Pelvic lipomatosis

　　The etiology of pelvic lipomatosis is unknown. Initially, it was considered to be related to perivesical inflammation caused by chronic lower urinary tract infection. It is generally believed that urinary tract infection is only secondary to pelvic lipomatosis.

　　Some scholars believe that this disease is a local manifestation of obesity, and there are reports that the condition improves after controlling diet and weight loss, but most patients are not obese, and there are also relatively thin patients. Some people propose that this disease is a local manifestation of a systemic disease. There are also scholars who propose that this disease is caused by fat deposition secondary to some hormone mechanism or local metabolic manifestation.

　　1. Uterine deformation, shrinkage, and ovulatory disorders.

　　2. Cystitis, with symptoms of frequent urination and urgency.

　　Patients with pelvic lipomatosis may develop various diseases, including hypertension, bladder mucosal cysts, adenocystitis, non-specific proctitis, prostate cancer, sigmoid colon mucinous cancer, bladder cancer, hydronephrosis, ureteral dilation, thromboembolism, and bilateral varicocele.

　　The lesions and extent of pelvic lipomatosis vary, and the symptoms are different.

　　1.50% of PL patients have lower urinary tract symptoms (early symptoms are not obvious, with the progression of the disease, about 50% of patients may experience: hematuria, bladder irritation symptoms (frequent urination, urgency, dysuria), incomplete urination, and a feeling of incomplete voiding. The most frequent urinary tract symptoms are frequent urination, difficulty in urination, and increased nocturia. Lower urinary tract symptoms are related to bladder outlet obstruction caused by the proliferation of adipose tissue around the bladder, combined with hypertrophic cystitis.

　　2.25% of patients have intestinal symptoms mainly characterized by constipation.

　　About 30% of patients have hypertension.

　　Pelvic lipomatosis, first reported by Engels in 1959, is described as an increase in fat around the sigmoid colon and bladder, leading to fixed deformation of the sigmoid colon and bladder. The etiology is unknown, and it is generally believed to be related to pelvic infection caused by inflammation of the bladder and ureter; or related to obesity, abnormal lipid metabolism, changes in endocrine and hormone metabolism, local hypersensitivity, and congenital venous vascular abnormalities.

　　There is no specific preventive method for this disease. For pelvic infection, active treatment should be given, and overweight individuals should lose weight.

　　1. IVP

　　Characteristic 'upside-down pear', 'tear drop', or 'gourd' shape extrinsic elongation changes of the bladder are seen, with the bladder base elevated. At the same time, signs of upper urinary tract obstruction can be seen. Moss et al. summarized the above X-ray findings as a triad: bladder deformation elongation, elevation of position, and median displacement of the ureter.

　　2. Cystography

　　The bladder is deformed and compressed by pelvic fat, presenting a 'upside-down pear' shape; the bladder neck is elongated.

　　3. CT

　　Large amount of fatty tissue proliferation around the bladder; uniform thickening of the bladder wall; CT diagnosis of pelvic fat accumulation syndrome is significantly better than plain X-ray examination, with high density resolution, which can distinguish fat tissue from other tissues and make a qualitative diagnosis. Gerson et al. described the CT characteristics of PL as: a large amount of uniform low-density shadow in the pelvis, with a CT value of about -100HU, most of which are distributed around the bladder and rectum, which is a characteristic manifestation of the disease. Local organs are compressed and deformed, with the bladder and rectum being the most obvious.

　　4. MRI

　　The T1 phase MRI of the pelvic fat accumulation syndrome shows that the bladder and rectum are surrounded by a large amount of fatty tissue; the bladder is compressed and deformed; the bladder is deformed and compressed, and the pelvic T2 phase MRI shows fat signal around the pelvis; the bladder wall is locally irregularly thickened; bladders are formed and project towards the bladder. Professor Zhou Liangping of the Department of Radiology, Peking University First Hospital, and others believe that MRI is the best imaging examination method for the diagnosis of this disease, especially the measurement of the sagittal T1W1 bladder shape index and bladder seminal vesicle angle (PL enlargement) is of great value for the quantitative diagnosis of this disease.

　　5. MRU

　　Pelvic ureteral junction obstruction; ureteral tortuosity; narrowing of the lower ureter; elongation of the bladder neck.

　　1. Control the intake of calories. Excessive calories can increase fat synthesis and accelerate the progression of pelvic fat accumulation syndrome. Proper calorie control can gradually reduce weight, which is conducive to the recovery of patients, and the recommended daily intake per kilogram of body weight is 71.4-105 kilojoules.

　　2. Controlling the intake of carbohydrates is beneficial for weight loss and the treatment of pelvic fat accumulation syndrome. Excessive sugar can increase insulin secretion, stimulate the liver to synthesize triglycerides, which is very unfavorable for pelvic fat accumulation syndrome. Therefore, it is especially necessary to limit the intake of sucrose, glucose, and desserts with high sugar content.

　　3. Intake of sufficient high-quality protein is beneficial for the repair and regeneration of liver cells. Fat-free milk, steamed egg whites, lean pork, lean beef, chicken, shrimp, and other foods can be chosen.

　　4. Limit the intake of fat. Excessive intake of saturated fat can increase calories, which is not conducive to the improvement of the condition, affect cholesterol levels, and also cause cholesterol to deposit in the liver, hindering glycogen synthesis in the liver, and impair liver function. It is forbidden to eat fatty meat, egg yolks, animal internal organs, and so on.

　　5. Increased pelvic adipose tissue affects the absorption and metabolism of vitamins in patients, and it is recommended to choose foods rich in vitamins in the diet, such as B vitamins have the effect of preventing fat transformation, vitamin B12 helps remove fat and has the effect of preventing the formation and development of increased pelvic adipose tissue. Vitamin C can increase cell resistance and promote cell regeneration.

　　6. Eat more fiber-rich foods to reduce the absorption of fat in the intestines. Fresh vegetables (recommended to eat more cucumbers, radishes, bamboo shoots, mushrooms, celery), fruits, millet, sesame seeds, beets, seafood, etc. are all good fat-reducing foods that can promote phospholipid synthesis and assist in fat decomposition. WHO recommends the most famous "Love Liver Foods" to the public: corn, kelp, apples, milk, onions, cucumbers, walnuts, etc.

　　7. Patients with increased pelvic adipose tissue should appropriately limit salt intake, controlling the daily salt intake to less than 6 grams. Eat less spicy and刺激性 food, such as scallions, ginger, garlic, chili, curry, etc. To ensure low-fat cooking, the cooking methods should mainly be steaming, boiling, stewing, and braising, and try to use less oil.

　　Traditional Chinese Medicine Treatment for Increased Pelvic Adipose Tissue:

　　1. Accumulation of heat in the uterus and ovaries: fever and headache, pain in the lower abdomen that is resistant to palpation, increased leukorrhea, yellow or red and white mixed, thick and foul-smelling, dry mouth and cold drinks, short and yellow urine, constipation or loose stools that are not smooth, red tongue with yellow greasy coating, slippery and rapid pulse. Clear heat and detoxify. Add and subtract the Yin Qiao Hong Jiao Detoxifying Decoction with Rhubarb, Coptis, Poria, and茵陈.

　　2.湿热证 of the uterus and ovaries: intermittent low fever, distension and pain in the lower abdomen, soreness in the lower back, decreased appetite, yellow leukorrhea, thick and foul-smelling, short and yellow urine, red tongue with yellow greasy coating, slippery and rapid or soft and rapid pulse. Clear heat and resolve dampness. Add and subtract the Er Bao Powder and Long Dan Xie Gan Decoction.

　　3. Stagnation of meridians of the uterus and ovaries:坠胀、刺痛、拒按 in the lower abdomen, soreness in the lower back and sacrum, unsmooth menstrual flow, with blood clots, possibly palpable mass in the lower abdomen, dark tongue with spots, wiry and涩 pulse. Activate blood circulation and Qi flow. Add Patrinia scabiosa and Leonurus japonicus to the Xiaobu Eliminate Blood Stasis Decoction.

　　4. Deficiency of Qi and retention of pathogenic factors: hidden pain and distension in the lower abdomen, soreness in the lower back and sacrum, exacerbated by fatigue, sexual intercourse, defecation, and menstrual flow, with increased leukorrhea, low fever, possibly palpable mass in the lower abdomen, pale and dark tongue, greasy coating, wiry pulse. Reinforce the healthy and expel the pathogenic factors. Add Patrinia scabiosa and Leonurus japonicus to the Suanxin Decoction.