Η οξύτητα της ουροδόχου κολπίτιδας

　　First, cause of the disease

　　The cause of the disease has not been established, and there are roughly the following views, namely, the fibrosis of the fibrous tissue of the sphincter and adjacent tissues caused by inflammation, non-inflammatory, or aging phenomena, long-term spasm of the bladder neck; it is inferred that the disease is a connective tissue disease because collagen-forming fibroblasts are found in the structure of the local tissue; congenital malformation, especially poor nerve and muscle structure of the bladder neck; 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:

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

　　2Bodian et al. found that the smooth muscle tissue of the bladder neck was largely replaced by elastic fiber tissue, with an increase in fibrous elastic tissue.

　　3In some cases, it can be seen in the pathological sections of the bladder neck that there are hyperplastic glands, and these glands are very similar to the male prostate in morphology.

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

　　If the obstruction at the bladder neck is not diagnosed and properly treated in time, it can lead to dilation and积水 of the upper urinary tract, affecting kidney function. In severe cases, or when complications such as infection occur, renal function damage can lead to a serious prognosis. Western medicine believes that the kidneys are important organs that secrete urine, excrete 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 excretory and regulatory functions of the kidneys will also decrease. Severe kidney damage can also lead to uremia, which is life-threatening.

　　1Symptoms:The main symptom is progressive difficulty in urination, manifested as delayed urination, thinning of urine flow, difficult urination, dribbling, and gradually appearing residual urine, urinary retention, and overflow incontinence.

　　2Bladder neck palpation:When touching the bladder neck through the vagina, it can be felt that the neck tissue has varying degrees of thickening, especially when a urinary catheter is placed in the urethra, the thickening sensation of the neck tissue is more obvious.

　　For women over middle age with unknown causes of difficulty in urination, it should be considered that there may be bladder neck sclerosis, and further examination should be carried out.

　　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 closely related to the anatomical characteristics of the female urethra, endocrine disorders, and drinking habits. Therefore, if urinary tract infection occurs, effective antibiotics should be used as soon as possible to control the infection, and surgery should be performed as soon as possible when conservative treatment in internal medicine is ineffective, in order to actively protect renal function.

　　1, urinalysis:White blood cells or pus cells can be seen.

　　2, renal function examination and blood biochemical examination: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. Phenolsulfonphthalein (phenolsulfonphthaleinPSP) excretion test can earlier indicate renal pelvis hydrops 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 in electrolyte balance and whether there is acidosis.

　　3, cystoscopy:It is the most important and most direct examination method. Under the microscope, the mucosa of the bladder neck is stiff and edematous, the posterior lip is elevated, the neck contracts, the opening movement is weakened or disappeared, and there are small ridges, small chambers, and renal pelvis ridges in the bladder, indicating chronic obstructive changes.

　　4, micturition bladder urethra contrast examination:It can be seen that the bladder neck is stiff, in the process of urination, the neck opens slowly or incompletely, the neck orifice is narrow, and at the same time, the bladder wall is uneven, and sometimes diverticula can be seen.

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

　　6, urodynamic examination:In the early stage of obstruction, the intravesical pressure during micturition is higher than normal, the maximum urine flow rate is normal. When the obstruction further worsens and the detrusor muscle loses compensation, the intravesical pressure during micturition can drop to normal, with residual urine, the maximum urine flow rate decreases, and the urodynamic examination shows that the urine flow rate is close to the maximum, and the synchronous imaging shows that the bladder neck is poorly open.

　　I, health-preserving diet

　　1, persimmon cake and reed grass soup

　　Persimmon cake2roots, reed grass6grams, sugar to taste, boil the soup and drink. It has the effects of cooling the body, promoting diuresis, and stopping bleeding in stranguria.

　　2, red bean and plantago herb soup

　　mung beans60 grams, red bean30 grams, plantago herb, sugar to taste, boil and drink the soup. It cools the body, detoxifies, promotes diuresis, and relieves stranguria.

　　3, plantago seed and mung bean soup

　　mung beans50 grams, black beans50 grams, plantago seed15grams, honey1scoop. Wrap the plantago seed in a cheesecloth, add mung beans and black beans together in a pot, add an appropriate amount of water, boil until the beans are soft, turn off the heat, discard the medicine bag, add honey and mix well, eat the beans and drink the soup. It is suitable for patients with difficulty urinating, short and urgent pain, and lumbar pain.

　　4, lonicera japonica tea

　　Lonicera japonica30,50 grams, powdered licorice10grams, soak in boiling water10minutes, drink as tea. It cools the body, detoxifies, promotes diuresis, and relieves stranguria. It can treat fever and dysuria.

　　5, clam meat soup

　　Clam meat20 grams, begonia30 grams, rock sugar to taste, add water and boil together, eat the meat and drink the soup. It cools the body and promotes diuresis, and treats urinary tract infections.

　　6, winter melon and mung bean soup

　　Fresh winter melon500 grams, mung beans50 grams, add sugar to taste, boil and drink the soup. It can both cool the body and promote diuresis, and prevent summer heat and reduce temperature. It is the best beverage for preventing and treating urinary tract infections.

　　7, mung bean juice

　　Mung bean sprouts500 grams, sugar to taste. Rinse the mung bean sprouts clean, crush them, squeeze the juice out with a cheesecloth, add sugar as tea and drink. It can treat urinary tract infections, red urine, frequent urination, turbid urine, and other symptoms.

　　8、Celery juice

　　celery2500 grams. Clean the fresh celery, crush and squeeze the juice, heat to boiling, take60 milliliters, once a day3times.

　　Second, what female bladder neck obstruction patients should not eat during medication

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

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

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

　　4、Patients should avoid eating chicken, chili, fish, shrimp, beef, seafood, pickles, and only use vinegar, salt, monosodium glutamate (do not use other spices) during medication. If the patient's diet control is not good, it will prolong the treatment time.

　　First, prevention

　　This disease often occurs in middle-aged and elderly women, and may be related to the decrease in estrogen levels, the atrophy of the urogenital epithelium, and the decreased resistance to repeated infections. Therefore, it is necessary to take a small amount of long-acting estrogen for a long time, pay attention to the cleanliness and hygiene of the perineum, and remove the hyperplastic part of the bladder neck after surgery, cutting it to the same depth as the trigone to avoid excessive electrocoagulation to avoid postoperative scar stricture. Do not cut the neck sphincter too deeply to avoid incontinence, and perform regular urethral dilation after surgery until the urine stream is thick and stable.

　　Second, preoperative preparation

　　1、Before surgery, a comprehensive and detailed examination and estimation of the patient's overall condition must be made. In addition to general physical examination, special attention should be paid to the determination of renal function (such as blood non-protein nitrogen, co2and phenol red test, etc.). In addition, blood pressure should be measured multiple times, fundus examination, electrocardiogram, chest X-ray, and liver function. For those with renal insufficiency, the bladder should be drained, and surgery should be performed after renal function improves.

　　2、Preoperative patients often have urinary tract infections, catheterization can improve the above conditions, but long-term placement can also cause infection. To reduce postoperative wound infection, antibiotics can be taken a few days before surgery, and the bladder can be rinsed with an antibacterial solution half an hour before surgery. The commonly used antibacterial solution is1∶2000 Furazolidone,1∶5000 Potassium permanganate. After the bladder is cleaned, fill it with rinsing solution.

　　3、Cystoscopy can directly observe the condition of the bladder, the type of benign prostatic hyperplasia, and whether there are other complications (such as stones, diverticula, etc.), but does not require routine preoperative implementation.