Bladder neck obstruction in elderly women
Introduction
Introduction to bladder neck obstruction in elderly women Female bladder neck obstruction, also known as female "prostate disease" or bladder neck contracture, is a common cause of elderly women. The older the older the higher the incidence rate. If not treated promptly, the late stage can cause severe consequences of upper urinary tract dilatation, hydronephrosis, and renal dysfunction. basic knowledge Prevalence ratio: The incidence rate of elderly women is about 0.01%-0.02%, which is related to bladder stones. Susceptible people: elderly women Mode of infection: non-infectious Complications: hydronephrosis
Cause
Causes of bladder neck obstruction in elderly women
(1) Causes of the disease
The etiology of female bladder neck obstruction is still not very clear. It is currently believed that the main cause is chronic urinary tract infection, and urinary tract infection is related to female urethral anatomy and endocrine disorders.
Female urethra is short and straight, urethral opening is wide and close to the vagina, susceptible to infection, due to repeated urinary tract infections, long-term chronic inflammation of the bladder neck, mucosal hyperemia, submucosal cell infiltration, smooth muscle and connective tissue hyperplasia of the bladder neck, In addition, there are multiple branches of the paraurethral gland in women. More than 3 to 30 glandular ducts surround the urethra and open in the urethral cavity. The proximal gland is short, sulcate or sulcate, susceptible to infection and hyperplasia. , causing bladder neck obstruction, endocrine disorders are the main cause of urinary tract infections.
(two) pathogenesis
Female hormones have the effect of increasing glycogen in vaginal epithelial cells. The glycogen is decomposed into lactic acid by vaginal bacteria to inhibit the growth of bacteria. When the female hormone activity is reduced or disappeared, the local resistance is reduced, and vaginitis is prone to occur, thereby secondary to the urethra bladder. Triangitis, leading to bladder neck obstruction.
Prevention
Prevention of bladder neck obstruction in elderly women
Use effective antibiotics to control infection as soon as possible. When the internal medicine is conservative, it should be operated as soon as possible to protect kidney function.
Complication
Complications of bladder neck obstruction in elderly women Complications hydronephrosis
Severe cases can be complicated by upper urinary tract dilatation, hydronephrosis, renal damage.
Symptom
Elderly women with bladder neck obstruction symptoms common symptoms urinary incontinence lower abdominal pain female bladder neck obstruction enuresis renal failure
The main clinical manifestations of female bladder neck obstruction are dysuria, early urination is slow, urine flow becomes thinner, the range is short, and gradually develops into urination, which is dripping, often with urinary insufficiency, and later residual urine gradually increases or even urine. Detention, there are also enuresis, urinary incontinence, repeated urinary tract infections, and finally cause hydronephrosis or kidney failure, often accompanied by low back pain, lumbosacral pain, umbilical and lower abdomen pain.
Women with middle-aged or older, especially older women, have progressive dysuria and should consider the possibility of bladder neck obstruction.
Examine
Examination of bladder neck obstruction in elderly women
Residual urine measurement: It can be measured by catheterization and ultrasonic measurement. The catheterization method is the most accurate. The patient can urinate and insert the catheter under aseptic operation. All the urine is released as residual urine. The residual urine of normal people should be Below 10ml, the residual obstruction of early obstruction is less than 60ml, and the late stage can reach more than 300ml. There are many methods for ultrasonic measurement of residual urine. Because of the change of bladder shape, the average residual error of formula is calculated to be about 15%. The commonly used formula is: residual urine = The upper and lower diameters × left and right diameters × 0.5, the residual urine volume is proportional to the degree of obstruction, and the amount of residual urine volume contributes to the choice of treatment methods.
X-ray inspection
Urinary bladder urethrography, continuous filming under TV observation, can observe the bladder filling state and bladder contraction function during urination, or can not be opened in the closed state; or can not be completely open in a semi-closed state; The bladder can be emptied early in the neck, and the anterior and posterior position can be taken. The oblique position shows that the posterior lip of the bladder neck is raised. Doing double contrast of sodium iodide in the bladder can show changes in the bladder neck such as male prostate hyperplasia, and can know whether there is any Bladder neck reflux and degree, intravenous urography, can understand renal function and renal ureteral hydrops.
2. Cystoscopy
Cystoscopy is the main method for the diagnosis of bladder neck obstruction. By inserting a cystoscope, you can directly understand the bladder neck obstruction, and observe the intravesical lesions, such as intravesical trabeculae, small column and crypt, pseudo armpit, polyp; bladder Cervical mucosa is stiff and edematous, loses elasticity; the triangle is congested and edema, and the posterior lip is prominently embankment. If the patient performs urination, the bladder neck movement can be observed to be weakened, and cystoscopy can rule out bladder stones, tumors and other causes of urination. difficult.
3. Urodynamic examination
Urine flow rate examination is the most useful indicator for objective evaluation of urinary status. Patients with bladder neck obstruction can see a significant increase in intravesical pressure, a decrease in urine flow and a change in urinary flow curve, but it is not enough to diagnose obstruction by urinary flow rate alone. The urinary flow rate is determined by the strength of the bladder detrusor and the urethral resistance. Statistics show that the maximum urinary flow rate <10ml/s, obstruction accounted for 88%, and >15ml/s, 68% without obstruction, Therefore, in order to further clarify obstruction or not, the detrusor pressure during urination should be measured, and the method of measuring the pressure-urine flow rate during urination is a more accurate method.
Diagnosis
Diagnosis and diagnosis of bladder neck obstruction in elderly women
Diagnostic criteria
Urethral examination
Elderly patients often have urethral fistula, urethral stricture, urethral mucosal prolapse, urethral tumors and other diseases should be excluded.
2. Vaginal diagnosis
Patients with bladder neck obstruction can touch the bladder neck through vaginal finger examination. They can feel different degrees of thickening, smooth surface and medium hardness. Especially when the urethra is built into the catheter, the thickening of the bladder neck is more obvious.
3. According to the auxiliary examination, the diagnosis can generally be confirmed.
Differential diagnosis
Clinical needs to be differentiated from urinary tract infections in the elderly, urinary calculi in the elderly, and bladder tumors in the elderly.
