Bladder neck obstruction in women is also known as bladder neck sclerosis, Marion’s disease or bladder neck contracture. It is a common occurrence in older women. The incidence increases with age. If left untreated, it can lead to serious consequences of upper urinary tract dilatation, hydronephrosis, and renal impairment in advanced stages.
The examination measures for patients with bladder neck obstruction in women are mainly as follows: 1. Cystoscopy: microscopically, the mucosa of the bladder neck is seen to be stiff and edematous, the posterior lip is elevated, and the neck contraction and open motion are reduced or absent. Chronic obstructive changes such as trabeculae, small chambers, and elevated inter-ureteral crest are seen in the bladder.
2. Residual urine measurement: With normal drinking, normal people usually have no residual urine, and if they do, it will not exceed 10 ml. An increase in residual urine indicates obstruction in the lower urinary tract or bladder forceps dysfunction, and the amount of residual urine is usually proportional to the degree of obstruction. The amount of residual urine is usually proportional to the degree of obstruction. The amount of residual urine is used to determine the degree of obstruction and select effective treatment. It can also be used to observe the effect of treatment.
3.X-ray examination: voiding cystourethrography, continuous film taking under TV observation, can observe the bladder filling state and the bladder contraction function during urination. Either it is closed and cannot open completely; or it is semi-closed and cannot open completely; or the bladder cannot be emptied by early closure of the neck. Elevation of the posterior lip of the bladder neck is seen in the anterior-posterior and oblique views. A dual bladder air sodium iodide imaging can show changes in the bladder neck as in men with prostate enlargement. The presence and extent of bladder neck reflux can also be understood. Intravenous urography can understand renal function and hydronephrosis.
4.Urodynamic examination: urine flow rate examination is the most useful index to objectively evaluate the urination condition. In patients with bladder neck obstruction, a significant increase in pressure in the bladder, a decrease in urine flow and a change in the urine flow curve can be seen. However, the diagnosis of obstruction by urine flow rate alone is not sufficient. The urinary flow rate is determined by a combination of the force of the bladder forcing muscles and urethral resistance. Some statistics point out that 88% of those with a maximum urine flow rate <10 ml/s are obstructed, while 68% of those with >15 ml/s are not obstructed. Therefore, in order to further clarify whether obstruction is present or not, the force of the detrusor muscle during voiding should be determined, and the application of the method of detrusor pressure-urinary flow rate determination is a more accurate method.