Urethral mucosal prolapse

　　1. Etiology

　　The exact etiology is not yet fully clear. It is currently believed that pediatric urethral mucosal prolapse occurs in weak girls, related to the rapid enlargement of the pelvis, changes in pelvic organs, and the congenital defect of weak urogenital diaphragm, weak adhesion between urethral mucosa and submucosa, which are prone to mucosal prolapse. The prolapse in elderly women may be due to delivery injuries, decreased estrogen levels after menopause, atrophy of the surrounding urethral tissues, or general weakness, leading to weak urethral walls and relaxed surrounding urethral tissues, causing the urethral mucosa to flip out. In addition, various causes such as severe coughing, constipation, diarrhea, delivery, urinary tract infection, and carrying heavy loads can cause excessive bladder pressure, leading to an imbalance in bladder-urethral pressure. In addition, insufficient strength of the supporting tissues around the urethra can also lead to the occurrence of this disease. Other factors such as direct compression by bladder stones, urethral stones, or tumors can also trigger the disease.

　　2. Pathogenesis

　　The female urethra is vertically downward, short and wide. If the muscle layer's elastic fibers are relatively weak, the surrounding tissues are relaxed, and the mucosal development exceeds the muscle layer, the urethral mucosa, especially the posterior wall, flips out of the urethra, forming a partial urethral mucosal prolapse. If the urethral wall is also relaxed, the entire urethral mucosa will prolapse, forming a complete urethral mucosal prolapse. The prolapsed mucosa may become congested and swollen due to circular compression at the urethral orifice, friction stimulation from clothing, and even vascular thrombosis and necrosis. It can also lead to secondary infections and erosions.

　　1, Urethral obstruction:There may be a ring-shaped or semi-circular purple-red mass prolapse, the urethral orifice is located in the center of the mass, and there is urine flow when a catheter is inserted. Severe cases may also be accompanied by infection, erosion, patchy necrosis, or purulent crust, with bloody serous secretion and odor, leading to urethral obstruction.

　　2, Urinary tract infection:Due to the increased adhesion sensitivity of elderly urinary tract epithelial cells to bacteria, especially in women, some speculate that it may be related to changes in estrogen levels. Estrogen stimulation may increase the density of bacterial receptors on the cell surface and increase the activity of cell adhesion. In addition, due to the increased factors of urinary tract obstruction and poor urine flow in the elderly, it is more prone to concurrent urinary tract infection.

　　1, There may be symptoms of urinary urgency, frequent urination, and pain during urination, etc.

　　2, Urethral orifice hemorrhage: There may be bleeding at the urethral orifice after activity, with varying amounts of bleeding.

　　3, Urethral orifice mass: There may be a ring-shaped or semi-circular purple-red mass prolapse, the urethral orifice is located in the center of the mass, and there is urine flow when a catheter is inserted. It may also be accompanied by infection, erosion, patchy necrosis, or purulent crust, with bloody serous secretion and odor.

　　Manifested as a mass at the urethral orifice, partial prolapse patients have a mass located on the posterior side of the urethral orifice, complete prolapse patients have the mucosa prolapse in a ring shape, and the urethral orifice is located in the center of the mass. The diameter of the mass is about 1-5 cm, the color changes from bright red to dark red and even purple, often accompanied by serous bloody exudate. Mild cases often have local burning pain and frequent urination and dysuria, symptoms similar to urethral hemangioma. Severe cases may have difficulty urinating and severe pain due to thrombosis and tissue necrosis.

　　1, Prognosis:The prognosis of this disease is good.

　　2, Health care:For pediatric patients, most can recover spontaneously, so non-surgical treatment is mainly used for this type of child. For adult incomplete prolapse, injection therapy can be used, while the treatment for complete prolapse is mainly surgical, but there are more complications after surgery. In addition, whether for pediatric or adult patients, if the mucosa prolapses, it should be immediately repositioned. If the prolapse is long-lasting, and the prolapsed tissue is severely congested and edematous, go to the hospital and try to have the doctor manually reposition it.

　　1, Urinalysis:There may be symptoms of infection such as an increase in white blood cells and red blood cells.

　　2, Blood routine:The blood count may increase, with an increase in white blood cells, usually dominated by neutrophils.

　　3, Urinary bacterial culture:If there is a suspicion of urethral infection, the urethral secretion can be subjected to a smear staining examination or bacterial culture to identify the pathogenic bacteria. If the results are positive, it indicates an infection.

　　1, Diet

　　Therapeutic diet for preventing urinary system infection

　　2, Astragalus and White茅根 Drink

　　30 grams of Astragalus membranaceus, 30 grams of white茅根, 20 grams of Cistanche deserticola, 60 grams of watermelon rind. Wash the four herbs and place them in a pot, add an appropriate amount of water and boil to a thick juice, then add an appropriate amount of sugar to taste. Take one dose per day, divided into two servings, which can benefit the spleen, warm the kidneys, and promote diuresis and relieve stranguria.

　　3. Chinese Wolfberry and Poria Cocos Tea

　　50 grams of Chinese wolfberry, 100 grams of Poria cocos, appropriate amount of black tea. Grind the Chinese wolfberry and Poria cocos into coarse powder for reserve. Take 10 grams of the coarse powder once a day, add an appropriate amount of black tea, and brew with boiling water as a tea. Invigorate the spleen and kidneys, promote diuresis and relieve stranguria.

　　4. Others

　　100 grams of millet cooked with water into porridge, taken as breakfast and dinner, taken for 1-2 months. It can benefit the spleen and kidneys, dilute the interior and promote diuresis.

　　5. Lotus Honey Drink

　　100 milliliters of fresh lotus juice, 30 milliliters of white honey, 60 milliliters of raw rehmannia juice. Mix the above three juices, and simmer over low heat for 10-15 minutes. Take 10 milliliters each time, 4 times a day, swallow slowly, and take for 3 days. It can nourish yin and clear heat, cool blood and stop bleeding.

　　6. Celery and Shrimp Soup

　　Shrimp 15 grams, fresh celery 60 grams. First cook the shrimp with a small amount of water, then add celery together and boil, add seasonings when eating. Nourish yin and calm the liver, clear heat and promote diuresis.

　　1. Conservative Treatment

　　For pediatric patients, most can recover spontaneously, so non-surgical treatment is mainly used for this type of child.

　　For girls before menstruation and those with mild mucosal prolapse, conservative treatment can be used first. Antibiotics, local estrogen ointment, and hot sitz bath can be used. Menopausal women can take estrogen orally, such as Tiboロン (Levia), and perform prolapse复位.

　　2. Surgical Treatment

　　Applicable to patients with mucosal prolapse that is not effective with conservative treatment, especially those with incarcerated prolapse. Adult incomplete prolapse can be treated with injection therapy, while the treatment of complete prolapse is mainly surgical, but there are many postoperative complications.

　　1. Circular resection is the most commonly used surgical method. However, attention should be paid not to pull the urethral mucosa outward with force during resection to avoid excessive resection.

　　2. The ligation operation is generally less used. An indwelling catheter is placed in the urethra, and the base of the prolapsed mucosa is tied to the catheter with 4号线, allowing it to necrose and fall off.

　　3. Radial Electrocoagulation

　　Perform radial electrocoagulation around the prolapsed mucosa, once every two weeks, and shrink due to fibrosis after several times.

　　Whether it is a child or an adult patient, if the mucosa prolapses, it should be复位 immediately. If the prolapse is long, the prolapsed tissue is seriously congested and edematous, go to the hospital as soon as possible, and try to have the doctor manually复位.