Bladder neck obstruction

　　The clinical symptoms of bladder neck obstruction are mainly progressive difficulty in urination. The etiology and pathogenesis of the disease are complex, and there is currently no unified understanding or definitive conclusion. Generally, there are the following views:

　　1. Possible causes include inflammation, non-inflammatory, or aging phenomena leading to hyperplasia of bladder neck fibrous tissue, hypertrophy of bladder neck muscles, sclerosis due to chronic inflammation, and hyperplasia of periurethral glands in elderly women due to hormone imbalance.

　　2. Severe bladder neck obstruction can lead to difficulty in urination and even urinary retention, which, if left untreated for a long time, can cause hydronephrosis and produce symptoms and outcomes similar to those of benign prostatic hyperplasia in males.

　　3. The disease is speculated to be a connective tissue disease due to the presence of fibroblasts forming collagen in the local tissue structure.

　　4. Congenital malformations, especially poor neural and muscular structure of the bladder neck: early neural damage; secondary formation of bladder neck sclerosis after surgery for vagina, urethra, and bladder neck, etc.

　　If obstruction at the bladder neck is not diagnosed and treated in a timely manner, it generally leads to upper urinary tract dilation and hydronephrosis, affecting kidney function as well. In severe cases or those with concurrent infection, it can lead to a serious prognosis of kidney function damage.

　　1. Upper urinary tract dilation and hydronephrosisAccumulation of urine is caused by obstruction of the urinary system, leading to dilation of the renal pelvis and calyces, and the upper urinary tract, where urine is retained, is collectively referred to as upper urinary tract hydronephrosis. Edema and dysuria are the most common symptoms.

　　2. Kidney function damageThe kidney is an important organ responsible for secreting urine, excreting waste and toxins, and regulating the concentration of electrolytes in the human body, maintaining acid-base balance. When kidney function is impaired or gradually declines, the kidney's excretion and regulatory functions will also decrease. Severe kidney damage can lead to uremia, which may be life-threatening. Kidney damage can manifest as fatigue, dry mouth and throat, loss of appetite, frequent urination, urgency, dysuria, and even hematuria and asymptomatic pyuria, accompanied by symptoms such as joint pain. Some cases may directly lead to acute nephritis or glomerulonephritis, and severe cases may lead to kidney failure and death.

　　Bladder neck obstruction refers to a segmental tubular structure extending about 1-2cm from the internal urethral orifice to the urethra, which occurs obstruction. The etiology is divided into congenital and acquired. Congenital ones are often due to thickening of the bladder neck muscles. Acquired ones are often due to fibrous stricture of the bladder neck caused by local chronic inflammation, which is more common in women than in men and often occurs after middle age. Prostatic surgery, bladder neck stenosis, and coordination disorders between the bladder neck sphincter and detrusor muscle can also cause bladder neck obstruction.

　　The clinical symptoms of this disease are mainly progressive difficulty in urination, manifested as effortful urination, thin urinary stream, weak ejection, segmental urination, dribbling, urinary retention, and overflow incontinence, etc. Long-term obstruction can lead to urinary tract infection and renal insufficiency.

　　This disease often occurs in middle-aged and elderly women, which may be related to the decrease in estrogen levels, atrophy of the urogenital epithelium, reduced resistance, and easy to suffer from repeated infections. Therefore, a small amount of long-acting estrogen should be taken for a long time. Specific preventive measures are as follows:

　　9. Long-term administration of a small amount of long-acting estrogen to supplement the estrogen content in the body.

　　8. Pay attention to personal hygiene, especially the cleanliness of the perineum during menstruation and puerperium.

　　7. After resection of the bladder neck and the lip of hyperplasia, the depth of the incision should be equal to the trigone area to avoid excessive electrocoagulation, so as not to cause urinary incontinence after surgery. Do not cut the neck sphincter too deeply to avoid urinary incontinence after surgery. Regular urethral dilation should be performed after surgery until the urinary stream is thick and stable.

　　6. In addition, it is necessary to strengthen physical fitness and improve immunity: pay attention to the combination of work and rest, participate in more physical exercise, and eat more fresh fruits and vegetables rich in vitamins.

　　The clinical symptoms of bladder neck obstruction are mainly progressive difficulty in urination, manifested as effortful urination, thin urinary stream, weak ejection, segmental urination, dribbling, urinary retention, and overflow incontinence, etc. Long-term obstruction can lead to urinary tract infection and renal insufficiency. The diagnosis of this disease, in addition to clinical manifestations, also requires the following examinations:

　　1. Measurement of residual urine

　　Urodynamic and ultrasonic measurements can be used. Urodynamic measurement is the most accurate. After the patient urinates on their own, an indwelling catheter is inserted under sterile conditions, and all urine released is residual urine. Normal residual urine should be less than 10ml. Early obstruction residual urine is less than 60ml, and late stages can reach more than 300ml. There are many methods to measure residual urine by ultrasound, due to the variable shape of the bladder, the average error of residual urine calculated by formula is about 15%. The commonly used formula is: residual urine = anteroposterior diameter × transverse diameter × 0.5. The amount of residual urine is proportional to the degree of obstruction. The amount of residual urine helps in the selection of treatment methods.

　　2. X-ray examination

　　Cystourethrography, performed under television observation and continuous filming, can observe the bladder filling state and the contraction function of the bladder during micturition. It may be in a closed state and cannot be fully opened; or in a semi-closed state and cannot be fully opened; or the neck closes prematurely and the bladder cannot be emptied. The posterior lip of the bladder neck is elevated in the anteroposterior and oblique position photos. Performing cystic air sodium iodide double contrast, it can show changes in the bladder neck like benign prostatic hyperplasia in men. It can also understand whether there is a bladder neck reflux and the degree. Intravenous urography can understand the renal function and renal pelvis hydronephrosis situation.

　　3. Cystoscopy

　　Cystoscopy is the main method for diagnosing bladder neck obstruction. By inserting a cystoscope, the obstruction at the bladder neck can be directly understood, and the changes in the bladder lesions, such as small trabeculae, small columns, and crypts, pseudo-diverticula, polyps; the mucosa of the bladder neck is rigid and edematous, losing elasticity; the trigone is congested and edematous, and the posterior lip protrudes in a dam-like manner. If the patient is asked to perform a micturition action, the weakened movement of the bladder neck can be observed. At the same time, cystoscopy can exclude difficulties in urination caused by bladder stones, tumors, and other reasons.

　　4. Urodynamic examination

　　Uroflowmetry is the most useful index for objectively evaluating urinary status. In patients with bladder neck obstruction, it can be seen that the bladder pressure is significantly increased, the urine flow is reduced, and the change of the urine flow curve. However, it is not enough to diagnose obstruction solely based on uroflowmetry. Uroflowmetry is determined by the strength of the bladder detrusor muscle and the resistance of the urethra. Statistics show that 68% of those with a maximum urine flow rate of 15ml/s have no obstruction. Therefore, in order to further clarify whether there is an obstruction or not, it is necessary to measure the detrusor pressure during micturition, and the method of measuring detrusor pressure-uroflowmetry is relatively accurate.

　　This disease often occurs in middle-aged and elderly women, and may be related to the decrease in estrogen levels, the atrophy of the urinary tract and vaginal epithelium, and the reduced resistance, which is prone to repeated infections. Therefore, it is recommended to take a small amount of long-acting estrogen for a long time.

　　In addition, patients with bladder neck obstruction should also pay attention to diet and nourishment in their diet. Appropriate diet and nourishment can help prevent the recurrence or aggravation of the disease. Patients with bladder neck obstruction should avoid eating sour and spicy刺激性 food, such as strong alcohol, chili, original vinegar, sour fruits, etc. Caffeine can cause bladder neck contraction and cause spasmodic pain in the bladder, so coffee should be drunk less. It is best to avoid eating citrus fruits because they can cause alkaline urine, which is conducive to the growth of bacteria. During the medication period, patients should avoid eating chicken, chili, fish, shrimp, beef, seafood pickles, and only use vinegar, salt, monosodium glutamate (other seasonings should not be used). If the patient does not control their diet well, it will prolong the treatment time.

　　Health-preserving medicine and diet

　　①Persimmon cake and scutellaria heart grass decoction

　　Two persimmon cakes, 6 grams of scutellaria heart grass, and appropriate amount of sugar, decocted into a soup for drinking. It has the effects of clearing heat, promoting diuresis, and stopping bleeding.

　　②Mung bean and Plantago asiatica decoction

　　Mung beans 60 grams, red beans 30 grams, Plantago herb, sugar to taste, boil and take. It can clear heat and detoxify, promote diuresis and relieve stranguria.

　　③ Plantago bean soup

　　Mung beans 50 grams, black beans 50 grams, Plantago 15 grams, honey 1 spoon. Wrap Plantago in gauze, boil mung beans and black beans together with water, until the beans are soft, remove the medicine bag, add honey, and eat the beans and drink the soup. It is suitable for patients with difficulty in urination, short and urgent pain, lumbar pain.

　　④ Lonicera tea

　　Lonicera japonica 30-50 grams, licorice powder 10 grams, soak in boiling water for 10 minutes, drink as tea. It can clear heat and detoxify, promote diuresis and relieve stranguria. It can treat fever and urinary pain.

　　⑤ Clam meat soup

　　Clam meat 20 grams, begonia 30 grams, sugar to taste, boil together with water, eat the meat and drink the soup. It can clear heat, promote diuresis, and treat urinary tract infection.

　　⑥ Winter melon and mung bean soup

　　Fresh winter melon 500 grams, mung beans 50 grams, add sugar to taste, boil soup for drinking. It can clear heat, promote diuresis, prevent summer heat, and cool down. It is the best drink for preventing and treating urinary tract infection.

　　⑦ Bean sprout juice

　　Mung bean sprouts 500 grams, sugar to taste. Wash the mung bean sprouts, crush, squeeze juice with gauze, add sugar as tea to drink. Can treat urinary tract infection, red urine, frequent urination, turbid urine, etc.

　　⑧ Celery juice

　　Celery 2500 grams. Wash the fresh celery, crush and squeeze juice, heat to boiling, take 60 milliliters each time, three times a day.

　　The clinical symptoms of bladder neck obstruction are mainly progressive difficulty in urination, manifested as effortful urination, thin urinary stream, weak ejaculation, segmented urination, dribbling, urinary retention, and overflow incontinence. In traditional Chinese medicine, it mostly belongs to the category of stricture. Stricture has the distinction of deficiency and excess, with excess due to damp-heat, qi stagnation, and blood stasis obstructing the flow of qi; deficiency due to qi deficiency and kidney yang deficiency leading to failure of qi transformation. Clinically, it is often due to blocked seminal fluid, urological surgery, etc., causing the bladder to lose its function of qi transformation, waterway obstruction, with small amount of urine, dripping out, or even obstruction. It belongs to kidney disease and urinary disorders. Modern medicine calls it urinary retention. The treatment of this disease in traditional Chinese medicine requires differentiation of symptoms and treatment to achieve good results. The specific differentiation is as follows:

　　1. Bladder damp-heat

　　Syndrome: Difficulty in urination with small amount of urine, dripping slowly, or even difficult to flow, distension and pain in the lower abdomen, dry mouth without desire for drink, red tongue with yellow greasy coating, and slippery and rapid pulse. Treatment principle: To clear heat and drain dampness in the bladder.

　　(1) Main prescription: Modified Bazi San. Medication: Talc, Coptis, Plantago, Polygonum aviculare, Equisetum, Anemarrhena, Phellodendron, Gardenia, Rhubarb. Decocted for oral administration.

　　(2) Patent medicine: Tongguan Zishen Wan, Fenqing Wulin Wan.

　　(3) Single prescription: Tongbi Fang (Xue Ji Lian 'Xin Zhongyi' 1988.10). Medication: Cinnamon, Anemarrhena, Phellodendron, Rehmannia, Bamboo leaf. Decocted for oral administration.

　　2. Liver depression and qi stagnation

　　Syndrome: Sudden obstruction of urination or urination not smooth, with pain in the ribs, urgency and distension of urination, bitter taste in the mouth, mostly due to mental tension or fear, thin white tongue coating, and wiry pulse. Treatment principle: To soothe the liver and regulate qi, and to open orifices and drain turbidity. Main prescription: Modified Chen Xiang San.

　　3. Blood stasis and turbidity blocking the seminal palace

　　Syndrome: Difficulty in urination with dripping or urine thin as thread, or even obstruction, with distension and pain in the lower abdomen, purple and dark tongue with ecchymosis, and涩脉. Treatment principle: To remove blood stasis and unblock meridians, and to open orifices and drain turbidity.

　　(1) Main Formula: Daidi Dangwan modified. Herbs: Angelica sinensis, Prunus persica, Carthamus tinctorius, Poria cocos, Plantago asiatica, Alisma orientale, Rheum officinale, Bubalus bubalis. Decocted for oral administration.

　　(2) Patent Medicine: Qianlitong Tablets, Fufang Lintong Tablets, Qianlitong Yuyu Capsules.

　　(3) Single Formula: Yimu Sàojiāo Decoction (from Sui Dianjun et al. 'Essence of Famous Chinese Doctors' Recipes'). Herbs: Leonurus japonicus, Strychnos nux-vomica, Paeonia lactiflora, Morinda officinalis, Smilax glabra, Taraxacum mongolicum, Plantago asiatica, Zea mays, Glycyrrhiza uralensis. Decocted for oral administration.

　　4. Spleen Deficiency and Qi Sinking

　　Symptoms: Feeling of descent of Qi, frequent desire to urinate but dripping, weak urination, debility, shortness of breath upon exertion, decreased appetite, abdominal distension, loose stools, pale complexion, pale tongue with thin white coating, deep and fine pulse. Treatment principle: Tonifying Qi and lifting it upwards.

　　(1) Main Formula: Bu Zhong Yiqi Decoction (from Li Gao's 'Spleen and Stomach Theory') modified. Herbs: Astragalus membranaceus, Codonopsis pilosula, Atractylodes macrocephala, Cimicifuga foetida, Bupleurum chinense, Angelica sinensis, Citrus reticulata blanco var. tangerina, Cinnamomum cassia, Alisma orientale, Glycyrrhiza uralensis. Decocted for oral administration.

　　(2) Patent Medicine: Bu Zhong Yiqi Pill.

　　(3) Single Formula: Yiqi Guantong Decoction (from Zhang Shengping 'Shandong Traditional Chinese Medicine Journal' 1984). Herbs: Astragalus membranaceus, Lepidium meyenii Walp., Codonopsis pilosula, Poria cocos, Atractylodes macrocephala, Anemarrhena asphodeloides, Fritillaria thunbergii, Bupleurum chinense, Cimicifuga foetida, Cinnamomum cassia, Coptis chinensis, Glycyrrhiza uralensis. Decocted for oral administration.

　　5. Kidney Qi Deficiency

　　Symptoms: Dullness in the lower abdomen, difficulty in urination or dripping, weak urination, soreness in the loins and knees, debility, tinnitus, pale complexion, pale tongue with thin white coating, deep and fine pulse. Treatment principle: Warming the kidneys and benefiting water passages.

　　(1) Main Formula: Jisheng Shenqi Pill (from Yan Yonghe's 'Jisheng Fang') modified. Herbs: Rehmannia glutinosa, Dioscorea opposita, Alisma orientale, Morinda officinalis, Poria cocos, Cinnamomum cassia, Cornus officinalis, Aconitum carmichaelii, Plantago asiatica, Achyranthes bidentata, Moutan cortex. Decocted for oral administration.

　　(2) Patent Medicine: Jinkui Shenqi Pill.

　　(3) Single Formula: Wenyang Liuyi Decoction (from Lai Tian Song et al. 'Clinical Effective New Formula'). Herbs: Aconitum carmichaelii, Cinnamomum cassia, Codonopsis pilosula, Atractylodes macrocephala, Huoxiu, Moschus moschatus, Schisandra chinensis, Ophiopogon japonicus, Bambusa textilis, Poria cocos. Decocted for oral administration.

　　6. Exuberant Lung Heat

　　Symptoms: Difficulty in urination, dry throat, thirst, rapid breathing or cough. Thin yellow tongue coating, rapid pulse. Treatment principle: Clear lung heat, benefit water passages. Main formula: Qing Fei Yin (from Li Yongcui's 'Compendium of Treatments and Cures'). Herbs: Scutellaria baicalensis,桑白皮,栀子,麦冬,茯苓,北杏仁,木通,车前子. Decocted for oral administration.