Urinary syndrome

　　Studies have shown that urinary syndrome is mainly related to the following causes:
　　1. Urinary system infection, the pathological changes of the tissue at the urethral orifice of the patient are all chronic inflammatory reactions.
　　2. Urethral obstruction: such as bladder neck obstruction, fibrosis of the surrounding tissue at the distal urethra, or sphincter spasm leading to narrowing of the distal urethra.
　　3. Anatomical abnormalities at the urethral orifice, such as fusion of the hymen, hymen prolapse, and fusion of the labia minora. It has been reported that the distance from the urethral orifice to the vaginal orifice is closely related to urinary syndrome, and the closer the distance, the higher the incidence rate. The incidence rate reaches 72.15% for those with a distance of 3mm or less.
　　4. Abnormal nerve function, injury, infection, and X-ray radiation can cause the proliferation of fibrous tissue inside the urethra, leading to abnormal reflexes of the nerves.
　　5. Psychological factors. States such as tension, anxiety, suspicion, and introversion are susceptible factors for urinary syndrome.
　　6. Other factors, such as immunological factors, decreasing estrogen levels, magnesium ion deficiency, and iatrogenic factors, etc.

　　The complications of urethral syndrome differ according to gender, as follows:
　　Complications in male patients: epididymitis, prostatitis, seminal vesiculitis, etc.;
　　Complications in female patients: endometritis, salpingitis, pelvic inflammation, peritoneum, etc.
　　Urethral infection can spread directly to the bladder or prostate, causing cystitis or prostatitis. If urethral syndrome is not treated properly, it may lead to complications such as paraurethral abscess, which can penetrate the skin of the penis to become a urethral fistula. Fibrosis during the healing process of urethral inflammation can cause urethral stricture.

　　Symptoms of urethral syndrome:Patients with symptoms of frequent urination, urgency, and dysuria, some patients accompanied by urethral burning sensation and difficulty in urination, and at the same time, there may be suprapubic bladder pain, lumbar pain, and sexual pain.

　　The preventive measures for urethral syndrome are as follows:
　　1. Keep the local area dry and clean, take a bath frequently. Avoid inflammation and eczema caused by frequent urination, urgency, and urinary incontinence.
　　2. Eat less spicy food in diet.
　　3. Drink plenty of water, at least about 2000 milliliters a day, after drinking more water, the frequency of urination increases, and the large amount of urine excretion can flush the bacteria in the urinary tract out of the body.
　　4. Apply heat compresses to the lower abdomen and bladder area, or take a hot bath and hot sitz bath, the purpose is to accelerate the blood circulation of the lower urinary tract, control inflammation, and relieve symptoms.
　　5. Abstain from sexual activity, stop sexual activity during the illness to avoid further aggravating the condition.

　　The examination items for urethral syndrome are as follows:
　　1. Urinalysis:No abnormalities were found in non-infectious urethral syndrome; in infectious urethral syndrome, there were only a few white blood cells and pus cells, less than 5 per high-power field.
　　2. No fungal bacteriuria:Three consecutive midstream urine bacterial cultures were negative, and the possibility of false-negative results caused by tuberculosis bacteria, anaerobic bacteria, fungi, and other pathogens causing urinary tract infection was excluded.
　　3. Chlamydia and mycoplasma tests:In infectious urethral syndrome, sometimes bladder, urethra, or adjacent organ infection foci can be found, and chlamydia, mycoplasma, and other tests are positive.
　　4. Intravenous urography (IVU):Can preliminarily exclude diseases such as urinary tuberculosis, tumor, calculus, and bladder diverticulum.
　　5. Urethral cystoscopy:To understand whether there is infection, tumor, urethral stricture, interstitial cystitis, and other conditions in the urethra and bladder.
　　6. Urodynamic examination:The symptoms include overactivity of the bladder, bladder weakness, narrowing of the distal urethra, and increased urethral pressure, among which narrowing of the distal urethra is the most common, and overactivity of the bladder is often the pathological basis of the prolonged symptoms.

　　Urethral syndrome can be treated with diuretic foods in diet, such as watermelon, grapes, pineapple, celery, pears, etc. In addition, snails, corn, mung beans, and scallion whites can help alleviate symptoms such as frequent urination, urgency, and dysuria. Patients with cystitis also need to drink plenty of water to maintain a daily urine output of at least 1500 milliliters. However, it is important to note that:

　　1. It is necessary to avoid eating sour and spicy刺激性 foods, such as strong alcohol, chili, original vinegar, sour fruits, etc. In addition, caffeine can cause the bladder neck to contract, leading to spasmodic pain in the bladder, so coffee should be drunk in moderation. It is also necessary to avoid eating citrus fruits, as citrus can cause alkaline urine, which is conducive to bacterial growth.

　　2. It is strictly forbidden to drink alcohol, chili, chicken, fish, beef, shrimp, seafood, salted vegetables during the medication period. Seasonings can only be salt, vinegar, monosodium glutamate (other seasonings should not be used). If the patient does not control their diet well, it will prolong the treatment time.

　　The specific measures for the Western treatment of urethral syndrome are as follows:
　　One, general treatment
　　Rest, diuresis, hot water sitz bath, lower abdominal heat compress, physical therapy, and acupuncture treatment, etc.
　　Two, behavioral treatment
　　Behavioral treatment includes psychological treatment and biofeedback treatment. Doctors need to have patient and thorough conversations with patients to ensure that patients have a correct understanding of the disease and actively cooperate with treatment. Bladder function training is an important part of behavioral treatment and biofeedback treatment. Through bladder training, the nervous system's control over micturition can be enhanced, the sensitivity of the bladder reduced, and normal micturition function rebuilt, thereby alleviating or eliminating symptoms of frequent urination and urgency. The specific method is to encourage drinking more water during the day, engage in other work or leisure activities, and distract attention from the urge to urinate. Actively control the time of urination and gradually extend the interval between urinations, and appropriately combine it with relevant drug treatment.
　　Three, drug treatment
　　1. Alpha-adrenergic blockers: such as 25mg of nafiganide, once a day, 2mg of trazodone, once a day, or 0.2mg of tanlaoxin (Hale) once a day or twice a day, taken orally.
　　2. Antispasmodic analgesics: Anticholinergic drugs such as bromisovalerate (Prupenxin) and hyoscyamine hydrobromide; or selective smooth muscle relaxants such as urinary ling; muscarinic receptor blockers such as senecionin, etc.
　　3. Magnesium ion oral solution: It can increase the concentration of extracellular magnesium ions, reduce the excitability of the detrusor muscle, keeping it in a relaxed state, and improve the compliance of the bladder.
　　4. Sedatives and antidepressants; such as 0.25mg of alprazolam (Kailiding), 3 times a day, or 20mg of fluoxetine (Prozac), 2 times a day or 3 times a day, which have a synergistic effect of anti-anxiety and antidepressant.
　　5. Capsaicin or capsaicin-like substances: 40ml of lidocaine 2% is injected into the bladder and retained for 30 minutes as a local anesthetic. For individuals with normal bladder capacity, 100ml of a capsaicin solution with a concentration of 100μmol is infused at a rate of 30ml/min after the bladder is emptied, and retained for 30 minutes. After infusion, the bladder capacity increases, and there may be local burning pain side effects. The efficacy is good, with a long duration of action, and it can be an effective treatment method for intractable urethral syndrome. Studies have shown that there are nerves in the human bladder that are sensitive to capsaicin. After blocking the传入 nerves with capsaicin, 94% of patients experience improvement or even disappearance of symptoms. Capsaicin-like substances have a pungency 1000 times that of capsaicin, require a lower infusion concentration, have the same therapeutic effect, and have no side effects of capsaicin, making them seem more worthy of application.
　　6. Antibiotics: Infection may still be a basic factor in this condition, so it is still recommended to use appropriate antibiotics for treatment during an attack, but long-term use should be avoided.
　　7. Local Infiltration Therapy: Commonly used infiltration drugs include gentamicin 80,000U, dexamethasone 5mg added to 2% procaine 6ml. It can be used for bladder neck and proximal urethra infiltration, and bladder trigone area infiltration.
　　8. Estrogen: Used for those with low estrogen levels, including systemic medication and local medication. The commonly used尼尔雌醇2mg is taken once every two weeks or once a month; or diethylstilbestrol 0.5mg, once a day, for 3 weeks, then stop for 1 week, and repeat the course according to circumstances; or tibolone (Libi Love) every other day or every 3 days half a tablet; or diethylstilbestrol ointment, applied locally to the vulva or vagina, etc.
　　4. Surgical Treatment
　　1. Urethral dilation: Suitable for different degrees of urethral obstruction, including asymptomatic cases, performed under urethral mucosal anesthesia, once a week, the urethral dilator number should gradually increase to F36-F42, and the symptoms of most patients are improved.
　　2. Urethral release surgery: For those who have failed to relieve urethral stricture after dilation, this surgery can be performed under local anesthesia, and urethral dilation can be used every two weeks after wound healing. The surgery removes 1/2 of the elastic tissue cord between the urethra and vagina or cuts multiple circular elastic tissue cords, which can reduce urethral resistance.
　　3. Correction of urethral and hymen variations:
　　(1) Labial fusion: Labial separation surgery.
　　(2) For those with a valve-shaped or dam-shaped urethral orifice, perform dam or valve resection; the hymen prolapse should be removed.
　　(3) Urethrovaginal处女膜融合型：There are various surgical methods, such as urethral orificeplasty, vaginal orifice anterior margin repositioning, and urethral vestibule transplantation, etc. The design of the first two methods seems more reasonable and the effect is also better. Indications: Patients with urethrovaginal hymen fusion symptoms closely related to sexual intercourse are most suitable for this surgical treatment; those who have been treated with various methods but are ineffective, although the symptoms are not closely related to sexual life, can also consider surgical treatment. Those who have not given birth after marriage are not suitable for surgical treatment at present to avoid affecting the surgical effect due to delivery trauma in the future. The surgery requires achieving smooth urethral orifice and distal urethra, extending the urethral orifice-vaginal orifice distance (more than 1cm), which has a good effect and improves the satisfaction of sexual life.