Funnel-like change in the urethra
Introduction
Introduction When the bladder neck contracture X-ray examination, there is a funnel-like change in the urethra. 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, and there may be congenital and acquired points in terms of the pathogen. In addition to the typical pathological changes of the local congenital, there are often no other clear reasons, more males; acquired people are often caused by local chronic inflammation such as posterior urethritis, prostatitis, trigonitis, etc. The incidence is not lower than that of men. Congenital people are more common in children. They often have symptoms of urinary dysfunction before the age of six, but it is not uncommon for those who develop after 20 or 30 years of age.
Cause
Cause
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, and the neck is narrowed. The appearance of bladder neck obstruction, that is, long-term dysuria. Women are also known as "female prostate disease", which is more common among middle-aged and older women. Male bladder neck contracture can occur simultaneously with benign prostatic hyperplasia. Therefore, the bladder neck should be formed after the prostate is removed, otherwise the obstructive symptoms cannot be relieved.
Examine
an examination
Related inspection
Bladder ultrasound cystoscopy
Diagnosing this disease is mainly based on the difficulty of urinating in the medical history. Therefore, the details of dysuria should be asked. When examining the body, pay attention to the presence or absence of mass in the bilateral renal area, palpation and percussion, whether the bladder is bulging. However, the diagnosis of this disease depends on bladder urethra microscopy and X-ray examination.
1. Cystoscopy: It is best to use bladder urethroscopic or omnipotent cystoscopy to check the bladder condition and the urethra. Through this examination, it can be found that the urethra is tight after the cystoscope is placed, but it can still be placed. At the time of examination, the posterior edge of the urethra was slightly raised, and the triangular area was also raised. It was found that most of the trabeculae were concave, and the ureteral orifice was often visible. Through this examination, other diseases in the bladder and urethra can be ruled out, such as bladder diverticulum, ureteral spinal hypertrophy, bladder tuberculosis, urethral stricture, posterior urethra membrane, fine hypertrophy and the like.
2. X-ray examination: plain film can exclude urinary calculi. Intravenous pyelography is very important, and the renal function of both sides can be understood. Because the disease is a long-term lower urinary tract obstruction, especially in congenital, the urinary system on both sides is often enlarged, especially the ureter can be thickened as the intestine. After decompressing the abdominal band, taking a cystogram, it is obvious that the bladder neck protrudes slightly into the bladder. This point is important for the diagnosis of this disease. Due to urethral stricture or urinary tract obstruction caused by the valve, there is often no such change, and sometimes there is a funnel-like change in the urethral opening, which can be distinguished from 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. If the residual urine is measured after continuous urination for several times, the residual amount may be small; 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 amount of urine discharged from the upper urinary system. The amount of urine remaining in the upper urinary system is actually a false residual urine. These factors must be taken into consideration when performing this test.
In short, the diagnosis of this disease is based on a long history of dysuria, with endoscopic X-ray examination. On the basis of excluding other obstructive lesions, the characteristics of the disease such as the instrument examination, the posterior urethra is tight, and the neck of the bladder is contrasted. The diagnosis is determined by slightly protruding into the bladder.
Diagnosis
Differential diagnosis
Urethral adhesion: normal urethra has urethral glands, which can secrete a small amount of mucus every day to play a role in lubricating and protecting the urethra. Under normal circumstances, these mucus remain in the urethra and have a protective effect on the urethra mucosa. When the urethra or prostate is inflamed, the secretions may increase. After the urethral secretions are dried in the outer urethra, the mucosa and the skin on both sides of the urethra are slightly adhered, the urinary passage is slightly unsatisfactory, and bifurcation occurs in the initial stage of urination. The urine will stick out and the fork will disappear.
There is a white film formation in the urethral opening: the urine sensation caused by mycoplasma, its clinical manifestation is similar to the general bacterial urinary sensation, and a white film is formed in the urethral opening in the morning. Nodular or red hemorrhagic mass in the urethra: early symptoms of paraurethral adenocarcinoma are dysuria, urethral bleeding, frequent urination, and dysuria. A nodular or red hemorrhagic mass appears in the distal urethra or urethra, and local swelling of the urethra can reach the mass. When the tumor is enlarged, it can block the urethra or expand into the vestibular vestibule and vaginal opening, and there are obvious ulcers and hemorrhagic masses, accompanied by pain and possible metastasis of the groin and pelvic lymph nodes. There are erythema and edema in the urethra: repeated episodes of Candida balanitis appear as erythema at the glans, and there may be small pustules or small papules on the surface. It can also be expressed as local edema of the glans mucosa, mild desquamation at the edges, and the presence of papules and small pustules to expand around to form glans erosion.
