Female bladder neck obstruction is a group of syndromes caused by different causes and pathogenesis, which was first reported by Marion in 1933, so it is also called Marion’s disease, and was previously called “female prostatic disease”, “female bladder neck sclerosis “The main clinical manifestation is difficulty in urination. The main clinical manifestations are difficulty in urination and irritation of the lower urinary tract, which can cause urinary retention and hydronephrosis in severe cases, with symptoms and results similar to those of male prostate enlargement. The disease can occur at any age, mostly in the elderly, and the older the age the higher the incidence, accounting for 2.7% to 8.0% of abnormal urinary disorders in women Female bladder neck obstruction can be divided into functional obstruction and organic obstruction, functional obstruction is mostly seen in patients of younger age and shorter duration, probably due to the stimulation of chronic inflammation of the bladder, resulting in bladder hypersensitivity, dysfunction, and the occurrence of internal sphincter spasm, urination The internal sphincter does not open properly during voiding and symptoms of obstruction occur. The urodynamic indicators in these patients are often low maximum urinary flow rate, prolonged functional urethral length, and increased urethral resistance. The use of C-blockers can effectively open the bladder neck and achieve rapid relief. The main causes of organic obstruction may be the proliferation of fibrous tissue in the bladder neck due to long-term inflammatory stimulation of the urethra, hypertrophy of the bladder neck muscle, and hyperplasia of the periurethral glands due to imbalance of hormonal balance in women. The postoperative pathology of our patients suggested bladder neck fibrous tissue hyperplasia with chronic inflammatory changes, and the examination was consistent with organic obstruction.
The diagnosis of bladder neck obstruction in women is mainly based on medical history, clinical symptoms, urodynamic testing and cystoscopy. The possibility of bladder neck obstruction should be considered when women of middle age or older present with progressive voiding difficulties. The history, clinical presentation and physical examination can initially exclude neurogenic bladder and dyspareunia due to uterine, rectal and urethral lesions. Further comprehensive analysis combined with urodynamic examination and cystourethroscopy is required to make a correct diagnosis. Urodynamic examination is currently the most useful index for objective evaluation of voiding symptoms, especially pressure C urinary flow rate measurement during voiding, which is the most accurate method for diagnosing bladder neck obstruction. The determination of residual bladder urine volume can determine the presence or absence of bladder obstruction, and the amount of residual urine volume is directly proportional to the degree of obstruction. It should be noted that the determination and analysis of residual urine volume must exclude urinary retention due to weak contraction of the bladder’s detrusor muscle in order to determine its relationship with the degree of bladder neck obstruction. Although urodynamic testing can diagnose bladder neck obstruction, it cannot determine the cause of bladder neck obstruction. Cystoscopy allows direct observation of the bladder neck morphology, contraction, intravesical lesions and, if necessary, biopsy, and is therefore extremely important in determining the cause of bladder neck obstruction and selecting surgical treatment, and is a reliable method to detect organic obstruction of the bladder neck. Some scholars also consider urodynamic imaging as the “gold standard” for diagnosing bladder neck obstruction in women, but its widespread use is limited by its high cost, time-consuming, and radiological nature, as well as its high hardware requirements.
Treatment of female bladder neck obstruction is divided into conservative and surgical treatment. Conservative treatment is mostly indicated for patients with functional female bladder neck obstruction and for those with mild clinical symptoms, residual urine volume <50 ml, and insignificant vesicoureteral reflux, including oral C-blockers and periodic urethral dilatation. For those with more severe symptoms and longer duration surgical treatment is necessary for cure. The presence of bladder neck obstruction in women predisposes to recurrent infections and aggravated fibrosis, therefore, early surgical release of the obstruction is beneficial to prevent further aggravation of bladder neck obstruction and its resulting further damage to the bladder forcing muscle and renal function. In the past, open wedge resection of the posterior lip of the bladder neck or Y-V molding was mostly used, although it has certain efficacy, but the open surgery is more traumatic, plus factors such as surgical sutures and scar tissue formation, the efficacy is often unsatisfactory and prone to urinary fistula and incontinence. Transurethral resection is less invasive, safer, and more effective, and has gradually replaced open surgery as the procedure of choice for the treatment of female bladder neck obstruction.