis of the foreskin, and normal urethra.

Digital rectal examination: First understand the anal sphincter tension, the anal canal relaxation should be thought of the neurogenic bladder. The prostate enlarges, the middle groove disappears, the surface is smooth, and the hyperplastic nodules seen by histology are usually no nodular changes due to the pseudo-envelope formed by the outer peripheral zone. The enlargement of the two sides of the prostate can be asymmetrical. If the enlarged part of the prostate protrudes into the bladder, the rectal examination may not reach the upper edge of the prostate. The texture of the prostate can be softer or harder, depending on the proportion of glandular components and fiber smooth muscle. If the prostate enlarges irregularly, there are nodules and even hard as stones, the possibility of prostate cancer should be considered. During the physical examination, the ball sponge muscle reflex, lower limb movement and perception should be monitored for normality, and possible neuropathy is found.

2. Perform blood and urine tests to assess the patient's kidney function and to rule out the possibility of urinary tract infections. Because infections in the male reproductive system or any part of the urinary system can cause dysuria, some symptoms of benign prostatic hyperplasia resemble prostatitis, which can easily lead to misdiagnosis.

3. Ultrasound examination (also used for the diagnosis of prostate cancer) can monitor the size of the prostate for the patient. In addition, through a pressure-sensitive sensing device, the doctor can measure the urinary flow force when the patient urinates urinarily. The decrease in urinary flow force often indicates that the patient may have benign prostatic hyperplasia.

4. Renal angiography (intravenous injection of contrast agent for urinary X-ray examination) is mainly used for the diagnosis of kidney and ureteral diseases, but it also has a certain diagnostic value for benign prostatic hyperplasia. Through pyelography, the doctor can find out whether the patient has occlusion or abnormal stenosis in the entire urinary tract. Prostate urethral stricture will highly suggest the presence of benign prostatic hyperplasia.

5. Through cystoscopy, we can directly find the stenosis or blockage in the patient's urethra. Before performing cystoscopy, we should first inject a certain amount of anesthetic into the urethra through the urethral orifice, and then insert the probe with the probe into the patient's urethra, so that we can search for the stenosis in the patient's urethra through the monitor. .

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