Urethral neck obstruction in elderly women

　　How is urethral neck obstruction in elderly women caused? The following is a brief description:

　　1, Etiology

　　The etiology of female urethral neck obstruction is not yet fully clear. It is currently believed that the main cause is chronic urinary tract infection. Urinary tract infection is also related to the anatomical characteristics of the female urethra and endocrine disorders.

　　The etiology of female urethral neck obstruction is not yet fully clear. It is currently believed that the main cause is chronic urinary tract infection. Urinary tract infection is also related to the anatomical characteristics of the female urethra and endocrine disorders. The female urethra is short and straight, the urethral orifice is wide and close to the vagina, and it is prone to infection. Due to repeated urinary tract infections, long-term chronic inflammation of the bladder neck, mucosal congestion and hypertrophy, submucosal cell infiltration, smooth muscle and connective tissue hyperplasia of the bladder neck, in addition, there are multiple branches of female paraurethral glands, 3 to 30 or more gland ducts surrounding the urethra and opening into the urethral lumen. The proximal ducts are very short, showing grooves or pouches, which are prone to infection, hyperplasia, and cystic change, causing urethral neck obstruction. Endocrine disorders are another main cause of urinary tract infection.

　　2, Pathogenesis

　　Female hormones have the effect of increasing glycogen in vaginal epithelial cells. Glycogen is decomposed into lactic acid by vaginal bacteria, which inhibits the growth of bacteria. When the activity of female hormones decreases or disappears, local resistance decreases, and vaginal inflammation is prone to occur, thus secondary urethritis and bladder trigone inflammation, leading to urethral neck obstruction.

　　What diseases can be caused by urethral neck obstruction in elderly women? The following is a brief description:

　　1, Urinary tract dilation. When there is urinary tract obstruction, cystoscopy can detect bladder neck stenosis, bladder stones, and small columns, small chambers, diverticula, and other lesions in the bladder, causing urinary tract obstruction. Generally, cystoscopy and urinary tract imaging can be used for diagnosis.

　　2, Renal hydronephrosis. Enlargement of the renal pelvis accompanied by atrophy of renal tissue due to urinary tract obstruction, which can be differentiated by renal pelvis imaging.

　　3. Renal function damage. All patients with unexplained renal insufficiency should be considered for obstructive urinary tract disease. The medical history may suggest symptoms caused by urinary stones, tumors, and other conditions.

　　The main clinical manifestations of female bladder neck obstruction are difficulty in urination. In the early stage, there may be slow urination, thinning of the urine stream, short射程, and gradually developing into difficult urination, presenting as droplets, often with a feeling of incomplete emptying. In the later stage, the residual urine gradually increases, even leading to urinary retention, and there may also be enuresis, urinary incontinence, recurrent urinary tract infections. Finally, it may cause renal calculi or renal failure, often accompanied by low back pain, lumbosacral pain, umbilical and lower abdominal坠痛, etc.

　　For women over the age of 40, especially elderly women, if there is progressive difficulty in urination, the possibility of bladder neck obstruction should be considered.

　　The etiology of female bladder neck obstruction is not yet fully understood. Currently, it is believed that the main cause is chronic urethral infection. Urethral infection is closely related to the anatomical characteristics of the female urethra, endocrine disorders, and drinking habits. Therefore, if urinary system infection occurs, effective antibiotics should be used as soon as possible to control the infection. If conservative medical treatment in internal medicine is ineffective, surgery should be performed as soon as possible to actively protect renal function.

　　What examinations should elderly female patients with bladder neck obstruction undergo? A brief description is as follows:

　　1. Residual Urine Measurement

　　Uroflowmetry can be measured using catheterization or ultrasonography, with catheterization being the most accurate method. After the patient has urinated, a catheter is inserted under sterile conditions to release all urine, which is considered residual urine. Normal residual urine should be less than 10ml, early obstruction residual urine should be less than 60ml, and in the later stage, it can reach more than 300ml.

　　2. X-ray Examination

　　Cystourethrography, performed under continuous filming with the aid of a television, can observe the bladder filling status and the contraction function of the bladder during micturition; or it may present as a completely closed state, unable to open; or as a semi-closed state, unable to fully open; or the neck may close prematurely, preventing the bladder from emptying. Posterior-anterior and oblique position photographs can show the posterior lip of the bladder neck elevated; double-contrast cystography with air and sodium iodide can display changes in the bladder neck similar to those in benign prostatic hyperplasia in males, and can also determine the presence and degree of vesicoureteral reflux; intravenous urography can understand renal function and the condition of renal pelvis and ureteral hydronephrosis.

　　3. Cystoscopy

　　Cystoscopy is the main method for diagnosing bladder neck obstruction. By inserting a cystoscope, one can directly understand the situation of obstruction at the bladder neck and simultaneously observe any lesions within the bladder.

　　4. Urodynamic Examination

　　Uroflowmetry is the most useful objective indicator for evaluating urinary status. In patients with bladder neck obstruction, it can be observed that the intravesical pressure is significantly increased, urine flow is reduced, and the urinary flow curve changes. However, diagnosis of obstruction solely based on uroflowmetry is insufficient. Uroflowmetry is determined by the strength of the detrusor muscle in the bladder and the resistance of the urethra. Statistics indicate that for those with a maximum urine flow rate of 15ml/s, 68% have no obstruction. Therefore, to further clarify whether there is an obstruction or not, it is necessary to measure the detrusor pressure during micturition. The method of measuring detrusor pressure during micturition and uroflowmetry is considered to be relatively accurate.

　　In daily life, attention should be paid to reasonable nutrition, food should be as diverse as possible, eat more high-protein, high-vitamin, low-animal-fat, easily digestible foods, fresh fruits and vegetables, do not eat stale, deteriorated or stimulating things, eat less smoked, roasted, salted, pickled, fried, salty food, staple foods should be mixed with coarse and fine grains to ensure nutritional balance. Do not eat or eat less cream, candy or sour drinks, eat less sweets, eat less refined sugar, and eat more standard flour. This can improve digestion, reduce calorie intake, and reduce the absorption of fat and cholesterol in the intestines.　

　　The following is a brief description of the treatment methods for female bladder neck obstruction in the elderly:

　　I. Treatment

　　1. Symptomatic treatment: For early cases without residual urine, long-term anti-inflammatory treatment can be adopted, and the application of alpha-blockers should be observed. For patients with concurrent infection, effective antibiotics should be selected to control infection while fully draining urine. For patients with excessive residual urine or severe renal function damage, bladder fistula should be performed to drain urine, so that renal function can be restored or stabilized before selecting other methods.

　　2. Urethral dilation: For patients with mild obstruction and no complications, urethral dilation can have certain efficacy. Generally, it needs to be dilated to about 30. Effective ones can be dilated regularly, 1 time/week or 1 time/2 weeks, and supplemented with physical therapy.

　　3. Transurethral bladder neck resection: For moderate cases that are ineffective after conservative treatment, many scholars have adopted the method of transurethral resection of the thickened and hyperplastic tissue of the posterior lip of the bladder neck with an electrocautery scope in recent years, which has been widely used and the effect is satisfactory.

　　4. Bladder neck Y-V plasty: For patients whose treatment with other methods is not ideal, bladder neck Y-V plasty can be performed. That is, Y-shaped incision and V-shaped suture to enlarge the bladder neck lumen. This surgery will shorten the length of the urethra, so it is required that the preoperative measurement of urethra length should be more than 3cm, otherwise urinary incontinence may occur after surgery. At the same time, it is required that the distal end of the Y-shaped incision should not be too long to avoid cutting the urethral sphincter muscle and causing urinary incontinence.

　　II. Prognosis

　　It is reported that the cure rate is 50%, and 30% of the patients have improved symptoms. However, regular urethral dilation is still needed after surgery, and it is especially important to avoid extensive and long incisions to prevent urinary incontinence or vesicovaginal fistula.