Bladder and urethral foreign body
Introduction
Introduction to foreign body of bladder and urethra There are fewer foreign bodies in the urinary tract, and the lower urinary tract is more common. The lower urinary tract foreign body can be divided into bladder foreign body and urethral foreign body. Generally, metal or woody foreign matter left after gunshot wounds and other penetrating wounds can also be caused by human factors, such as non-absorbent sutures left after surgery, wires inserted from the outer urethra, plastic wires, ball refills, hairpins, etc. The foreign body stays in the bladder for a long time or a short period of time, up to several years, often secondary to infection and bladder stones. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: cystitis peritonitis
Cause
Bladder urethra foreign body etiology
Foreign body enters the bladder (35%):
(1) Foreign body is placed in the bladder by the urethra or by other people: It is the most common type of bladder foreign body by the urethra or by other people. The patient is in a manner of masturbation as a form of masturbation, and the foreign body is placed in the urethra and then enters. Bladder, some in order to achieve the purpose of abortion or to achieve the purpose of contraception, the foreign body into the bladder, mentally abnormal or drunk after the foreign body into the bladder through the urethra; very few people forcibly forcibly inserted foreign bodies into the urethra of others into the bladder .
(2) iatrogenic bladder foreign body: iatrogenic bladder foreign body system is introduced or left in the bladder during surgery or device examination, intracavitary examination or surgery during cystoscopy, etc., due to instrument quality or operation, etc. It remains in the bladder, and the double "J" tube is placed in the cavity for surgery. The stone wall is formed for a long time, so that the tube cannot be taken out.
(3) Foreign body enters the bladder through an open wound: Open bladder injury can bring foreign objects such as fabric, buttons and bone fragments into the bladder as a sequela of war wounds.
(4) foreign body migrated from the bladder into the bladder: the patient has a history of firearm injury, history of pelvic fracture, history of pelvic chronic osteomyelitis, open surgical history of femoral neck fracture, inflammatory adhesion of foreign body and bladder wall, causing bladder wall Erosion, rupture and foreign matter into the bladder, the female contraceptive ring also enters the bladder in this way.
(5) foreign matter enters the bladder from the intestine: the foreign body that enters the bladder from the intestine enters the bladder from the intestine of the intestine, and the foreign body is mostly undigested food or parasites, often with symptoms of gas and urine, causing guilt. Mostly tumors or tuberculosis.
Foreign body enters the urethra (30%):
(1) Placement through the external urethra: the most common route of entry into the urethra and bladder foreign body.
(2) Excretion through the bladder: Some foreign bodies can be discharged from the bladder into the urethra, which is stuck and cannot be discharged.
(3) Brought by surgery or open injury: such as unabsorbed silk thread, cotton ball for compression hemostasis, metal mesh stent placed by surgery, and infection.
Pathogenesis
Foreign body of the bladder and urethra can directly cause mechanical stimulation and injury of the bladder and urethra, infection of the urethra and its surrounding tissues, dysuria, hematuria, extravasation of urine, stones, bladder spasm or urethral fistula. Men have long urethra. And there are two natural bends, the foreign body is easy to stay without entering the bladder, the female urethra is short and straight, and the foreign body is easy to enter the bladder through the urethra.
Prevention
Bladder urethra foreign body prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Bladder urethra foreign body complications Complications cystitis peritonitis
1. Inflammation into the bladder of foreign bodies, such as short time, only 1 to 2 days to remove, generally no urinary tract infection symptoms, if a little longer, mechanical stimulation of the bladder mucosa, and the bacteria brought in Bladder inflammation, cystitis is the most common complication of foreign body in the bladder.
2. The foreign matter of the stone in the bladder can become the core of the stone. The salt crystals in the urine gradually deposit on the foreign body, forming stones in a long time. One patient with bladder stones in the elderly is found to be coiled in the stone when X-ray filming. The wire, the history of the disease was not inserted into the urethra three years ago, and another patient with vaginal vagina was exposed to the bladder with a chrome-intestinal suture. After half a year, the gut was formed with the gut. .
3. Perforated foreign body mechanically stimulates the bladder wall, forming an ulcer over a long period of time and penetrating the bladder to the peritoneal cavity, the space around the bladder, the rectum or the vagina, often causing vesicovaginal fistula, peri-bladder inflammation, peritonitis, etc. Schwartz (1931) has reported 1 For example, a crochet for weaving from the bladder to the peritoneal cavity causes peritoneal inflammation.
Symptom
Bladder urethra foreign body symptoms Common symptoms Urethral nodules dysuria dysuria Urinary bladder Bladder irritation Puriria Urinary incontinence Blood urinary urgency Urinary frequency abscess
History
The foreign body in the bladder area generally has a clear history of the introduction of foreign bodies into the urethra. The foreign body in the urethra is a urinary tract foreign body. When entering the bladder, it becomes a foreign body in the bladder. Individual patients have a history of masturbation or mental illness. There may also be a history of surgery in the bladder area.
2. Clinical symptoms
Symptoms vary with the nature, location, retention time, and complications of the foreign body. Early symptoms can be pain and dysuria. Hematuria can occur in patients with injury. Foreign bodies in the bladder can stimulate the bladder mucosa. Frequent urination occurs when infected. Urinary urgency, dysuria and other bladder irritation, pus can also occur, severe cases can be complicated by periurethral inflammation or periurethal abscess, and systemic and local infection symptoms, such as foreign body in the bladder neck or urethra, with foreign bodies as the core When stones are formed, it can cause dysuria or even urinary retention. When the stones are huge, there may even be symptoms of urinary incontinence and water in the upper urinary tract. Long-term stimulation of foreign bodies can induce cancerous changes in the bladder wall, and hematuria occurs. When the urinary tract is sputum, there may be feces, food residue, and gas discharge during urination.
3. Physical examination
Foreign bodies located in the anterior urethra can be seen in the outer urethra or touched on the body surface. The foreign body in the posterior urethra can be touched by the rectum. The double-diagnosis can touch the foreign body in the bladder (especially in women).
Examine
Examination of foreign bodies in the bladder and urethra
Urine examination may have pus cells and red blood cells, and the white blood cells in the blood of the infected person are increased.
1. Imaging examination B-ultrasound can be seen in the urethra, abnormal echo images in the bladder, KUB plain film and IVU can find the X-ray metal and other foreign objects in the urinary tract, because the foreign body stays in the bladder for too long The foreign body is the core to form the stone. In the KUB plain film and the IVU, the shadow of the stone can also be displayed. For those suspected of having a urinary tract digestive tract, the digestive tract angiography can be seen, and the fistula can be seen.
2. Urethral cystoscopy can clearly determine the shape and nature of foreign bodies, the damage and degree of foreign body damage to the bladder, and the formation of stones with foreign bodies as the core.
Diagnosis
Diagnosis and diagnosis of foreign body of bladder and urethra
Diagnostic criteria
If the patient can tell the medical history truthfully, the diagnosis is very easy, but many patients often conceal the history of the foreign body, or many falsehoods, because of various unwillingness to sue. Difficulties, usually after the urinary tract infection treatment is invalid and after cystoscopy or X-ray filming, it is not uncommon to confirm the diagnosis. Therefore, if there is doubt about the diagnosis, the medical history should be further pursued. If necessary, the bladder should be performed. Mirror or X-ray film inspection.
Differential diagnosis
1. Bladder stones are mainly to determine whether the original stone or the stone formed by the foreign body as the core, on the one hand need to carefully ask whether there is a history of the placement of foreign bodies into the urethra and bladder, on the other hand need to carefully read the X-ray film, foreign body After staying in the bladder for a long time, if the volume of the formed stone is large and the volume of the foreign body itself is small, the shadow of the foreign body can not be seen on the X-ray film, which is easily misdiagnosed as the primary stone, and the IVU can be seen in the bladder. The contrasting agent has a relatively large density of filling defects.
2. Bladder tumors The main symptoms of bladder tumors are intermittent, painless gross hematuria. Frequent urination, urgency, dysuria and other symptoms only occur when the infection is combined. Generally, there are no symptoms of dysuria. B-ultrasound can be found in the bladder. Space-occupying lesions; X-ray plain film is not abnormally found, only in the IVU examination can be found in the bladder filling defect, cystoscopy and simultaneous biopsy is very important to determine the diagnosis, foreign body stay in the bladder for a long time It also stimulates the bladder wall and can cause cancer of the bladder wall mucosa.
3. Cystitis can also have frequent urination, urgency, and dysuria symptoms, but no abnormal findings were found in B-ultrasound and X-ray examination. In addition to the inflammatory changes in the bladder mucosa, no foreign bodies were visible in the bladder.
