Congenital bladder neck stenosis

　　Congenital bladder neck stenosis is more common in adolescents, and it is related to the maldevelopment of mesenchymal tissue during bladder development, and the hyperplasia and hypertrophy of the sphincter muscle. The disease may also be due to congenital autonomic nervous system dysplasia, abnormal bladder neck neuromuscular structure, or congenital endocrine metabolic disorders, leading to dysfunction of bladder emptying or coordination disorder between the detrusor muscle and the sphincter muscle, and secondary thickening of the bladder neck. Acquired bladder neck stenosis is often due to chronic local inflammation such as prostatitis, post-urethral inflammation, and trigone bladder inflammation, which leads to fibrosis of the bladder neck and scar contracture after various related surgeries. It may occasionally be seen in bladder tuberculosis and bladder schistosomiasis, and it is also related to acquired endocrine and metabolic disorders.

　　先天性膀胱挛缩是由于膀胱颈部的功能改变所致，而不是因为结构的改变。此病常见的并发症如下。

　　Congenital bladder stenosis is caused by functional changes in the bladder neck rather than structural changes. The common complications of this disease are as follows.1. Bladder calculi:

　　The main symptoms include dysuria, urinary disorders, and hematuria, but there are also a few cases, especially in patients with lower urinary tract obstruction and residual urine, in which stones may be large but asymptomatic.2. Bladder diverticula

　　: There are no special symptoms of bladder diverticula, but if there is obstruction or infection, symptoms such as difficulty in micturition, frequent urination, urgency, and urinary tract infection may occur. Some diverticula can be as large as 2000ml, compressing the bladder neck and urethra, leading to lower urinary tract obstruction.3. Bladder infection:

　　The main symptoms of bladder neck stenosis are progressive micturition difficulty. Early symptoms include delayed micturition, weak urinary stream, narrowing of the urinary line, frequent urination, and increased nocturia. In the later stage, there may be residual urine, acute urinary retention, overflow incontinence, and so on. In the late stage, it can lead to vesicoureteral reflux, hydronephrosis, renal insufficiency, and other complications.

　　The pathogenesis of congenital bladder neck stenosis is related to the poor regression of mesodermal tissue during bladder development and the hyperplasia and hypertrophy of the sphincter, so there is no direct preventive method for this disease. It is recommended to do regular physical examinations to achieve early detection. If confirmed, active surgical treatment should be carried out, and at the same time, attention should be paid to develop good living habits, such as drinking more water, eating more fruits and vegetables, not retaining urine, which can reduce the incidence of this disease to a certain extent.

　　This disease can be understood through laboratory tests, including urine, renal function, and general conditions. The phenol red (PSP) excretion test can indicate renal pelvis dilation and renal function early. In addition to laboratory tests, this disease can also adopt other auxiliary examinations.

　　1. Determination of residual urine volume

　　B-ultrasound is commonly used to determine the residual urine volume (common formula: residual urine volume = height × width × 0.5, and when the residual urine volume is less, height × width × 0.7 can be used), and catheterization is more accurate for determining residual urine.

　　2. Imaging examination

　　The voiding cystourethrogram in anteroposterior, lateral, and oblique positions shows narrowing of the bladder neck, with the posterior lip protruding into the bladder cavity. Under fluoroscopy, the bladder's filling state and the process of micturition can show incomplete opening, delayed opening, or early closure of the bladder neck orifice, and at the same time, it can show the degree of bladder enlargement and ureteral reflux. In addition, intravenous pyelogram (KUBIVP) can be performed to exclude urinary tract stones, understand the morphological and functional conditions of the kidneys, and if necessary, radioactive nuclide renal mapping and renal scanning examinations can be performed to clarify the renal blood supply and the extent of renal function damage.

　　3. Cystoscopy examination

　　There is a significant resistance during cystoscopy insertion, with a circumferential narrowing at the neck, and no obvious distension of the urethral wall below the sphincter from distant to near. The mucosa of the neck is rigid, the posterior lip of the internal urethral orifice is elevated, the posterior wall of the bladder is concave, and the contraction movement of the posterior lip is weakened when asked to perform a micturition action, often requiring pressure on the bladder neck to observe the posterior wall of the bladder. Chronic inflammatory changes are often present in the bladder, with small trabeculae, and the orifices of the ureters may be open, and there may be pseudodiverticula or calculi present. Sometimes, a steep ridge-like prominence resembling a dam can be seen at the posterior lip of the neck orifice before the cystoscope is withdrawn.

　　4、下尿路尿流动力学检查

　　4. Urodynamic examination of the lower urinary tract

　　Dietary taboos for congenital bladder neck stricture patients

　　The conventional method of Western medicine for treating congenital bladder neck strictureFor patients with severe fibrosis of the bladder neck, bladder neck Y-V plasty can be performed. For patients with less residual urine, no obvious recurrent urinary tract infection, no obvious reflux in the ureter, and good renal function, urethral dilation can be performed under antibiotic treatment, and it can be combined with the use of multi-selective α-adrenergic receptor blockers (such as tolterodine, terazosin, etc.) and 5α-reductase inhibitors (such as finasteride, etc.) to improve symptoms. Most cases require surgical treatment, and common surgeries include bladder neck wedge resection, bladder neck Y-V plasty, and transurethral bladder neck resection, etc. Simple bladder neck stricture is generally treated by urethral bladder neck incision, and no open surgery is necessary. When complications such as bladder diverticula, bladder stones, or vesicoureteral reflux occur with bladder neck stricture, bladder neck wedge resection should be performed simultaneously to treat the above lesions. During the operation, the internal orifice of the urethra should be explored and should be able to pass through the second phalanx of the index finger. If necessary, further wedge resection of the posterior lip should be performed. The range of resection for female patients should not be too large or too deep to prevent urinary incontinence or urethrovaginal fistula..