女性原发性膀胱颈部梗阻的诊治体会

目的:提高女性原发性膀胱颈部梗阻的诊治水平。方法:34例患者,平均年龄57岁,平均病程4.1 a。诊断方法以临床症状、尿动力学和膀胱镜检为主,辅以影像学和实验室检查。对逼尿肌压力正常或轻度升高者,行α-受体阻滞剂治疗;对药物治疗效果不佳、膀胱镜检示膀胱颈后唇抬高、僵硬、狭窄、膀胱小梁小室形成者,行经尿道膀胱颈部电切术。结果:本组6例(17.4%)α-受体阻滞剂治疗有效,均为内括约肌痉挛者;28例行经尿道膀胱颈部电切,均为膀胱颈部纤维化或挛缩者,其中27例(96.4%)术后排尿症状明显改善,1例加服增强膀胱收缩力的药物。切除组织病理报告为膀胱颈纤维平滑肌增生,25例(90%)合并慢性炎症。随访7个月～36个月,平均22个月,排尿量220 ml～460 ml,平均385 ml,最大尿流率(Qmax)16.7 ml/s～25.4 ml/s,平均20.6 ml/s,剩余尿量12 ml～100 ml。平均28 ml。结论:女性原发性膀胱颈部梗阻多由膀胱颈纤维化或平滑肌增生引起。对α-受体阻滞剂治疗无效并伴有膀胱颈部抬高或狭窄者,经尿道膀胱颈部电切术是一种安全而有效的治疗选择。

Diagnosis and Treatment of Primary Bladder Neck Obstruction in Women

Objective To improve the diagnosis and treatment of primary bladder nech obstructionin in female pation. Methods 34 cases were include,with a mean age of 57 years and symptoms lasting an average of 4.1 years.The diagnosis of feamale bladder nech obstructionwas based mainly on clinical symptoms,ruodynamics and cystoscopy,supplemented with im- aging studies and laboratory tests.For patients whose detrusor pressure was normal or mildly increased,αblocker was used; and for patients who failed to respond to medical treatment or whose posterior lips of the bladder neck became elevated,rigid and nar rowed with vesical trabecula and cella formation,transurethral resection of the bladder neck was performed.Results Treatment withαblocker was effective in 6 cases(17.4%),all had internal sphincter spasm.Of the 28 cases who had bladder neck fibrosis and contracture,and treated with transurethral resection of the bladder neck,27 cases(96.4%)had improvement in voiding function;1 had to take medicine for strengthening bladder contractility.Pathology revealed leiomy of ibrosis,hyper- plasia of the bladder neck in them,and 25 cases(90%)had concomitandy chronic inflammations invading intomucosa,submu- cosa and muscles.The mean peak flow rate(Qmax)was 20.6 ml/s(range,16.7ml/s～25.4 ml/s),mean voiding volume was 385 ml(range,220 ml～460 ml),and mean residual urine volume was 28 ml(range,12 ml～100 ml)during a mean follow up of 22 months(range,7 months～36 months).Conclusion Female bladder neck obstruction is primarily caused by leiomy of ibrosis,hyperplasia and chronic inflammations in the tissues surrounding the bladder neck.Transurethral resection of the bladder neck is safe and effective for the patients who fail to respond toαblocker and have elevated or contracted bladder neck.