Female bladder neck obstruction

　　First, etiology

　　The etiology has not been established, and there are roughly the following views, namely, the fibrosis of the sphincter and adjacent tissues caused by inflammation, non-inflammatory or aging phenomena, long-term spasm of the bladder neck; it is speculated that the disease is a connective tissue disease because fibroblasts that form collagen are found in the local tissue structure; congenital malformation, especially poor bladder neck nerve and muscle structure: early nerve damage; secondary formation of bladder neck sclerosis after vaginal, urethral, and bladder neck surgery, etc.

　　Second, pathogenesis

　　The pathological changes of female bladder neck obstruction are relatively complex, mainly manifested as follows:

　　1. In many cases, the specimens of bladder neck resection show hyperplasia and hypertrophy of smooth muscle fibers, causing muscle hypertrophy at the internal orifice, similar to congenital pyloric hypertrophy.

　　2. Bodian et al. found that a large amount of smooth muscle tissue in the bladder neck is replaced by elastic fiber tissue, and there is an increase in fibrous elastic tissue.

　　3. In some cases, the pathological sections of the bladder neck show hyperplastic glands, which are morphologically very similar to the male prostate.

　　4. Submucosal inflammatory infiltration and edema thickening of the bladder neck, and a large proportion of squamous metaplasia.

　　If the obstruction at the bladder neck orifice is not diagnosed and properly treated in time, it can lead to upper urinary tract dilation and hydrops, affecting kidney function. In severe cases, or in cases with concurrent infection, kidney function damage with serious prognosis may occur. Western medicine believes that the kidney is an important organ for secreting urine, excreting waste and toxins, and can regulate the concentration of electrolytes in the human body and maintain acid-base balance. When kidney function is damaged or gradually deteriorates, the excretion and regulatory functions of the kidney will also decrease. Severe kidney damage can also lead to uremia, which is life-threatening.

　　1. Symptoms:It is mainly characterized by progressive difficulty in urination, manifested as delayed urination, thinning of the urine stream, difficult urination, dribbling, and gradually appearing residual urine, urinary retention, and overflow incontinence, etc.

　　2. Bladder neck palpation:Touching the bladder neck through the vagina, one can feel that the neck tissue has varying degrees of thickening, especially when a catheter is placed in the urethra, the thickening of the neck tissue is more obvious.

　　If middle-aged and older women have difficulty urinating for unknown reasons, they should consider the possibility of bladder neck sclerosis and further examination should be performed.

　　The etiology of female bladder neck obstruction is not yet fully clear. It is currently believed that the main cause is chronic urethral infection. Urethral infection is also 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. At the same time, if conservative treatment in internal medicine is ineffective, surgery should be performed as soon as possible to actively protect kidney function.

　　1, Urinalysis:It can be seen that there are white blood cells or pus cells.

　　2, Renal function tests and blood biochemical tests:Only when both kidneys are significantly damaged will azotemia (non-protein nitrogen, urea nitrogen, creatinine, etc.) appear, so this examination cannot reveal the damage to renal function in the early stage. Phenol red (phenolsulfonphthalein PSP) excretion test can earlier indicate hydronephrosis and renal function status. For patients with renal damage, blood potassium, sodium, chlorine, and carbon dioxide binding power should also be measured to determine whether there is an imbalance of electrolytes and acidosis.

　　3, Cystoscopy:It is the most important and direct examination method. Under the microscope, the mucosa of the bladder neck is rigid and edematous, the posterior lip is elevated, the neck contracts, the opening movement is weakened or disappears, and the bladder can be seen with trabeculae, small chambers, and renal pelvis ridge elevation, and other chronic obstructive changes.

　　4, Cysto-urethrogram during micturition:It can be seen that the neck of the bladder is stiff, in the process of urination, the neck is open late or not fully open, the neck orifice is narrow, and at the same time, the bladder wall is uneven, and sometimes diverticula may form.

　　5, Residual urine measurement:Judging the degree of obstruction according to the amount of residual urine, choosing effective treatment, and also used to observe the effect of treatment.

　　6, Urodynamic examination:In the early stage of obstruction, the bladder pressure during micturition is higher than normal, and the maximum urine flow rate is normal. When the obstruction is further exacerbated and the detrusor loses compensation, the bladder pressure during micturition can decrease to normal, with residual urine, and the maximum urine flow rate decreases. Urodynamic examination shows that when the urine flow rate is close to the maximum, the simultaneous imaging shows that the bladder neck is poorly open.

　　One, Health-preserving diet

　　1, Date and lamp cord grass decoction

　　Two dates, 6 grams of lamp cord grass, sugar to taste, boiled into a decoction for drinking. It has the effects of clearing heat, promoting urination, and relieving stranguria and stopping bleeding.

　　2, Mung bean and plantago herb soup

　　60 grams of mung beans, 30 grams of red bean, plantago herb, and sugar to taste, boiled and taken as a decoction. It can clear heat and detoxify, promote urination and relieve stranguria.

　　3, Plantago seed and bean soup

　　50 grams of mung beans, 50 grams of black beans, 15 grams of plantago seed, 1 spoon of honey. Wrap the plantago seed in a cloth, boil the mung beans and black beans together in a pot with an appropriate amount of water, until the beans are soft and cooked, turn off the heat, discard the medicine bag, and add honey to mix. Eat the beans and drink the soup. It is suitable for patients with difficulty urinating, short and urgent pain, and soreness and pain in the waist.

　　4, Lonicera japonica tea

　　30 to 50 grams of lonicera japonica, 10 grams of licorice powder, soaked in boiling water for 10 minutes, and drunk as tea. It can clear heat and detoxify, promote urination and relieve stranguria. It can treat fever and urinary pain.

　　5, Clam meat soup

　　20 grams of clam meat, 30 grams of begonia, sugar to taste, boiled together with water, eat the meat and drink the soup. It can clear heat, promote urination, and treat urinary tract infection.

　　6, Winter melon and mung bean soup

　　500 grams of fresh winter melon, 50 grams of mung beans, and sugar to taste, boiled into soup for drinking. It can both cool the body and promote urination, and prevent summer heat and lower body temperature. It is the best beverage for preventing and treating urinary tract infection.

　　7, Bean sprout juice

　　Mung bean sprouts 500 grams, sugar to taste. Wash the mung bean sprouts clean, crush them, squeeze the juice out with a cloth, and add sugar to drink as tea. It can treat urinary tract infection, reddish urine, frequent urination, turbid urine, and other symptoms.

　　8. Celery Juice

　　Celery 2500 grams. Clean the fresh celery, beat and squeeze the juice, heat to boiling, take 60 milliliters each time, three times a day.

　　Second, What women with bladder neck obstruction should not eat during the period of taking medicine

　　1. Avoid eating sour and spicy刺激性 foods, such as strong alcohol, chili, balsamic vinegar, sour fruits, etc.

　　2. Caffeine can cause the bladder neck to contract and cause spasmodic pain in the bladder, so coffee should be drunk less.

　　3. Avoid eating citrus fruits because they can cause alkaline urine, which is conducive to bacterial growth.

　　4. During the period of taking medicine, patients should avoid eating chicken, chili, fish, shrimp, beef, seafood, salted vegetables, and only vinegar, salt, monosodium glutamate (other seasonings should not be used). If the patient's diet control is not good, it will extend the treatment time.

　　First, Prevention

　　This disease often occurs in middle-aged and elderly women, which may be related to the decrease in estrogen levels, atrophy of the vaginal epithelium, and reduced resistance, making it easy to suffer from repeated infections. Therefore, a small amount of long-acting estrogen should be taken for a long time, attention should be paid to perineal cleanliness and hygiene, the hyperplastic part of the bladder neck lip should be excised and cut to the same depth as the trigone, to avoid excessive electrocoagulation and postoperative recurrence of scar stricture, and the neck sphincter muscle should not be cut too deeply to avoid incontinence. After surgery, regular urethral dilation should be performed until the urine line is thick and stable.

　　Second, Preoperative Preparation

　　1. A comprehensive and detailed examination and estimation of the patient's overall condition must be made before surgery. In addition to general physical examination, special attention should be paid to the determination of kidney function (such as blood non-protein nitrogen, CO2 binding capacity, and phenol red test, etc.). In addition, blood pressure should be measured multiple times, and fundus examination, electrocardiogram, chest X-ray, and liver function should be checked. For patients with kidney insufficiency, the bladder should be drained, and surgery should be performed after the renal function improves.

　　2. Patients often have urinary tract infections before surgery, and catheterization can improve the above conditions, but long-term indwelling can also cause infection. To reduce postoperative wound infection, antibiotics can be taken several days before surgery, and the bladder can be flushed with antibacterial solution half an hour before surgery. Common antibacterial solutions are 1:2000 furazolidone and 1:5000 potassium permanganate. After the bladder is cleaned, it is filled with flushing solution.

　　3. Cystoscopy can directly observe the condition of the bladder, the type of benign prostatic hyperplasia, and whether the bladder has other complications (such as stones, diverticula, etc.), but it is not necessary to perform routine preoperative procedures.