Congenital bladder neck contracture
Introduction
Introduction to congenital bladder neck contracture The bladder neck refers to a tubular structure extending from the urethra to the urethra by 1 to 2 cm. The bladder neck obstruction refers to the narrowing or opening restriction of the bladder neck due to mechanical or functional reasons, resulting in difficulty in urinating. Such as obstructive symptoms, it can be divided into primary and secondary. Primary bladder neck obstruction is caused by functional changes in the bladder neck, not because of structural changes, that is, the bladder neck is not open but vaginally contracted during urination. basic knowledge The proportion of illness: 0.003%-0.004% (the above is the incidence of infants and young children) Susceptible people: teenagers Mode of infection: non-infectious Complications: bladder stones, bladder diverticulum
Cause
Congenital bladder neck contracture
(1) Causes of the disease
Congenital bladder neck contracture: more common in adolescents, associated with poor degeneration of mesoderm during bladder development, sphincter hypertrophy, and congenital autonomic dysplasia, bladder neck neuromuscular structure, or congenital endocrine and metabolic disorders, bladder lining Empty dysfunction or bladder detrusor and sphincter synergistic disorders, bladder neck secondary thickening.
Acquired bladder neck contracture: Mostly due to prostatitis, posterior urethritis, bladder trigeminal inflammation and other chronic local inflammation caused by bladder fibrosis and various types of postoperative scar contracture, even in bladder tuberculosis and schistosomiasis It is also associated with acquired endocrine and metabolic disorders.
(two) pathogenesis
The contracted bladder neck may have mucosal hyperemia, submucosal inflammatory cell infiltration, submucosal and myometrial fibrous elastic tissue, muscle tissue and adenoid tissue hyperplasia, and the lesion range may include the bladder neck portion, all including the bladder triangle region. Make the internal urethra protrude into the bladder, especially after the lip, so that the local tissue is thick and firm, causing bladder neck stenosis, lower urinary tract obstruction, causing urinary retention, vesicoureter reflux, and then upper urinary tract water, resulting in renal function Decreased, and may be accompanied by secondary infection of the urinary tract. In elderly women, the bladder neck mucosa may have squamous metaplasia.
Prevention
Congenital bladder neck contracture prevention
The cause of the disease is related to poor degeneration of mesoderm tissue during bladder development and hypertrophy of sphincter. Therefore, there is no direct prevention method for this disease. It is recommended that regular physical examination can be used for early detection. If it is clear, it should be treated surgically. At the same time, pay attention to develop a good habit of living, do more water, eat more fruits and vegetables, do not urinate, to a certain extent can reduce the incidence of this disease.
Complication
Congenital bladder neck contracture complications Complications bladder stones bladder diverticulum
1. Bladder stones: The main symptoms include dysuria, dysuria and hematuria, but there are also a few cases, especially those with lower urinary tract obstruction and residual urine. Stones are sometimes large but asymptomatic.
2. Bladder diverticulum: There are no special symptoms in the bladder diverticulum. If there is obstruction or infection, there may be symptoms of dysuria, frequent urination, and urinary urinary tract infection. Some diverticulum can be as large as 2000ml, which compresses the bladder neck and urethra, leading to lower urinary tract obstruction.
3. Bladder infection: mainly urinary frequency, urgency, urinary burning and other performance.
Symptom
Congenital bladder neck contracture symptoms Common symptoms Nocturia increased urinary frequency urinary flow fine or interrupted weakness Urethral valve acute urinary retention urinary incontinence
The main symptoms of bladder neck contracture are progressive dysuria. Early manifestations include delayed urination, weak urine flow, thinned urinary tract, frequent urination, nocturia, residual urine, acute urinary retention, and overflow urinary incontinence. Can lead to vesicoureteral reflux, hydronephrosis, renal insufficiency and so on.
Examine
Congenital bladder neck contracture examination
Routine, biochemical examination: to understand the urine, renal function and general conditions, phenol red (PSP) excretion test can prompt the hydronephrosis and renal function.
1. Determination of residual urine volume
Multi-use B-ultrasound measurement (common formula: residual urine volume = upper and lower diameter × anteroposterior diameter × 0.5, when the residual urine volume is small, the upper and lower diameter × left and right diameter × 0.7), the catheterization method is more accurate.
2. Imaging examination
Urinary bladder urethra angiography positive, lateral, oblique radiograph showing bladder neck stenosis, posterior lip protruding into the bladder cavity; fluoroscopy of the bladder filling state and urinary process can be seen in the bladder neck atelectasis, insufficiency, open delay or Early closure, at the same time can show the degree of enlarged bladder and ureteral reflux, feasible intravenous pyelography (KUB IVP) to exclude urinary calculi, understand the morphological function of the kidneys, if necessary, radionuclide kidney map, kidney scan, clear kidney Blood supply and the extent of renal damage.
3. Cystoscopy
When the cystoscope is placed, the resistance is large, the neck is narrow, and the urethral wall of the lower sphincter has no obvious signs of expansion. The neck mucosa is stiff, the posterior lip of the urethra is raised, the posterior wall of the bladder is sunken, and the urination of the bladder is performed. When the posterior lip contraction movement is weakened, it is often necessary to press the bladder neck down to observe the posterior wall of the bladder. Chronic inflammatory changes often occur in the bladder. There are many trabeculae, and the ureteral opening may be open, which may be accompanied by pseudo diverticulum or stones. Exist, sometimes the cystic rim-like protrusion of the posterior lip of the neck is visible before the cystoscope exits.
4. Lower urinary tract urodynamics
Obstructive early detrusor compensatory hyperplasia, intravesical urinary pressure is significantly higher than normal (70 ~ 80cmH2O), mild bladder neck obstruction neck opening delay, normal urine flow rate; moderate obstruction maximum urinary flow rate bias Low, manifested as obstructive urinary flow rate, obstruction aggravated detrusor decompensation, bladder dilatation residual urine appeared, bladder pressure can be reduced to the normal range, at this time, the intravesical pressure and urine flow rate during urination were measured, the ratio between the two >0.45, indicating the presence of obstruction.
Diagnosis
Diagnosis and diagnosis of congenital bladder neck contracture
diagnosis
Patients with dysuria and urinary dysfunction, regardless of age or gender, should consider bladder neck contracture, ask for medical history, analyze symptoms, estimate the cause of stenosis, type and degree of obstruction, vaginal or rectal examination, combined with various Examination and exclusion of urethral valve, urethral stricture, fine hypertrophy and other obstructive factors can be clearly diagnosed.
Differential diagnosis
1. Urethral stricture:
There are many cases of urethritis and urethral trauma, vaginal examination can not touch the hypertrophic bladder neck tissue, urethra urethral urethral stricture, imaging urodynamics test shows that the maximum urinary flow rate is prolonged, the urine flow rate is close to the maximum bladder The neck is still open.
2. Neurogenic bladder:
Both have dysuria, urinary retention, renal ureteral hydrops, renal dysfunction, but patients with neurogenic bladder are often associated with neurological disease, often with lower extremity dyskinesia, rectal finger test shows anal sphincter relaxation, increasing When the abdominal pressure is urinating, the urinary flow can be lined up, and the catheter can be smoothly inserted through the catheter or the urethra. The urodynamic examination shows that the bladder detrusor has no reflection, and the pressure measurement curve is a horizontal line.
3. Female urethral syndrome:
More common in married young and middle-aged women, frequent urination, urgency, dysuria symptoms, some patients have symptoms of dysuria, mucosal edema at the outer urethra, urethral secretions, sometimes visible urethral meat, urethra and fusion Hymenal umbrella, etc., urodynamic examination showed overactive bladder, bladder weakness, distal urethral narrowing and increased urethral pressure.
