Bladder neck sclerosis
Bladder neck sclerosis — the cicatricial deformation of uretro-vezikalny transition caused by traumatic influences, inflammatory processes. It is shown by difficulty of an urination, slackness of a stream of urine, the dizurichesky phenomena. It is diagnosed by means of an urofloumetriya, a retrograde and miktsionny uretrografiya, ultrasonography of urinary bodies, MSKT of a tsistouretrografiya, a back uretroskopiya, a tsistoskopiya. It is treated quickly by a transurethral resection of the sklerozirovanny site. Surgical intervention is supplemented with antibacterial and anti-inflammatory therapy, at the expressed obstruction or an obturation preceded by an epitsistostomiya.
Bladder neck sclerosis
By results of researches in the sphere of urology, sclerous deformation with narrowing of a gleam of a mochepuzyrno-urethral segment comes to light at 0,4-1,5% of the patients who underwent an operation for a good-quality giperplaziya of a prostate. The cases caused by other reasons are less widespread. The probability of development of a sclerosis depends on a way of performance of an adenomektomiya. Most less often cicatricial deformation arises after the TOUR by the holmium laser and a bipolar plasma and kinetic resection, most often – after a chrezpuzyrny adenomektomiya. Usually the disease is diagnosed for men aged after 45 years, the idiopathic congenital form of a disease can be shown even at babies.
Bladder neck sclerosis reasons
The disease has a polietiologichesky basis, can be as acquired, and congenital. Sclerous processes in a neck of a bubble are usually secondary, develop against the background of other urological pathology or under the influence of various damaging factors. Are immediate causes of emergence of a sclerosis in a zone of a mochepuzyrny triangle:
- Surgical treatment of urological diseases. Usually sclerous changes come to light at the patients who underwent open and endoscopic operations for prostate gland adenoma. Less often the intensive sklerozirovaniye begins after radiation therapy bladder cancer or a prostate.
- Inflammation of bodies of an urinary system. The probability of a sclerosis in the area a mochepuzyrno-urethra of lny transition increases at chronic prostatitises and cystitis. In such cases the regenerative phase of an inflammation accepts pathological character, in affected areas dense connecting fabric is formed.
- Dizembriogenez. The idiopathic form of a sclerosis of a mochepuzyrny neck carries the name of a disease of Marion. Pathology meets seldom, is characterized by ring-shaped fibrosis of submucous and muscular layers at the exit from a bladder. The factors promoting emergence of a congenital sclerosis are not established yet.
Anatomic prerequisite to development of a disease are features of a structure of a wall of a bubble in the field of a mochepuzyrny triangle. Connecting fabric of own plate under uroteliy this zone differs in smaller friability because of what the mucous membrane less rastyazhim and has practically no folds. As a result sclerous changes are badly compensated and quickly shown clinically.
The mechanism of a sklerozirovaniye of a neck of a bladder is based on excessive growth of soyedinitelnotkanny elements at pathological regeneration of the damaged fabrics. As a rule, the contributing factors to emergence of sclerous changes are violation of power metabolism in a wall of body, the local inflammatory reaction, cellular dystrophy, microcirculator violations characteristic of a good-quality giperplaziya of a prostate gland. Sometimes process is provoked by action of the direct damaging factors (an operational trauma, beam radiation).
The sclerosis of a mochepuzyrny wall is formed step by step. At first after a fagotsitoz of the destroyed cages and collagenic fibers active proliferation of fibroblast happens macrophages in a zone of damage, collagen synthesis amplifies. In the conditions of ischemia, a post-traumatic inflammation, the distsirkulyatorny phenomena the balance between kollagenogenezy and kollagenolizisy with increase of excess of connecting fabric, prevalence of mass of fibers over cellular elements, reduction of quantity of specialized cages is broken. As a result the neck of a bladder is exposed to a fibrozirovaniye, a sklerozirovaniye or scarring with partial narrowing (striktury) or full overlapping (obliteration) of a gleam that is shown by the corresponding clinical picture.
Bladder neck sclerosis symptoms
The main clinical symptom of a disease is the accruing deterioration in outflow of urine up to its full sharp delay. At the initial stages of pathological process patients complain of difficulties at an urination, note slackness of an uric stream. In process of progressing of a sclerosis and increase in amount of residual urine in a cavity of body patients have a feeling of incomplete depletion of a bladder. Accession of an inflammation is demonstrated by frequent desires to an urination, a painful otkhozhdeniye of urine, temperature increase of a body to subfebrilny figures.
Urine outflow violation gradually leads to increase in its residual volume and stagnation in the above-located bodies of an urinary system. In extreme cases expansion of mochetochnik and cup systems comes to the end with development of a bilateral ureterogidronefroz and a chronic renal failure. Existence of a puzyrno-mochetochnikovy reflux promotes the ascending distribution of uroinfektion with emergence of an ureterit, pyelonephritis. Against the background of mochepuzyrny stagnation of urine chronic cystitis is more often observed, microdiverticulums can be created. Some patients have a wrinkling of a bladder. Long violation of an urination promotes emergence of neurotic frustration, a depression, social disadaptation of patients.
Inspection of men with suspicion on a sclerosis of a neck of a bladder includes the tool methods allowing to reveal signs of narrowing of the site of puzyrno-urethral transition, having excluded other reasons of obstruction. An important role in diagnostic search is played by connection of pathological process with the performed prostate operation, radiation therapy of pelvic bodies, urological infections. Have the greatest informational content:
- Urodinamichesky researches. At the kept urination to patients usually appoint an urofloumetriya. Long increase and reduction of volume speed of current of urine confirms obstruction of the lower departments of an urinary system, however does not allow to reveal the exact place of a stenosis. Therefore the technique usually precedes carrying out other tool researches.
- Uretrografiya. The radiological method gives the chance to find an obstacle to urine current in the field of transition of a bladder to an urethra, at the same time the urethral channel remains completely passable. The retrograde uretrografiya visualizing filling of an urethra with X-ray contrast solution is more often applied, is more rare — a miktsionny research of process of urination.
- Ultrasonography of a bladder. By means of an ekhografiya estimate anatomic features of a structure of body, including a puzyrno-urethral segment, determine its capacity and volume of residual urine which at a neck sclerosis usually exceeds 20 ml. Additional ultrasound examination of kidneys, mochetochnik, prostates (at its existence), urethras allows to establish other causes of infringement of an urination.
- MSKT tsistouretrografiya. The multispiral computer tomography providing creation of three-dimensional model of the struck area — one of the most exact noninvasive methods of diagnostics of a sclerosis. Using MSKT, it is possible to define precisely the place of a striktura of the lower urinary tract, expressiveness of sclerous changes, thickness of a wall of vezikalno-urethral transition.
- Back uretroskopiya and tsistoskopiya. Visualization of the struck area gives the chance not only to reveal the site of a striktura, but also to estimate a condition of a mucous membrane, extent of cicatricial changes. At a gleam of a neck, sufficient for passing of the endoscope, the bladder cavity looks round. Inspection can be supplemented with a biopsy for a histologic research of fabrics.
The general analysis of urine at a sclerosis of a mochepuzyrny neck plays a supporting role, is directed to identification of the possible accompanying inflammatory processes. The disease is differentiated with prostate gland adenoma, the false course from an urethra in a bladder, a bladder prebubble, a prostate sclerosis, malignant and benign tumors of a bladder. According to indications the urologist can appoint consultation of the oncologist, andrologist.
Treatment of a sclerosis of a neck of a bladder
Effective conservative therapy of a disease is not offered. The only method of restoration of passability of an uretro-vezikalny segment — surgical excision of cicatricial fabric. The effect of elimination of a striktura by means of a buzhirovaniye temporary, often leads carrying out this intervention to emergence of various complications. At a stage of preoperative preparation and in the postoperative period to the patient antibacterial therapy for prevention of infectious complications is carried out. In the presence of signs of an inflammation and a pain syndrome perhaps additional purpose of nonsteroid resolvents.
For bystry unloading of an urinary system at considerable obstruction of a neck the open or troakarny epitsistostomiya can be carried out previously. The most effective and least traumatic intervention for restoration of a normal passage of urine is the TOUR of a neck of a bladder. At a transurethral resection sklerozirovanny fabrics completely are removed laser or electrocoagulative knives that allows to eliminate obstruction. Open invasive a mochepuzyrny neck operations because of injury and high risk of complications are practically not applied now.
Forecast and prevention
Efficiency of surgical treatment of sclerous deformation of a mochepuzyrny neck reaches 91%, however at considerable narrowing of its gleam the risk of a postoperative recurrence increases. Prevention of a sclerosis is directed to adequate timely therapy of urological diseases, the sparing performance of an adenomektomiya, other interventions on a prostate and a bladder. For prevention of a recurrence of obstruction after the TOUR use of the modern vysokoenergetichny generators working in the mode of less traumatic bipolar cutting and coagulation is recommended.