Bladder prolapse

　　First, etiology

　　1. Pregnancy and childbirth Overpressure on the pelvic floor muscles by the presenting part of the fetus, increased abdominal pressure caused by forceps and postpartum cough, and other factors can lead to relaxation and injury of the pelvic floor tissues.

　　2. Urethral and vaginal surgery The removal of urethral cancer, urethral trauma defects, radical hysterectomy for cervical cancer, and other surgeries can destroy the normal structure and support of the urethra and bladder.

　　3. Urethral injury Severe urethral lacerations or extreme urethral dilation, such as sexual intercourse through the urethra, can cause relaxation of the urethral and vaginal sphincters and the bladder neck.

　　4. Weakness and estrogen deficiency Long-term illness can lead to local tissue relaxation; estrogen deficiency can cause a decrease in urethral closure pressure.

　　5. Increased intra-abdominal pressure Chronic cough, constipation, dysentery, acute cystitis can all lead to increased intra-abdominal pressure, becoming a trigger for bladder prolapse.

　　Second, pathogenesis

　　The premise for the occurrence of this disease is that the pelvic floor muscles, bladder neck, and urethra are too relaxed, so there is often a history of urinary incontinence before bladder prolapse. Bladder prolapse often occurs when abdominal pressure increases, with a tumor protruding from the urethra, which is pale red and smooth. Bladder prolapse can be divided into incomplete and complete types, with the former being more common. The protruding part is mostly the anterior part of the bladder trigone and the bladder neck. The mucosal surface that repeatedly protrudes has edema, congestion, and even erosion, and sometimes the trigone and the ureteral orifice can be seen on the protruding tumor. Bladder prolapse can be divided into three degrees: Degree I: prolapse does not reach the level of the urethral orifice; Degree II: prolapse reaches the level of the urethral orifice; Degree III: prolapse is below the level of the urethral orifice.

　　The bladder that protrudes cannot be retracted, which may lead to strangulation, severe abdominal pain, burning pain during urination, frequent urination, often accompanied by urgency, and in severe cases, resembling incontinence. Complications such as necrosis and infection can be life-threatening. There is also a possibility that due to the inability of the bladder to retract, narrowing may occur, leading to complications such as renal pelvis dilation and even renal function failure. It is necessary to check the patient's vital signs.

　　1. There is a history of difficult labor or injury to the urethra and vagina.

　　2. There is a history of urinary incontinence, and there are diseases that increase abdominal pressure, such as chronic cough and constipation.

　　3. There is a mass prolapse in the urethra,呈淡红色, with a smooth surface, which often occurs when abdominal pressure suddenly increases, and sometimes the trigone and ureteral orifice can be seen on the prolapsed mass.

　　The premise for the occurrence of this disease is that the pelvic floor muscles, bladder neck, and urethra are too relaxed, so there is often a history of urinary incontinence before cystocele. Secondly, due to delivery, iatrogenic injury, and trauma, cystocele can be directly caused. Therefore, it is necessary to pay attention to the protection of the perineum during delivery and to require medical personnel to gradually improve their medical technology level to reduce the occurrence of iatrogenic cystocele.

　　Visual examination: cystocele can be divided into 3 degrees, Ⅰ degree: prolapse below the level of the urethral orifice. Ⅱ degree: prolapse to the level of the urethral orifice. Ⅲ degree: prolapse below the level of the urethral orifice.

　　The general examinations required for this disease usually include: routine blood tests, urine tests, and abdominal ultrasound.

　　For the treatment of cystocele, it is necessary to tonify the middle and invigorate the Qi, with the main formula consisting of 12 grams of Angelica sinensis, 10 grams of dried tangerine peel, 8 grams of Cimicifuga foetida, 10 grams of Bupleurum chinense, 12 grams of Pseudostellaria heterophylla, 12 grams of Poria cocos, 15 grams of Astragalus membranaceus, 10 grams of Panax ginseng, 10 grams of Atractylodes macrocephala, and 10 grams of Glycyrrhiza uralensis.

　　The surgical treatment for cystocele includes two methods: manual reduction and surgical suspension. Manual reduction involves gently pushing the bladder back to its original position under anesthesia using hands or a straight urethral metal probe or cystoscope. After the incomplete cystocele is reduced, a large amount of retained urine often needs to be voided, and a F6 balloon catheter is left in place for one week. Simply reducing the bladder without leaving a catheter is often not effective in achieving reduction, and recurrence occurs shortly thereafter. Surgical suspension is suitable for those who fail to reduce surgically. The surgical method involves fixing the bladder to the fascia on the anterior abdominal wall.