transurethral resection of the bladder neck

Treatment of diseases: female bladder neck obstruction Indication Transurethral bladder neck resection is applicable to: 1. The clinical symptoms are heavier. 2. Non-surgical treatment is invalid. 3. Bladder neck obstruction is heavier. 4. Remaining urine > 50ml. Contraindications 1. Bladder neck obstruction complicated by severe urinary tract infection. 2. Bladder neck obstruction complicated by severe renal insufficiency. The above two points are relative contraindications, and surgery should be performed after the condition is improved. Preoperative preparation 1. Patients with urinary tract infection should be placed in the catheter to drain urine, and systemic and topical antibiotics to control infection. 2. Patients with renal dysfunction should be placed in the catheter to drain urine, and the operation should be performed after the renal function is restored. Surgical procedure Insert a resectoscope to observe the lesions in the bladder neck and bladder. For example, if the posterior lip of the bladder neck is levee-like uplift, first cut to the muscular layer at 5 o'clock and 7 o'clock, and then mark the muscle layer at 5 o'clock and 7 o'clock, and cut it at 6 o'clock to prevent electric cutting. Deep, causing urinary incontinence or vaginal fistula. The width of the electric cut is 1.5 to 2 cm, which makes the posterior urethra and the triangle of the bladder close to the same plane. If the bladder neck is narrow, it is advocated to perform total bladder neck resection. Some people advocate that the muscle layer is cut at 3 o'clock and 9 o'clock, and then cut to the muscle layer at 6 o'clock. After electrocutting, the patient was completely electrocoagulated to stop bleeding, and 400 ml of water was injected into the bladder. After removing the resectoscope, the vaginal bladder area was compressed. If the urinary line was shot in a water column, the impulse was large, indicating that the electric cut was satisfactory. Then put a F18 ~ 20 three-chamber balloon catheter, the capsule is filled with water, pressure to stop bleeding. complication 1. Bleeding is mainly due to incomplete hemostasis or secondary infectious bleeding during surgery. The treatment method is to strengthen the catheter traction and continuous bladder irrigation to prevent blood clot formation and retention. Use effective broad-spectrum antibiotics to control infection. If the above method is still unable to stop bleeding, it should be considered to observe the electrocoagulation again under direct vision. 2. Bladder neck obstruction has not been completely relieved due to insufficient depth or range of electric resection, bladder neck obstruction is not completely relieved, and dysuria is still difficult after operation. The treatment method is to add urethral dilatation and -adrenergic receptor blockers, such as Harle. If it is invalid, it can be re-cut or bladder neck wedge resection and YV angioplasty.

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