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This article is published by Yimaitong authorized by the author, please do not reprint without authorization
.
Basic information of the case data: female, 76 years old, farmer, admitted to hospital due to repeated frequent urination, urgency with lower abdomen pain for 6 years, worsening for more than 10 days
.
History of present illness: The patient reported that there was no obvious cause for bladder irritation such as frequent urination and urgency, accompanied by falling pain in the lower abdomen, with intermittent gross hematuria and no blood clots about 6 years ago
.
No chills, fever, nausea, vomiting, and low back pain
.
During the period, he visited the local hospital many times and was diagnosed as "cystitis".
He received oral and intravenous injection of anti-inflammatory and analgesic drugs (specifically unknown).
The effect was not good and the symptoms were repeated
.
The above symptoms worsened more than 10 days ago
.
I took the medication by myself, but the effect was not good .
Now I came to the hospital for further treatment
.
The outpatient department was admitted to the hospital with "chronic cystitis"
.
Since the onset of the onset, the patient has been conscious and energetic, with acceptable diet, poor sleep, and unknown weight changes
.
Past history: For more than 10 years of previous hypertension, oral administration of "nifedipine sustained-release tablets", blood pressure control is acceptable; no history of diabetes, denial of history of infectious diseases such as hepatitis, tuberculosis, and history of close contact
.
He had regular menstruation and no dysmenorrhea; denied history of major trauma and blood transfusion
.
There is no history of drug allergy, and the history of vaccination is unknown
.
Physical examination after admission: soft abdomen, no tenderness and rebound pain, acceptable bowel sounds, small liver and spleen, no tenderness and percussion pain in the kidneys, no tenderness in the ureteral area, no bulge in the suprapubic bladder area, deep tenderness , The opening of the urethra is normal, and there is no abnormality in the perineum
.
Auxiliary examination: CT of the perfect urinary system showed no abnormalities in both kidneys and ureters, thick bladder wall, no abnormal density foci in the cavity, normal size and shape of the uterus, and no abnormal density foci in it
.
Round-shaped low-density lesions can be seen in the appendage area on the right, and appendage cysts are considered
.
Figure 1 shows the urine routine showing white blood cells + -, protein -, urine occult blood 3 + cystoscopy under general anesthesia + cystoscopy water expansion + bladder mucosal biopsy under general anesthesia after perfecting the preoperative preparations, the bladder volume is small and the side wall of the bladder is seen during the operation , The anterior wall, the mucosa of the triangle area were hyperemia and edema, the bilateral ureteral openings were normal, and the remaining mucosa was normal
.
After the resection microscope, the abnormal mucosa of the resection section was sent for biopsy
.
The bladder injection and expansion test was performed.
Extensive bleeding points were found in the bladder mucosa.
When the bleeding stopped, the water was stopped and kept for about 20 minutes.
The bladder volume was measured to be about 170ml
.
Figure 2 shows that postoperative pathology shows that inflammatory cell infiltration is seen in the bladder mucosa tissue submitted for examination, and some fibrinous necrosis is combined.
Considering the improvement of urinary tract irritation after "interstitial cystitis", the symptoms are repeated after a follow-up for 1 year.
Intermittent cystoscopy water dilation combined with bladder perfusion maintenance treatment
.
Analysis and discussion 1.
Overview Interstitial cystitis (IC) is a group of clinical syndromes with urgency, frequent urination, and suprapubic bladder pain as its main symptoms.
It is common in middle-aged women and its characteristics are mainly Fibrosis of the bladder wall, accompanied by a decrease in bladder capacity
.
Its pathogenesis is not yet entirely clear to the mainstream theory that immune disorders, infectious factors, such as psychological effects
.
Due to lack of sufficient understanding of interstitial cystitis, misdiagnosis is prone to occur, leading to ineffective treatment
.
2.
How to diagnose Because interstitial cystitis lacks specific manifestations, its diagnosis has always been a difficult problem for urologists
.
Currently, it is mainly an exclusive diagnostic method
.
It tends to be based on the patient's clinical symptoms and cystoscopy performance, and pathological biopsy is taken if necessary
.
Auxiliary routine laboratory examinations such as urine routine, urine culture, urodynamic examination
.
Cystoscopy requires the naked eye to observe the changes of the mucosa of each wall under general anesthesia, and the changes of the bladder mucosa after water expansion
.
The manifestations under cystoscopy are divided into ulcer type (shown as the obvious inflammatory changes in the mucosa and submucosa in the bladder, namely Hunner ulcer) and non-ulcer type (multiple patchy hemorrhages in the bladder mucosa) 3.
Hydrodilatation treatment under cystoscopy and hyaluronic acid perfusion Water dilatation under sodium and botulinum toxin cystoscopy is not only a common method for diagnosing interstitial cystitis, but also can relieve pain symptoms in some patients through water dilatation
.
The operation method is under general anesthesia, lithotomy position, and cystoscope with normal saline pressure 80-100cmH2O, until the maximum volume of the bladder is reached, the perfusion stops, and the retention time is 3-5min
.
After retention, the perfusion fluid is released.
If it is red, it indicates the presence of interstitial cystitis
.
Cystoscopy can reveal Hunner ulcers or flaky bleeding spots
.
There is an aminodextran layer protective film in the normal bladder mucosa, which can stabilize and protect the bladder from being damaged by toxic substances in urine
.
Sodium hyaluronate can restore the protective film morphologically, regulate the proliferation of endothelial cells and fibroblasts, inhibit the aggregation of white blood cells, and enhance tissue healing
.
Reduce the stimulation of nerve endings, thereby alleviating the patient's pain symptoms
.
The application of botulinum toxin to patients with interstitial cystitis can significantly improve urinary frequency and urgency, and increase bladder capacity
.
At present, cystoscope expansion combined with sodium hyaluronate or botulinum toxin bladder perfusion has become the first-line method of clinical treatment
.
However, some patients have repeated symptoms, and the long-term effect needs further study
.
4.
Urodynamic value Urodynamic examination is to measure the maximum bladder capacity, compliance, maximum urinary flow rate and bladder detrusor contraction force through filling bladder pressure measurement and urination pressure-flow rate analysis, which is helpful Assess bladder sensitivity and compliance, and reproduce the symptoms of the patient's bladder filling period
.
Patients in the storage period showed increased bladder sensitivity; in the voiding period, they showed functional bladder outlet obstruction
.
It has important clinical significance for the identification of stress urinary incontinence and overactive bladder
.
5.
The timing of surgical treatment The main surgical methods are transurethral resection or electrocautery
.
This operation is only effective for the treatment of Hunner ulcer under cystoscopy, achieving the purpose of alleviating the patient's symptoms, but it can lead to the risk of bladder contracture
.
Cystectomy and urinary diversion: Mainly for patients with severe bladder contracture, small bladder capacity, and intractable pain symptoms, but this operation may affect the quality of life, urinary extravasation and other risks
.
Summary At present, the research on the pathogenesis of interstitial cystitis is still unclear.
The diagnosis is mainly based on the patient's clinical manifestations and cystoscopy.
Urodynamic examination can be further clarified
.
Most treatments are mainly to improve the symptoms of urinary tract irritation, prevent recurrence of symptoms and reduce the impact on the quality of life
.
.
Basic information of the case data: female, 76 years old, farmer, admitted to hospital due to repeated frequent urination, urgency with lower abdomen pain for 6 years, worsening for more than 10 days
.
History of present illness: The patient reported that there was no obvious cause for bladder irritation such as frequent urination and urgency, accompanied by falling pain in the lower abdomen, with intermittent gross hematuria and no blood clots about 6 years ago
.
No chills, fever, nausea, vomiting, and low back pain
.
During the period, he visited the local hospital many times and was diagnosed as "cystitis".
He received oral and intravenous injection of anti-inflammatory and analgesic drugs (specifically unknown).
The effect was not good and the symptoms were repeated
.
The above symptoms worsened more than 10 days ago
.
I took the medication by myself, but the effect was not good .
Now I came to the hospital for further treatment
.
The outpatient department was admitted to the hospital with "chronic cystitis"
.
Since the onset of the onset, the patient has been conscious and energetic, with acceptable diet, poor sleep, and unknown weight changes
.
Past history: For more than 10 years of previous hypertension, oral administration of "nifedipine sustained-release tablets", blood pressure control is acceptable; no history of diabetes, denial of history of infectious diseases such as hepatitis, tuberculosis, and history of close contact
.
He had regular menstruation and no dysmenorrhea; denied history of major trauma and blood transfusion
.
There is no history of drug allergy, and the history of vaccination is unknown
.
Physical examination after admission: soft abdomen, no tenderness and rebound pain, acceptable bowel sounds, small liver and spleen, no tenderness and percussion pain in the kidneys, no tenderness in the ureteral area, no bulge in the suprapubic bladder area, deep tenderness , The opening of the urethra is normal, and there is no abnormality in the perineum
.
Auxiliary examination: CT of the perfect urinary system showed no abnormalities in both kidneys and ureters, thick bladder wall, no abnormal density foci in the cavity, normal size and shape of the uterus, and no abnormal density foci in it
.
Round-shaped low-density lesions can be seen in the appendage area on the right, and appendage cysts are considered
.
Figure 1 shows the urine routine showing white blood cells + -, protein -, urine occult blood 3 + cystoscopy under general anesthesia + cystoscopy water expansion + bladder mucosal biopsy under general anesthesia after perfecting the preoperative preparations, the bladder volume is small and the side wall of the bladder is seen during the operation , The anterior wall, the mucosa of the triangle area were hyperemia and edema, the bilateral ureteral openings were normal, and the remaining mucosa was normal
.
After the resection microscope, the abnormal mucosa of the resection section was sent for biopsy
.
The bladder injection and expansion test was performed.
Extensive bleeding points were found in the bladder mucosa.
When the bleeding stopped, the water was stopped and kept for about 20 minutes.
The bladder volume was measured to be about 170ml
.
Figure 2 shows that postoperative pathology shows that inflammatory cell infiltration is seen in the bladder mucosa tissue submitted for examination, and some fibrinous necrosis is combined.
Considering the improvement of urinary tract irritation after "interstitial cystitis", the symptoms are repeated after a follow-up for 1 year.
Intermittent cystoscopy water dilation combined with bladder perfusion maintenance treatment
.
Analysis and discussion 1.
Overview Interstitial cystitis (IC) is a group of clinical syndromes with urgency, frequent urination, and suprapubic bladder pain as its main symptoms.
It is common in middle-aged women and its characteristics are mainly Fibrosis of the bladder wall, accompanied by a decrease in bladder capacity
.
Its pathogenesis is not yet entirely clear to the mainstream theory that immune disorders, infectious factors, such as psychological effects
.
Due to lack of sufficient understanding of interstitial cystitis, misdiagnosis is prone to occur, leading to ineffective treatment
.
2.
How to diagnose Because interstitial cystitis lacks specific manifestations, its diagnosis has always been a difficult problem for urologists
.
Currently, it is mainly an exclusive diagnostic method
.
It tends to be based on the patient's clinical symptoms and cystoscopy performance, and pathological biopsy is taken if necessary
.
Auxiliary routine laboratory examinations such as urine routine, urine culture, urodynamic examination
.
Cystoscopy requires the naked eye to observe the changes of the mucosa of each wall under general anesthesia, and the changes of the bladder mucosa after water expansion
.
The manifestations under cystoscopy are divided into ulcer type (shown as the obvious inflammatory changes in the mucosa and submucosa in the bladder, namely Hunner ulcer) and non-ulcer type (multiple patchy hemorrhages in the bladder mucosa) 3.
Hydrodilatation treatment under cystoscopy and hyaluronic acid perfusion Water dilatation under sodium and botulinum toxin cystoscopy is not only a common method for diagnosing interstitial cystitis, but also can relieve pain symptoms in some patients through water dilatation
.
The operation method is under general anesthesia, lithotomy position, and cystoscope with normal saline pressure 80-100cmH2O, until the maximum volume of the bladder is reached, the perfusion stops, and the retention time is 3-5min
.
After retention, the perfusion fluid is released.
If it is red, it indicates the presence of interstitial cystitis
.
Cystoscopy can reveal Hunner ulcers or flaky bleeding spots
.
There is an aminodextran layer protective film in the normal bladder mucosa, which can stabilize and protect the bladder from being damaged by toxic substances in urine
.
Sodium hyaluronate can restore the protective film morphologically, regulate the proliferation of endothelial cells and fibroblasts, inhibit the aggregation of white blood cells, and enhance tissue healing
.
Reduce the stimulation of nerve endings, thereby alleviating the patient's pain symptoms
.
The application of botulinum toxin to patients with interstitial cystitis can significantly improve urinary frequency and urgency, and increase bladder capacity
.
At present, cystoscope expansion combined with sodium hyaluronate or botulinum toxin bladder perfusion has become the first-line method of clinical treatment
.
However, some patients have repeated symptoms, and the long-term effect needs further study
.
4.
Urodynamic value Urodynamic examination is to measure the maximum bladder capacity, compliance, maximum urinary flow rate and bladder detrusor contraction force through filling bladder pressure measurement and urination pressure-flow rate analysis, which is helpful Assess bladder sensitivity and compliance, and reproduce the symptoms of the patient's bladder filling period
.
Patients in the storage period showed increased bladder sensitivity; in the voiding period, they showed functional bladder outlet obstruction
.
It has important clinical significance for the identification of stress urinary incontinence and overactive bladder
.
5.
The timing of surgical treatment The main surgical methods are transurethral resection or electrocautery
.
This operation is only effective for the treatment of Hunner ulcer under cystoscopy, achieving the purpose of alleviating the patient's symptoms, but it can lead to the risk of bladder contracture
.
Cystectomy and urinary diversion: Mainly for patients with severe bladder contracture, small bladder capacity, and intractable pain symptoms, but this operation may affect the quality of life, urinary extravasation and other risks
.
Summary At present, the research on the pathogenesis of interstitial cystitis is still unclear.
The diagnosis is mainly based on the patient's clinical manifestations and cystoscopy.
Urodynamic examination can be further clarified
.
Most treatments are mainly to improve the symptoms of urinary tract irritation, prevent recurrence of symptoms and reduce the impact on the quality of life
.
