bladder neck contracture
Introduction
Introduction to bladder neck contracture Contracture of the bladder neck is another important problem of bladder neck obstruction. The bladder neck refers to a tubular structure in which the urethral opening extends to the urethra for a length of about 1 to 2 cm. It includes the internal sphincter, but the internal sphincter is not the entire neck of the bladder. The neck of the bladder is contracted. In terms of pathogens, there may be congenital and acquired. In addition to the typical pathological changes of the local congenital, there are often no other clear reasons, more males; acquired people are often due to local chronic Inflammation such as posterior urethritis, prostatitis, trigonitis, etc., the incidence of women is not lower than that of men, congenital solids are more common in children, often have symptoms of urinary dysfunction before the age of six, but at the age of 20 or 30 It is not uncommon for people to develop afterwards. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: urethritis Prostatitis Hydronephrosis Renal insufficiency
Cause
Cause of bladder neck contracture
It is thought to be related to chronic inflammation. Pathological manifestations of the lower layer of the mucosa of the neck are replaced by fibrous connective tissue. The bladder neck becomes pale and stiff and fixed, the neck is narrowed, and the bladder neck obstruction appears, that is, the long-term dysuria is difficult, and the female It is called "female prostate disease", which is more common in middle-aged and elderly women. Male bladder neck contracture can occur simultaneously with benign prostatic hyperplasia. Therefore, the bladder neck should be formed after prostate removal, otherwise the obstructive symptoms cannot be relieved.
Prevention
Bladder neck contracture prevention
Bladder neck contracture mostly occurs in middle-aged and elderly women, may be associated with decreased estrogen levels, urethral vaginal epithelial atrophy, reduced resistance, and easy to be repeatedly affected by infection, so long-term use of a small amount of long-acting estrogen, pay attention to the perineal cleanliness, remove the bladder The part of the posterior lip hyperplasia is cut to the level of the triangle to avoid excessive electrocautery, so as to avoid postoperative scar stenosis. Do not cut the sphincter to cause urinary incontinence. After the operation, the urethra should be dilated until the urinary tract is stable. until.
Complication
Bladder neck contracture complications Complications urethritis prostatitis hydronephrosis renal insufficiency
Posterior urethritis; prostatitis; trigonitis, may be complicated by hydronephrosis, renal insufficiency.
Symptom
Bladder neck contracture symptoms Common symptoms Poor urination urinary dysfunction Urinary flow slow urinary flow thinning or interruption of sacral dysplasia Urinary incontinence urethral mouth funnel-like change enuresis urinary flow interruption
Difficulties in urinating, urinating, urinating in stages, crying in children, urinary flow, and sometimes diarrhea. The above symptoms are more pronounced when combined with urinary tract infections. When examining the body, it may give the bladder with a lower abdomen, but it may not be obvious.
Examine
Bladder neck contracture examination
1. Cystoscopy: It is best to use bladder urethroscopic or omnipotent cystoscopy. It can not only check the bladder condition, but also the urethra. Through this examination, it can be found that the urethra is tight after the cystoscope is placed, but still When placed, the posterior edge of the urethra can be slightly raised, and the triangular area is also raised. It can be seen that most of the trabeculae are concave, and the ureteral orifice is often visible. This examination can exclude other lesions in the bladder and urethra. Such as bladder diverticulum, ureteral spinal hypertrophy, bladder tuberculosis, urethral stricture, posterior urethra membrane, fine hypertrophy and so on.
2. X-ray examination: plain film can exclude urinary calculi, intravenous pyelography is very important, can understand the renal function of both sides, because this disease is a long-term lower urinary tract obstruction, especially in congenital, on both sides The urinary system is often enlarged, especially the ureter can be thickened as the intestine, and the bladder contrast can be taken after the pressure is removed. It can be seen that the bladder neck protrudes slightly into the bladder. This point is important for the diagnosis of this disease. Posterior urethral stricture or urinary tract obstruction caused by valve, often no such changes, sometimes visible in the urethra mouth funnel-like changes, can be identified with the disease.
3. Determination of residual urine: It is also important for this disease, but sometimes it is not very reliable. It should be noted that the patient's urination can not be emptied once, but if it is urinated for 2 to 3 minutes, it can be discharged. Less urine, such as continuous urination several times and then test residual urine, there may be a small amount of residual; in addition, if the upper urinary system is dilated, the ureteral reflux is severe, and the residual urine volume is measured after urination, including the upper urinary system. The amount of urine, the amount of urine remaining in the upper urinary system, is actually a false residual urine, which must be taken into consideration when performing this test.
Diagnosis
Diagnosis and differentiation of bladder neck contracture
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
Posterior urethral valve
Both have lower urinary tract obstruction symptoms, dysuria, enlarged bladder, vesicoureteral reflux, renal pelvis, ureteral hydronephrosis and renal dysfunction, but posterior urethral valve is more common in boys under 10 years old, and valvular mucosal folds are formed in the valve system. The concave surface is upward, there is a one-way flap function from bottom to top, there is no resistance to urethral dilatation, but dysuria is difficult, and no retrograde urethrography is found. When urinary tract urethra is seen, the urethral dilation increases above the valve, the urethra below the valve becomes thinner, and the valve is presented. Strip shadow, urethroscopic examination, see the posterior urethral valve as a diaphragm, mostly located in the anterior wall, which is decisive for diagnosis.
2. Congenital hyperplasia of hyperplasia is 2, 3 times larger than normal. Obstruction of the urethra leads to difficulty in urinating. It often occurs in childhood. The clinical manifestations are difficult to distinguish from the posterior urethral valve. Urethral angiography shows filling defects in the posterior urethra. , urethroscopic examination, see fine sputum significantly increased obstruction of the posterior urethra, and extended into the bladder.
3. Posterior urethral stricture urethral stricture, mostly due to trauma, equipment damage, the patient has a history of trauma, clinical manifestations of fine and weak urination, urinary interruption and urinary flow bifurcation, urethral angiography see urethral stricture, mucosa is not smooth or The false passage formed, the contrast agent spilled into the tissue outside the urethra, the urethral dilatation had resistance, the dilator could not pass in severe cases, the posterior urethral stricture was seen in urethroscopic examination, or even completely occluded, the surrounding tissue was hard, and the urethra mirror could not pass.
4. Neurogenic bladder
Neurogenic bladder is divided into two categories, one is detrusor hyperreflexia, the other is detrusor-free reflex, the latter is differentiated from bladder neck contracture, both have dysuria, urinary retention, and bladder enlargement. , vesicoureteral reflux, renal dysfunction, both need to be identified, although the neurogenic bladder has dysuria, but increased abdominal pressure can still be urinary flow into the line, nervous system examination, such as spinal cord injury, often combined with lower extremity dyskinesia, In patients without spinal cord injury, the patient often had a feeling of sagging in the saddle area, no resistance to urethral dilatation, anal examination, anal sphincter relaxation, constipation, bladder pressure measurement, no dereflexion of the bladder detrusor, and a pressure curve.
