Bladder neck stenosis

　　It is generally believed to be related to chronic inflammation. Pathologically, the submucosal smooth muscle of the neck is replaced by fibrous connective tissue, the bladder neck becomes pale and rigid and fixed, the neck orifice becomes narrow, and the symptoms of bladder neck obstruction appear, that is, long-term difficulty in urination. Women also call it 'female prostatic disease', which is more common in middle-aged and elderly women. Male bladder neck stenosis can occur simultaneously with benign prostatic hyperplasia. Therefore, the bladder neck should also be shaped after the prostate is removed, otherwise the obstruction symptoms cannot be relieved.

　　Bladder neck stenosis, due to causing poor bladder urination, if not treated in time, can lead to various complications:

　　1, Urinary tract infection:Bladder neck stenosis causes poor urinary flow, resulting in residual urine in the bladder, which is prone to bladderitis, trigone inflammation, and in severe cases, pyelonephritis. The lower urinary tract, due to insufficient urine flushing, is prone to prostatitis and urethritis.

　　2, Renal hydrops and renal insufficiency:If urinary retention caused by bladder neck stenosis is not removed in time, it may lead to renal hydrops and renal insufficiency in the later stage.

　　Bladder neck stenosis is another important problem of bladder neck obstruction. The so-called bladder neck refers to a segment of tubular structure extending from the internal urethral orifice to the urethra, about 1-2 cm in length. It includes the internal sphincter, but the internal sphincter is not the whole of the bladder neck. Bladder neck stenosis, in terms of etiology, can be congenital or acquired. The pathological changes of bladder neck obstruction are relatively complex, mainly manifested as follows:

　　1, The main symptoms are progressive difficulty in urination, frequent urination, increased night urination, and other symptoms of bladder outlet obstruction. Severe cases may manifest as urinary retention or overflow incontinence.

　　2, The bladder may have complications such as calculi, diverticula, or infection.

　　3, Later complications may include renal hydrops and renal insufficiency.

　　4, Physical examination may not show any special findings, and some patients may feel an enlarged bladder above the pubic bone, and the catheter or urethral probe may be blocked or unable to pass through the bladder neck during cystoscopy.

　　5, Most patients have a history of prostate or bladder neck surgery, and some middle-aged patients may have a history of prostatic or post-urethral inflammation.

　　There are 2 reasons for the formation of bladder neck stenosisAmong them, one is congenital, generally more common in male patients. Another cause is acquired, mainly due to local chronic inflammation such as post-urethral inflammation, prostatitis, trigone inflammation, etc., leading to a higher incidence rate in female patients than in male patients. The latter's bladder neck stenosis may be related to the decrease in estrogen levels, atrophy of the urethral and vaginal epithelium, decreased resistance, and easy recurrence of infection. Therefore, long-term administration of a small amount of long-acting estrogen should be considered for the prevention of the disease. Pay attention to perineal cleanliness and hygiene. In daily life, it is important to maintain a good attitude and not to seek medical treatment randomly once the disease occurs; pay attention to dietary structure, balanced nutrition, and a combination of work and rest; avoid smoking, drinking, chili, garlic, celery, radish, and other foods; avoid prolonged sitting, staying up late, and excessive drinking.

　　The main symptom of bladder neck obstruction is difficulty in urination. In the early stage, it is characterized by delayed urination, slow urine flow, thinning of the urine stream, and gradually developing into difficult urination; in the late stage, urinary retention may occur, and enuresis and incontinence may also occur, often with urinary tract infection. Severe cases may present with bilateral renal hydrops and chronic renal insufficiency.

　　Women over middle age with progressive difficulty in urination should consider this disease, and combine the following examinations to help with diagnosis:

　　1) Bladder neck palpation

　　Tactile examination of the bladder neck through the vagina can feel the tissue of the neck has varying degrees of thickening. When a catheter is placed in the urethra, the thickening sensation of the above tissue is more obvious.

　　2) Ureteroscopy

　　It is the most important and reliable method for diagnosis. There are obvious trabeculae and small chambers and other lesions in the bladder. In addition, there may be stiffness and edema of the mucosa of the bladder neck, the posterior lip of the neck opening forming a steep ridge, and sometimes the bladder neck may be ring-shaped narrow, with the inner opening presenting a collar-like prominence.

　　3) Excretory Cystography

　　It can be seen that the neck is stiff, not fully open, and narrow, and some may see vesicoureteral reflux.

　　4) Bladder Pressure and Urodynamic Examination

　　In the early stage of obstruction, the detrusor compensates for its hyperplasia and hypertrophy, and the urinary pressure in the bladder is higher than normal; when the obstruction worsens, the urine flow rate can decrease significantly, and more residual urine may appear.

　　5) Upper Urinary Tract Examination

　　For those suspected of having upper urinary tract damage, intravenous pyelography should be performed to observe the functional state and morphological changes of the upper urinary tract.

　　If bladder neck obstruction is not treated in time, severe cases may develop bilateral hydronephrosis and chronic renal insufficiency. Therefore, do not hesitate to seek medical attention when symptoms appear, and go to the hospital for treatment in time to avoid exacerbation of symptoms. At the same time of treatment, in terms of diet, it should be regular and reasonable, that is, to take high-protein, high-vitamin foods as the mainstay. Choose high-nutrient plant or animal proteins, such as milk, eggs, fish, lean meat, various bean products, etc.

　　The main symptom of bladder neck obstruction is difficulty in urination. In the early stage, it is slow in urination, slow urine flow, and thinning of the urine stream, gradually developing into difficult urination; in the late stage, urinary retention may occur, and enuresis and urinary incontinence may also occur, often with urinary tract infection. If not treated in time, severe cases may develop bilateral hydronephrosis and chronic renal insufficiency. Therefore, do not hesitate to seek medical attention when symptoms appear, and go to the hospital for treatment in time. In traditional Chinese medicine treatment, acupuncture can be considered for the treatment of this disease, which has certain effects.

　　Acupuncture Treatment for Bladder Neck Stricture:

　　Group ①: Qihai, Guanyuan, Shuidao, Qugui, Sanyinjiao, Shenshu, Pangguangshu, Yanglingquan

　　Group ②: Qugui, Henggu, Sanyinjiao, Shenshu, Ashi Point (4.5 cm beside Zhongji Point), Huantiao

　　Group ③: Guanyuan, Gugui, Sanyinjiao, Shuidao, Guilai, Shenshu, Pangguangshu