urethral syndrome
Introduction
Introduction to urethral syndrome Female urethral syndrome refers to a group of non-specific syndromes with frequent urination, urgency, and dysuria, but no obvious organic lesions in the bladder and urethra. It is more common in married young and middle-aged women. Often due to anatomical abnormalities of the external urethra (such as labia minora fusion, urethral membrane fusion, hymen umbrella, etc.), distal urethral obstruction, urinary tract infection, and local chemical, mechanical stimulation and other factors. The pathological changes of the urethral orifice tissue of patients are chronic inflammatory reactions. Most patients may be positive for urine culture, 46% are Escherichia coli, 18% are chlamydia, anaerobic culture can increase positive findings, and 32% of patients have inaccurate causes. basic knowledge The proportion of illness: 0.005% Susceptible people: more common in women Mode of infection: non-infectious Complications: Epididymitis Prostatitis Seminal vesiculitis Endometritis Salpingitis Pelvic inflammatory disease Cystitis Urethral stricture
Cause
Cause of urinary tract syndrome
Stevens first described it in 1923, but the cause has not been fully elucidated so far, and current research indicates that it is mainly related to the following reasons:
Urinary system infection (30%):
The pathological changes of the urethral orifice tissue of patients are chronic inflammatory reactions. Most patients may be positive for urine culture, 46% are Escherichia coli, 18% are chlamydia, anaerobic culture can increase positive findings, and 32% of patients have inaccurate causes.
Abnormal anatomy of the external urethra (20%):
Such as urethral hymen fusion, hymen umbrella, labia minora fusion, etc., it has been reported that the distance from the external urethra to the vaginal opening is closely related to the urethral syndrome. The closer the interval is, the higher the prevalence rate is, the prevalence rate is 72.15%. .
Urethral obstruction (15%):
Such as bladder neck obstruction, fibrosis or sphincter spasm around the distal urethra leading to narrowing of the distal urethra.
Neurological abnormalities (10%):
Injury, infection, X-ray irradiation, etc. cause hyperplasia of fibrous tissue in the urethra, causing abnormal reflexes of the nerve.
Psychological factors (10%):
Mental states such as nervous anxiety, suspiciousness and introversion are susceptibility factors for urethral syndrome.
Other (5%):
Such as immune factors, estrogen levels, magnesium deficiency, iatrogenic factors.
Prevention
Urethral syndrome prevention
prevention
1. Pay attention to the cleanliness of the perineum, prevent the perineum from coming into contact with dirty things. It is best to wash the anus with warm water after stool; if there is vaginitis and cervical erosion, it should be treated in time; underwear is best cotton, don't wear chemical fiber; Wash the vulva with warm water, do not use potassium or soapy water; usually drink plenty of water, keep the urination unobstructed, prevent urine from concentrating; clean the perineum with clean and soft paper after urinating; the action of sexual life is not too big, end Wash the perineum with warm water.
2. Take a small dose of the estrogen nylestradiol under the guidance of a doctor, take it once a month, one tablet each time (5 mg).
3. Life should be regular, do not smoke, drink alcohol, eat more fruits and vegetables, if there is frequent urination, dysuria, zero urine, urinary tract itching, do not scratch with your hands, use warm water to wash several times of perineum, or oral chlorpheniramine , dexamethasone. If the symptoms are serious, ask your doctor for treatment.
Complication
Urinary tract syndrome complications Complications Epididymitis Prostatitis Seminal vesiculitis Endometritis Salpingitis Pelvic inflammation Cystitis Urethral stricture
Complications in male patients: epididymitis, prostatitis, seminal vesiculitis, etc.
Complications of women with endometritis: endometritis, salpingitis, pelvic inflammatory disease, peritonitis, etc.
Intraurethral infection can spread directly to the bladder or prostate causing cystitis or prostatitis. If the urethral syndrome is improperly treated, it can be complicated by paraurethral abscess. Abscess can penetrate the penis skin and become urethral fistula. Fibrosis can cause urethral stricture during the healing of urethral inflammation.
Symptom
Symptoms of urethral syndrome Common symptoms Urinary tract stenosis Male urinary tingling Urinary urgency Frequent urination Pain urinary tract urinary tract burning viscous urinary urinary sinus edema
1. Symptoms: Frequent urination, urgency, urinary pain, some patients with urinary tract burning sensation and dysuria symptoms, at the same time, there may be pain in the suprapubic bladder area, low back pain and sexual pain.
2. Physical examination: Mucosal edema, urethral secretions, urethral meat sputum, urethral hymen fusion and hymen umbrella are also seen at the outer urethra. The urethra, bladder neck has tenderness and urethral induration.
Examine
Examination of urethral syndrome
1. Urine routine examination: no abnormal findings in non-infectious urethral syndrome; in infectious urethral syndrome, only a few white blood cells, pus cells, less than 5 / high power field.
2. No fungal bacterial urine: 3 middle urinary bacterial cultures were negative, and the possibility of false negatives caused by tuberculosis, anaerobic bacteria, fungi and other urinary tract infections was excluded.
3. Chlamydia, mycoplasma examination: In the case of infectious urethral syndrome, sometimes the bladder, urethra or adjacent organs are found to be infected, and chlamydia and mycoplasma are positive.
4. IVU venous urinary tract infection: can initially exclude urinary tuberculosis, tumors, stones and bladder diverticulum and other diseases.
5. Urethral cystoscopy: to understand the urethra, bladder infection, tumor, with or without urethral stricture and interstitial cystitis.
6. Urodynamic examination: manifested as overactive bladder, bladder weakness, distal urethral stricture and increased urethral pressure, etc., of which distal urethral stricture is the most common, and overactive bladder is often the pathological basis of its symptoms.
Diagnosis
Diagnosis and differentiation of urethral syndrome
diagnosis
Female urethral syndrome can be diagnosed as urethral syndrome after excluding other diseases that can cause urinary tract irritation.
Differential diagnosis
Urinary tract infection
Including pyelonephritis and cystitis, etc., there are obvious symptoms of frequent urination, urgency, dysuria and urinary tract burning, pyelonephritis is often accompanied by fever, headache, low back pain, fatigue, loss of appetite and other systemic symptoms, kidney area has tenderness and Sputum pain, laboratory examination, urine can be seen a large number of white blood cells, pus cells and red blood cells, medium-stage urine culture has pathogenic bacteria growth, colony count 105 / ml urine.
2. Urinary tuberculosis
Frequent urination, urgency, urinary pain symptoms, long-term antibiotic treatment is not effective, urinary sediment acid-fast staining smear can be found in tubercle bacilli, using polymerase chain reaction (PCR) technology to detect the DNA of tuberculosis in urine can greatly improve urinary tract The diagnosis rate of tuberculosis can be clearly diagnosed by Mycobacterium tuberculosis culture. The early tuberculosis of ICU can be seen as a typical change of the edge of the kidney. In the late stage of tuberculosis, one side of the kidney can not develop, the bladder contracture, and the typical side of the hydronephrosis. Tuberculosis changes, and sometimes tuberculosis and calcification can be found.
3. Neurogenic bladder
More secondary to diabetes, spinal ash, white matter, encephalitis, stroke, meningocele, spina bifida, meningocele and nerve center or peripheral nerve injury, with bladder overactivity, its symptoms and urethra Syndrome has similarities, manifested as urinary frequency, urgency, dysuria, urgent urinary incontinence and other symptoms of urinary dysfunction, but urodynamic examination shows normal urethral pressure, increased bladder detrusor pressure, hyperreflexia, sometimes can appear Urinary retention, hydronephrosis and renal dysfunction.
4. Urinary tract fungal infection
It can show symptoms of urinary tract irritation. Urine generally has no pathogenic bacteria in bacterial culture, but it is different from female urethral syndrome. It has the following characteristics: multiple in diabetes, tumor, low immunity and long-term application of antibiotics, hormones. , immunosuppressive drugs and indwelling catheters, caused by ascending infections, characterized by: fungal spores and hyphae visible under the microscope of "fungal balls" in the urine.
