Interureteral ridge hypertrophy
Introduction
Introduction Transurethral spinal hypertrophy is one of the clinical manifestations of bladder neck contracture.
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
Venous urography urinary plain film
diagnosis method
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.
[clinical manifestations]
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.
Diagnosis
Differential diagnosis
1. posterior urethral valve, both have lower urinary tract obstruction symptoms, difficulty urinating, bladder enlargement, vesicoureter reflux. Renal pelvis, ureteral hydrops and renal dysfunction, but the posterior urethral valve is more common in boys under 10 years of age. The urethral mucosa wrinkles are formed in the valve system, and the concave surface faces upward, and there is a one-way flap function from bottom to top. There is no resistance to urethral dilation, but dysuria is difficult. There was no positive finding in retrograde urethrography. When urinary tract urination was seen, the urethral dilatation increased above the valve, the urethra below the valve became thinner, and the valve showed a strip shadow. Urethroscopy, see the posterior urethral valve as a diaphragm, mostly located in the anterior wall, 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, often in childhood. Clinical manifestations are difficult to distinguish from posterior urethral valves. Urethral angiography showed a filling defect in the posterior urethra. Urethroscopy, see fine sputum significantly increased the urethra after obstruction, and extended into the bladder.
3. The urethral stricture after posterior urethral stricture is caused by trauma and instrument damage. The patient has a history of trauma. Clinical manifestations of fine and ineffective urination, urinary disruption and urinary flow bifurcation. Urethral angiography sees posterior urethral stricture, mucosa is not smooth or has false tract formation, contrast agent spills into the tissues outside the urethra, urethral dilatation has resistance, and severe dilators cannot pass. The urethroscopic examination showed posterior urethral stricture, or even complete occlusion, the surrounding tissue was hard, and the urethra mirror could not pass.
4. Neurogenic bladder. Neurogenic bladder is divided into two major categories, one is detrusor hyperreflexia. One type is urine-reducing and non-reflective, and the latter type needs to be differentiated from bladder neck contracture. Both have dysuria, urinary retention, enlarged bladder, ureteral reflux, and renal dysfunction. Both need to be identified. Although the neurogenic bladder has difficulty in urinating, it can still be urinary flow by increasing abdominal pressure. Nervous system examinations, such as spinal cord injuries. Often combined with lower limb dyskinesia. In patients without spinal cord injury, patients often have a feeling of sagging in the saddle area. There is no resistance to urethral dilatation. Anal finger examination, anal sphincter relaxation, often constipation. Bladder pressure measurement, bladder detrusor no reflection, pressure measurement curve is a horizontal line.
