congenital anterior urethral valve
Introduction
Introduction to congenital anterior urethral valve Congenital anterior urethral valve may or may not be associated with the diverticulum. The valve is located at the ventral side of the urethra at the junction of the penis and scrotum. It does not obstruct the insertion of the catheter, but hinders the discharge of urine, leading to proximal urethral dilatation. The damage caused by the urethral valve is the same. The small mouth chamber with neck does not cause obstruction, but it can be complicated with stones and symptoms. When the wide mouth diverticulum is filled with urine, the distal lip will play a role in obstructing the flow of urine. This congenital diverticulum may be caused by a partial corpus cavernosum. basic knowledge The proportion of illness: the incidence rate is about 0.0003% - 0.0007% Susceptible people: infants and young children Mode of infection: non-infectious Complications: urinary tract infection sepsis abdominal mass
Cause
Congenital anterior urethral valve disease
(1) Causes of the disease
The etiology of the anterior urethral valve and the diverticulum is still unclear. It may be that the urethral plate is incompletely integrated at a certain stage of the embryonic stage, or the urethral cavernous dysplasia may cause the local urethra to lack support tissue, and the urethral mucosa protrudes outward.
(two) pathogenesis
The anterior urethral valve is generally located at the ventral side of the anterior urethra at the junction of the penis and scrotum. There are two mucosal flaps extending from the dorsal side of the urethra to the ventral midline of the urethra, with a fissure in the middle, resembling a vocal cord, which does not interfere with the posterior urethral valve. Catheter insertion, but obstruction of urine discharge, causing proximal urethral dilatation, renal ureteral dilatation in severe obstruction, and some with urethral diverticulum, Huang Chengru et al reported that 15 cases of 50 cases of anterior urethral valve with urethral diverticulum, The diverticulum is generally located in the penis body at the proximal end of the penis scrotum junction. The ball urethra and diverticulum are divided into two types:
1. When the wide mouth diverticulum is filled with urine, the distal lip constitutes a valve that protrudes into the urethral cavity and causes obstruction.
2. Most of the small diverticulum with neck does not cause obstruction, and symptoms can occur with stones.
Prevention
Congenital anterior urethral valve 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. Regular examination should be done during pregnancy. If the child has a tendency to develop abnormalities, chromosome screening should be done in time, and abortion should be performed in time to avoid the birth of the diseased child.
Complication
Congenital anterior urethral valve complications Complications, urinary tract infection, sepsis, abdominal mass
This disease can be complicated by urinary tract infections. Infants with severe obstruction can be treated for sepsis and severe electrolyte disorders, and those with abdominal mass or growth retardation.
Symptom
Congenital anterior urethral valve symptoms Common symptoms Post-urine drip urethral valve dysuria and urinary retention
There is difficulty in urinating, urine drip, bladder can have a large amount of residual urine, such as when the diverticulum is filled with urine, there may be a swelling of the penis scrotum junction, there is still drip after urinating, squeeze the mass by hand, there may be urine discharge.
Examine
Congenital anterior urethral valve examination
Urinary X-ray plain film to observe the presence or absence of stones, intravenous urography to understand the upper urinary tract, severe anterior urethral valve also often cause renal ureteral hydrops, intravenous urography and renal radionuclide scanning can understand renal function, kidney function Urodynamic examination should be performed. Urinary angiography shows the anterior urethra dilatation of the anterior urethra at the junction of the penis and scrotum. The diverticulum of the urethra can be seen in the diverticulum. The distal urethra is very thin. The bladder can have trabeculae and diverticulum. There is vesicoureteral reflux, urethroscopic examination can clearly observe the shape and position of the valve.
Diagnosis
Diagnosis and diagnosis of congenital anterior urethral valve
diagnosis
In addition to medical history, physical examination, urinary bladder urethra angiography, urethroscopic examination can confirm the diagnosis.
Differential diagnosis
Congenital bladder neck contracture
More common in children, due to bladder neck muscle, fibrous tissue hyperplasia and chronic inflammation leading to bladder neck stenosis and urinary tract obstruction, rectal examination can touch the bladder neck lumps, urinary tract urethra showed bladder outlet elevation, bladder bottom Round, urethroscopic examination: the neck is narrow and narrow, with a tight feeling, the posterior lip is raised, the triangle is thick, and the bottom of the bladder is concave.
2. Congenital fine hyperplasia
The essence of congenital enlargement, protruding into the urethra, the formation of obstruction caused by urinary disorders, urethroscopic examination showed bulging, hypertrophy.
3. Neurogenic bladder
Generally, there are trauma, surgery, systemic disease or history of drug application. In addition to dysuria, there are still manifestations of the nervous system. Bladder angiography shows that the bladder is slack, and urodynamic examination can be identified.
