1. Do you know the prostate?
The prostate is the largest accessory sex gland in men. Because it is arranged in front of the bladder like a guard, people named it "prostate".
The prostate surrounds the posterior urethra. People are not so familiar with it because of its hidden anatomical location. When examining the prostate, doctors usually use the index finger of the right hand, put on a rubber finger cot, and extend it through the anus for palpation.
Although the normal prostate is only chestnut-like size and weighs about 15g, its effect on the human body cannot be underestimated. First, it can secrete prostate fluid, which is an important component of semen, plays an important role in the normal function of sperm, and is very important for fertility. Second, the prostate is rich in 5α-reductase, which can convert testosterone into more physiologically active dihydrotestosterone. Third, the prostate surrounds the urethra and participates in the formation of the internal urethral sphincter. When the urge to urinate occurs, along with the contraction of the detrusor muscle, the internal sphincter relaxes, allowing smooth urination. Fourth, the urethra and two ejaculatory ducts pass through the prostate parenchyma. When ejaculation, the muscles of the prostate and seminal vesicle glands contract, which can press the contents of the vas deferens and seminal vesicle glands into the posterior urethra through the ejaculatory ducts, and then discharge them from the body.
2. What diseases are prone to occur in the prostate?
As the main accessory sex glands of men, different diseases occur in the prostate at different developmental stages. In childhood, the prostate develops slowly and rarely develops. The incidence of prostate diseases increases rapidly from the young and middle-aged period to old age. However, the types of diseases that occur vary with each stage.
In the young and middle-aged, the prostatic diseases are mainly acute and chronic prostatitis.
In old age, testicular function deteriorates, hormone levels decrease, the incidence of prostatitis decreases, and the incidence of benign prostatic hyperplasia increases significantly. Autopsy revealed that 50% of people aged 51 to 60 developed pathological benign prostatic hyperplasia, and by the age of 80, 90% developed benign prostatic hyperplasia.
Another common disease in the elderly is prostate cancer. The incidence of this disease in European and American countries is quite high, and the incidence in China is relatively low, but in recent years there has been a rapid increase trend.
In addition, tuberculosis, calculi, sarcoma and other diseases can also occur in the prostate.
3. What is the incidence of prostate cancer?
Clinically, there are obvious geographic and ethnic differences in the incidence of prostate cancer. It is the most common malignant tumor in men in Europe and the United States, and its mortality rate ranks second among all cancers. In Asia, its incidence is lower than that in Western countries. Has shown a rapid upward trend. According to relevant statistics, the lifetime chance of American blacks suffering from prostate cancer is 9.6% and that of whites is 5.2%; blacks who die of prostate cancer account for 3.0% and whites account for 1.4%. The average age of death is 72-77 years. According to statistics, the incidence of prostate cancer per 100,000 population in China has risen from 0.48 in the 1960s to 2.40 in the 1990s. The incidence of prostate cancer in Shanghai has increased the most, from 3.2/100,000 in 1995 to 12.4/100,000 in 2000. Statistics show that in 2000, the incidence of prostate cancer in genitourinary system malignant tumors jumped from the third to the top, and it rose rapidly from the original ninth to the seventh in the ranking of the top 10 male tumors. It is predicted that 10 years later, the incidence of prostate cancer in male malignant tumors will jump to the top three.
The increase in the prevalence of prostate cancer among Chinese residents is related to the aging of the population, the improvement of living standards, changes in dietary structure and environmental pollution. The results of the study show that low family income, rural births, smoking, drinking, divorce or widowed, regular milk drinking, and eating more eggs and pork are the main risk factors for prostate cancer; and eating green vegetables, fruits and beans Food is an important protective factor.
4. What are the types of prostate cancer clinically?
In clinical work, prostate cancer is generally divided into four types: latent cancer, occult cancer, incidental cancer and clinical cancer.
Latent prostate cancer: No clinical symptoms of prostate cancer appeared during his lifetime, and prostate cancer was only found at autopsy.
Concealed prostate cancer; clinical signs of metastatic cancer were first discovered, and after systematic examination, prostate cancer was found to be the primary lesion. If some patients have a pathological fracture as the first symptom, they may also metastasize to the lungs, kidneys, brain, adrenal glands, etc., showing symptoms of the corresponding organs, and finally the prostate cancer is found to be the primary lesion after examination.
Occasional prostate cancer: Non-malignant prostate disease (mainly benign prostatic hyperplasia) is diagnosed, and prostate cancer is found in specimens after surgical resection through pathological examination.
Clinical prostate cancer: clinically diagnosed as prostate cancer, pathologically confirmed as prostate cancer.
5. What are the main symptoms of prostate cancer?
Because prostate cancer mostly originates in the peripheral zone of the prostate, it grows slowly and passes invisible, so the early symptoms are not obvious. Once symptoms appear, it is often at a later stage. Prostate cancer sometimes mainly manifests as lower urinary tract obstruction similar to benign prostatic hyperplasia, or accompanied by hematuria and urinary retention. The detailed description is as follows:
(1) Urinary disorders: Mostly caused by the enlargement of cancerous foci and compression of the urethra, it is manifested as progressive dysuria, narrow or crooked urine flow, or bifurcation, prolonged urinary course, frequent urination, urgency, Painful urination, feeling of incomplete urination, etc. In severe cases, urine dripping and urinary retention occur. Only a small number of patients have symptoms of hematuria. When the tumor invades the neck of the bladder and blocks the double-layer ureter orifice, it can cause renal failure in the patient.
(2) Pain: Pain in the waist, sacrum, buttocks, hips, pelvis and sciatica are common, severe and unbearable. Mostly due to cancer metastasis to the bones or nerve invasion. Pain occurs in more than 30% of patients.
(3) Symptoms of metastases: About one-third or even two-thirds of patients have lymph node metastases when they first go to the doctor, most of which occur in the internal, external, waist, and groin areas. It can cause enlarged lymph nodes and swelling of the lower limbs. Blood transfer is more common in bones (such as pelvis, sacrum, lumbar spine, upper femur, etc.) and internal organs (such as lung, liver, brain, adrenal glands, testes, etc.) to produce corresponding symptoms.
(4) Symptoms of systemic failure: due to pain that affects diet, sleep and spirit, after long-term torture, the general condition is becoming weaker, weight loss, progressive anemia, and eventually systemic failure appears cachexia.
6. What is prostate specific antigen (PSA)?
In 1979, scientists discovered that a glycoprotein with a molecular weight of 33 to 34 kd was found in prostate tissue. Since this protein only exists in prostate tissue, it was named prostate-specific antigen (PSA). The secretory epithelial cells of the prostate glands and ducts secrete PSA into the prostate lumen, and are discharged from the body with semen. Prostate cancer is characterized by the rupture of the basal cell layer and basement membrane, the destruction of the lumen structure of the normal gland, and the PSA entering the interstitial space and then entering the blood circulation.
In 1980, PSA was detected in the serum, and then serum PSA measurement was used to monitor the progression of prostate cancer patients and their response to treatment. Further research found that PSA can be used as a tumor marker for prostate cancer. Since 1988, PSA has been widely used in the screening and diagnosis of prostate cancer. As a result, the diagnosis and treatment of prostate cancer have undergone tremendous changes, which are mainly reflected in the following aspects: the detection rate of localized prostate cancer has increased significantly, prostate cancer patients have become younger, the PSA level of prostate cancer patients decreased at the time of diagnosis, and prostate cancer patients The chance of obtaining radical treatment has increased significantly. Since 1994, the mortality rate of prostate cancer in the United States has declined. It is estimated that 25 million to 3.5 million PSA tests are carried out in the United States each year, and 1.2 million to 1.6 million men undergo prostate biopsy due to abnormal PSA, of which 220,000 are diagnosed with prostate cancer. In China, the rapid increase in the number of prostate cancer patients in recent years is also an indisputable fact, and an important reason is the widespread development of PSA testing.
It should be noted that in the past, it was considered that more than 4.0ng/ml was an indication for biopsy, but recently some medical centers in the United States have reduced the standard to 2.5ng/ml, and recent studies have found that people with PSA levels below 0.5ng/ml The detection rate of middle prostate cancer is 6.6%, and it includes poorly differentiated tumors.
7. How to detect prostate cancer as early as possible?
When elderly men have urinary symptoms, most people think of benign prostatic hyperplasia, which is a disease familiar to elderly friends, but when it comes to prostate cancer, little is known. Prostate cancer generally begins after the age of 50, 95% of which occurs in elderly men over 60, and the incidence continues to increase with age.
Prostate cancer has no symptoms in the early stage, and even if it is unwell, it is not enough to cause the patient's attention. When the tumor enlarges and oppresses the urethra, it is often confused with prostate hyperplasia. About 80% of patients in China first find distant metastatic lesions and then prostate cancer. At this time, the disease is in the advanced stage and the prognosis is poor. So how can prostate cancer be detected early?
The first is the digital rectal examination, which is the simplest, most economical and practical method. In layman's terms, the doctor's index finger touches the prostate, and many asymptomatic prostate cancer patients can be found, and early diagnosis and radical treatment can be obtained. If there is a prostate nodule, it is suspected that there is a possibility of prostate cancer and should be confirmed by a prostate biopsy.
The next thing is the serum prostate specific antigen (PSA) test.Under normal circumstances, the PSA in the blood is not high (not higher than 4ng/ml), and it rises when prostate cancer and other prostate diseases are in the state. It is currently the most sensitive tumor marker for prostate cancer screening. Patients should avoid examinations or operations that stimulate the prostate and cause elevated PSA, such as prostate massage, cystoscopy, catheterization, transrectal ultrasound, prostate biopsy, and transurethral prostatectomy. If the PSA is elevated, it should be checked again. If it is still elevated, and if it is obviously caused by inflammation or other factors, it is suspected that there is a possibility of prostate cancer, and a prostate biopsy should be performed.
The third is the transrectal ultrasound examination, that is, the ultrasound probe is put into the rectum like a digital rectal examination, without any damage and only slight discomfort. This check has an increase in serum PSA, so it should be done after blood draw.
If the patient feels nodules on digital rectal examination, elevated serum PSA, or finds suspicious lesions on ultrasound, they should undergo transrectal prostate biopsy. This is the final diagnosis of prostate cancer. It is recommended that men over the age of 50 should routinely find a specialist doctor to do a prostate examination every year, including digital rectal examination, PSA examination and transrectal B-ultrasound to detect prostate cancer early.
8. How is a prostate biopsy performed?
Prostate biopsy is the only way to obtain prostate disease tissue and ultimately diagnose prostate cancer. Patients need routine prostate biopsy in the following situations: ①The prostate nodules are found on digital rectal examination, the nature of which is unknown. ② Serum PSA level is higher than normal (such as PSA>4ng/ml). ③Ultrasound or other imaging examinations found that prostate occupying lesions. ④Determine the type of prostate tumor tissue in order to decide the treatment plan. ⑤The patient has metastatic cancer and it is clinically suspected that the primary cancer is in the prostate. ⑥ After prostate cancer treatment, the curative effect needs to be evaluated.
The prostate biopsy is usually transrectally, and the standard prostate biopsy must be completed under the guidance of B-ultrasound. The biopsy of the prostate system guided by transrectal ultrasound is the most commonly used biopsy method in clinical practice.
Routine bowel preparation and oral antibiotics should be performed before puncture to prevent infection. Intestinal preparations can be taken by oral senna soaked water one day before surgery or glycerin enema enema one hour before surgery. It is recommended to start oral antibiotics 1-2 days before surgery. Commonly used antibiotics include metronidazole (ie metronidazole) and levofloxacin. During the puncture, the patient was in the left decubitus position. The doctor uses an automatic puncture gun to puncture the prostate tissue under the guidance of transrectal B-ultrasound. Depending on the specific condition, it often requires 8-12 needles. After the puncture is completed, the patient should stay in the hospital for about 1 hour.
9. What diseases should be differentiated from prostate cancer?
(1) Benign prostatic hyperplasia: symptoms similar to those of prostate cancer can occur. However, the patient is generally in good condition, with repeated dysuria. The glands are diffusely enlarged, the surface is smooth, elastic, without induration, and the serum PSA level is usually normal.
(2) Prostate calculi: The prostate has hard nodules similar to prostate cancer. However, when prostate stones are used for digital rectal examination, rubbing sounds can sometimes be obtained. X-ray photographs show the shadow of stones near the pubic symphysis.
(3) Prostatic tuberculosis: a history of tuberculosis or tuberculosis in other parts of the urinary system. The prostate gland is slightly enlarged, hard, and nodules. Mycobacterium tuberculosis can be found directly in the urine.
(4) Prostate sarcoma: similar to prostate cancer, but the incidence of prostate sarcoma is higher in young people. Although the disease has prostate enlargement, it is flexible and soft as cystic. A biopsy can confirm the diagnosis.
(5) Prostatic fibrous induration: mostly chronic prostatic inflammation, long-term unhealed, fibrous tissue hyperplasia, local nodules, limited to the capsule, tough and resistant. The main difference is that serum PSA is not elevated.
(6) Chronic prostatitis: Urinary tract symptoms are similar to those of prostate cancer during an acute attack. But the glands are slightly enlarged, the quality is slightly harder, the middle groove exists, and the white blood cells in the prostate fluid increase.
It is recommended to see a specialist to distinguish prostate cancer from the above diseases.
10. What are the ways of metastasis of prostate cancer?
(1) Direct spread: Prostate cancer can penetrate the prostate capsule and spread locally, infiltrate adjacent tissues and organs, and first invade seminal vesicles, bladder, vas deferens, pelvic tissues, etc. At this time, the volume of the prostate increases, the boundary is unclear, and the texture becomes hard. Sometimes a local cancer can penetrate the capsule and infiltrate adjacent tissues and organs in a small volume.
(2) Lymphatic metastasis: The most common metastasis of prostate cancer along the lymphatic vessels to the pelvic lymph nodes, a few also can be seen in retroperitoneal, mediastinal and supraclavicular lymph nodes. Individual inguinal lymph node metastasis can occur.
(3) Hematological metastasis: Hematological metastasis is more common. Cancer cells invade blood vessels and the most common bone metastases are the pelvis, lumbar spine, femur and ribs. A small number of internal organs such as lung, liver, brain, pleura, adrenal gland metastasis can be seen.
11. How is prostate cancer staged and what is the significance?
Prostate cancer can be simply divided into four stages clinically:
(1) Stage A A lesions are not easy to detect clinically, and can only be diagnosed by pathological examination of prostatic hyperplasia specimens or needle biopsy specimens. Cancer lesions are completely confined to the prostate, cancer cells are often well differentiated, nodules cannot be palpable on digital rectal examination, and there is no clinical metastasis. Patients at this stage often have no clinical symptoms.
(2) Stage B typical stage B lesions are manifested as a single nodule of prostate during digital rectal examination with no signs of distant metastasis, and the local lesions found on digital rectal examination are confined to the prostate capsule, which must be passed through a prostate biopsy Pathological examination confirmed. 40% of patients in this period have urinary tract symptoms.
(3) Stage C cancerous lesions extend beyond the prostate capsule and invade the seminal vesicles and other adjacent tissues and organs, but there is no evidence of distant metastasis.
(4) Stage D cancerous lesions extend beyond the prostate and have distant metastases.
Clarifying the staging of prostate cancer helps to understand the extent of the disease, determine the prognosis and formulate treatment plans. For patients with stage A and B, because the disease is limited to the prostate, radical prostatectomy can be sought as soon as possible. If the patient is in poor general condition or short life expectancy, radical radiotherapy can be used. Most patients have a chance to be cured. For patients with stage C and D who have already had extra-prostatic and distant metastases, comprehensive treatment includes endocrine therapy, chemotherapy, radiation therapy and bone metastasis treatment.
12. Will prostate hyperplasia become prostate cancer?
The occurrence and development process of prostate cancer is divided into two steps: that is, there is pathological prostate cancer first, and then the transition from pathological prostate cancer to clinical prostate cancer.
Dihydrotestosterone in the local tissues of the prostate is the chief culprit for benign prostate hyperplasia and clinical prostate cancer. However, hyperplasia and cancer are two completely different pathological processes. So far, there is only evidence that androgens can promote the conversion of pathological prostate cancer to clinical prostate cancer, and there is no evidence that promotes the generation of new prostate cancer or benign prostatic hyperplasia to prostate cancer. Pathological anatomy found that benign prostatic hyperplasia occurred in the prostate tissue surrounding the urethra, while prostate cancer was more common in the peripheral tissue of the prostate. This shows that the two are obviously different in the occurrence mechanism, and there is generally no mutual transformation between the two.
13. Why does prostate cancer still occur after prostatectomy?
Lao Zhang is 78 years old. He underwent transurethral prostatectomy five years ago. However, when prostate cancer was found during the physical examination of the unit recently, he angrily went to the surgeon and asked why he didn't get his prostate "cleaned".
The doctor explained that whether it is an open surgery or a transurethral surgery, the continuity of the urinary tract must be preserved. Only the hyperplastic glands are removed and the outer envelope is preserved, which is equivalent to removing the orange flesh, but the orange peel must be preserved. The most common site for prostate cancer is in the peripheral zone, that is to say, prostate cancer will develop after prostatectomy. Therefore, despite the relief of urination symptoms, the risk of prostate cancer still exists.
Moreover, most prostate cancers can be found through digital anal examination and serum prostate-specific antigen examination. Therefore, patients who have undergone prostate surgery should still cooperate with their doctor during the physical examination to do this examination.
14. What is radical prostate cancer surgery?
When the patient's prostate cancer is confined to the prostate, radical prostatectomy should be used, that is, the prostate, seminal vesicles and pelvic lymph nodes where the tumor is born are completely removed to achieve the goal of clean removal of the tumor.
MD Anderson Cancer Center in the United States leads the world in its cure rate after radical prostatectomy. Director Ye Dingwei of our department has studied at MD Anderson Cancer Center for more than two years, trying to figure out every detail of the operation. After returning to China, he modified the conventional radical prostatectomy and found out a radical prostatectomy suitable for the anatomical characteristics of Orientals, which is improving the tumor-free survival of patients. At the same time, it preserves the patient’s sexual function and minimizes the incidence of urinary incontinence.
15. What is androgen removal treatment for prostate cancer?
Since the prostate is an androgen-dependent organ, most prostate cancers are androgen-dependent, that is, androgens in the body can promote the progression of prostate cancer, and the removal of androgens in the body can significantly relieve the pathological changes and symptoms of prostate cancer. Bilateral orchiectomy can greatly reduce androgens in the body, thereby controlling the development of prostate cancer. However, because of the surgical and psychological effects, and irreversibility, it is not recommended at home and abroad. It is advocated at home and abroad to use luteinizing hormone-releasing hormone agonists, such as Innate, Norride, Tephrine, etc., which can reduce the blood androgen concentration to the level of orchiectomy, that is, "drug excision". Because there is no surgical trauma, psychological impact, and reversibility, it has become the preferred treatment.
It should be noted that if using "medicinal test", anti-androgen drugs such as Kang Shide, flutamide, Fuzhier, etc. should be used first, and then luteinizing hormone releasing hormone agonist should be used to prevent rebound and tumor Progress deteriorated in the short term.
16. Do prostate cancer patients still take drugs after androgen removal treatment?
Most of the androgens in the prostate originate from the testes, which can be effectively and safely removed by drug treatment or surgical removal of the testicles, but a small part is derived from the adrenal glands, so simple medical castration or surgical castration cannot completely remove the prostate. The active androgen. Anti-androgen drugs such as Kang Shide, flutamide, Fuzhier, etc. can bind to the androgen receptor of prostate cancer cells to prevent the intake of androgen and/or prevent the binding of androgen to the nucleus, which is a powerful anti-androgen effect. The combined application of antiandrogenic drugs and medical castration or surgical castration can completely block the androgenic effects of the testes and adrenal glands. Compared with single androgen removal therapy, combined therapy can block the effect of androgens on the prostate to the greatest extent, so that prostate cancer cells can rapidly apoptotic and appropriately prolong the survival period of patients. This is the current hot spot for prostate cancer treatment- "Androgen block therapy."
17. What kind of prostate cancer patient needs chemotherapy?
After endocrine therapy, most prostate cancers will turn into androgen-independent prostate cancer after different remission periods (usually about 2 years). At this time, the treatment of various endocrine therapy drugs is ineffective. Antitumor drugs for the treatment of prostate cancer have developed rapidly in recent years and have attracted considerable attention. Systemic chemotherapy is mainly suitable for advanced metastatic prostate cancer. After endocrine therapy or radiotherapy fails, the tumor has entered the androgen-independent stage.
18. What should I do if a patient with prostate cancer has urinary obstruction?
Transurethral resection of the prostate is often used to treat symptoms of bladder neck obstruction caused by prostate cancer. Since 97% of prostate cancer is located in the peripheral area, and capsule infiltration can occur at an early stage, transurethral resection of the prostate can only remove part of the prostate tissue or cancer tissue. Therefore, this operation is not a thorough operation and has no curative significance, but it can prevent the occurrence of uremia, improve the quality of life of patients with advanced prostate cancer, and is the best operation to reduce bladder neck obstruction caused by the prostate. Transurethral resection of the prostate is mainly used for patients with bladder neck obstruction caused by prostate cancer above stage C, such as dysuria.
19. How should prostate cancer patients be followed up?
The serum prostate-specific antigen (PSA) level of most patients is elevated, and it is currently recognized that this indicator can reflect the effect of treatment. Generally speaking, after receiving endocrine therapy, the PSA level of advanced prostate cancer patients drops to the level of surgery. The first 50% or lower indicates a better clinical outcome. For patients whose PSA has been controlled, if there is a rebound, it often indicates that the disease has progressed to hormone-independence, and the outcome is not optimistic. In addition, because anti-androgen drugs such as Kang Shide, flutamide, and Fuzhier have certain toxic and side effects on the liver, patients need to check liver function monthly.
For patients undergoing radical resection or radical radiotherapy for prostate cancer, PSA follow-up is also very important, because theoretically, in patients without metastasis and recurrence, the postoperative blood PSA level should be less than 0.2-0.4ng/ml, If PSA is elevated, the possibility of recurrence and metastasis should be considered, and early evaluation and other treatment options should be used.
In addition, in the follow-up process, you should know whether there are bone, lung and liver metastases, and do corresponding examinations, such as lotosome bone scan, B-ultrasound, etc.
20. What are the manifestations of prostate hyperplasia?
If prostate hyperplasia develops around the urethra, it may only have mild manifestations or even no symptoms. If it develops to the neck of the bladder, severe symptoms will occur even if the proliferation is not large. Patients generally show an increase in the frequency of urination in the early stage, which is more obvious at night. Every time you urinate, it is often not clean, leaving residual urine, which can cause congestion and edema in the bladder neck over time. As time goes by, the bladder muscles become fatigued, urination becomes weaker, and residual urine increases. At this time, the prostate becomes more congested and swollen, making the discharged urine slender and bifurcated.
Sometimes the urine does not form a line and drips out, sometimes the urine line splits into two strands, and it takes half a minute to one minute to go to the toilet to urinate. In the later stage, if the amount of residual urine is equal to the normal bladder capacity, when the sound of running water or reflexes caused by other stimuli are heard, urine will automatically overflow. Extreme edema and congestion at the exit of the bladder neck, once stimulated, such as cold, holding urine, overwork, etc., acute obstruction will occur, and the ability to urinate automatically is completely lost, which is called "acute urinary retention".
21. What are the hazards and complications of prostate hyperplasia?
First, prostatic hyperplasia can cause kidney damage and even uremia. This is because the proliferative prostate oppresses the urethra, and the bladder needs to contract forcefully to overcome resistance and expel urine from the body. Over time, the bladder muscles will become hypertrophy. If the pressure on the bladder cannot be relieved for a long time, the residual urine in the bladder will gradually increase, the bladder muscle will become ischemic and hypoxic, become no tension, and the bladder cavity will expand. Finally, the urine in the bladder will be poured back into the ureter and renal pelvis, causing hydronephrosis, and uremia may occur in severe cases.
Second, bladder stones in the elderly are also related to benign prostatic hyperplasia. In the case of unobstructed urinary tract, stones generally do not grow in the bladder. Even if a stone falls from the ureter into the bladder, it can be excreted in the urine. Elderly people suffering from prostate hyperplasia are different. Lower urinary tract obstruction leads to urinary retention, nucleation of stone salts in the urine, followed by formation of bladder stones, and the incidence of prostate hyperplasia combined with bladder stones can reach more than 10%.
Third, prostatic hyperplasia may induce hernia (intestinal gas) and other diseases in the elderly. Some patients with benign prostatic hyperplasia will have symptoms of dysuria, requiring exertion and holding their breath to urinate. Due to frequent exertion, the intestines will protrude from the weak part of the abdomen, forming a hernia (small intestinal gas), and sometimes patients will have hemorrhoids and varicose veins in the lower limbs.
Fourth, cause infection. As the saying goes: "flowing water does not rot", but patients with benign prostatic hyperplasia often have different degrees of urinary retention. The residual urine in the bladder is like a pool of stagnant water. Once bacteria multiply, it will cause uncontrollable infections.
Fifth, cause urinary retention and urinary incontinence. Urinary retention can occur at any stage of the disease, mostly due to sudden congestion and edema of the prostate caused by climate change, drinking, and fatigue. Excessive residual urine can make the bladder lose its ability to contract, and the urine retained in the bladder gradually increases. When the bladder is over-inflated, urine will overflow from the urethra unconsciously. This phenomenon of urinary incontinence is called filling urinary incontinence. Such patients must receive emergency treatment.
In addition, although patients with benign prostatic hyperplasia who have only glandular hypertrophy and no lower urinary tract symptoms such as bladder outlet obstruction can not be treated, this kind of harm must not be ignored. You should seek medical advice in time for guidance and treatment, and good treatment It should be able to prevent long-term complications.
22. How to carry out daily self-care for prostate hyperplasia?
Prostatic hyperplasia is a common and frequently-occurring disease in elderly men. Triggers such as climate change, fatigue, drinking, sexual intercourse, or infection can easily cause urine retention, and even the urine can't be discharged at all, causing great pain. Therefore, self-care is very important. The following measures are introduced:
1). Preventing cold From late autumn to early spring, the weather is volatile, and cold often makes the condition worse. Therefore, patients must pay attention to cold protection, prevent colds and upper respiratory tract infections.
2). Absolutely avoid alcohol. Drinking alcohol can cause hyperemia and edema of the prostate and bladder neck and induce urinary retention.
3) Eat less spicy and spicy foods, which can not only cause congestion of sexual organs, but also aggravate symptoms of hemorrhoids and constipation, compress the prostate, and aggravate dysuria.
4). Do not hold back urine. Hold back urine will cause overfilling of the bladder, weaken the tension of the bladder detrusor, difficulty in urination, and easy to induce acute urinary retention. Therefore, it is necessary to urinate when there is urine.
5). Don't overwork. Overwork will damage the breath, and lack of breath will cause weakness in urination and easily cause urinary retention.
6). Avoid sitting for a long time. Sitting for a long time will aggravate hemorrhoids and other diseases, and easily congest the perineum and cause dysuria. Frequent participation in cultural and sports activities and exercises can help reduce symptoms.
7). Drinking adequate amounts of water. Drinking too little water will not only cause dehydration, but also adversely affect the flushing effect of urination on the urinary tract. It will also easily cause the urine to concentrate and form stones. Therefore, in addition to appropriately reducing drinking water at night to avoid overfilling the bladder after sleep, drink more water during the day.
8). Use drugs with caution. Some drugs can aggravate dysuria, and can cause acute urinary retention in large doses. The main ones are atropine, belladonna and ephedrine tablets, isoproterenol and so on. In recent years, it has been discovered that calcium blockers and verapamil can promote the secretion of prolactin, and can weaken the contractility of the detrusor muscles and aggravate dysuria. Therefore, some drugs should be used with caution or preferably not.
9). Timely treatment Prostatitis, cystitis and urinary calculi should be treated promptly and thoroughly.
10). Massage the lower abdomen Massage the lower abdomen, tap the Qiguanyuan and other points under the umbilicus, which is beneficial to the recovery of bladder function. A slight pressure massage after urination can promote bladder emptying and reduce residual fluid.
It is worth reminding that the development of this disease is slow and the course of the disease is long. If the prevention effect can be better from middle age, in addition to the above measures, it is necessary to prevent excessive sexual life, especially to beware of interrupted sexual intercourse and masturbation. According to clinical observation, as long as most patients can adhere to the implementation of self-care measures and pay attention to timely treatment, the effect is very good. On the contrary, the effect of poor persistence is not ideal.
twenty three. What are the surgical treatments for benign prostatic hyperplasia?
The patient is 60 or 70 years old. Except for benign prostatic hyperplasia, other health conditions are good. Long-term medication is economically overwhelming, or symptom control is still not satisfactory after medication. Surgical treatment can be selected. Surgical treatment includes open surgery and transurethral Resection of the prostate. Except for a small number of extremely large prostates or bladder diverticula that require open surgery, other patients can undergo transurethral resection of the prostate. Compared with traditional open surgery, this surgical method has less damage, less bleeding, and surgery. The risk is small, the hospital stay is short, and the treatment effect is equivalent to that of open surgery. Although there are new technologies such as laser, the effect has not exceeded that of transurethral resection of the prostate, so this surgery is recognized as the "gold standard" for the treatment of benign prostatic hyperplasia.
twenty four. What should be paid attention to after transurethral electrical resection of prostate?
A more vivid analogy is transurethral electrical resection of the prostate in which the yolk and egg white of a boiled egg are dug out from the eggshell. The inner side of the "eggshell" that has just been operated on is actually an unhealed "cut", which is completely healed. It takes about 3 months, during which self-care is essential.
1). Prevention and treatment of urinary tract infections after the operation of the patient's "egg shell" is large and bare, with attached necrotic tissue and blood clots that have not completely fallen off. These may become a good medium for bacterial growth. In addition, after the patient's operation Decreased resistance also increases the risk of urinary tract infection. After urinary tract infection, the wound is congested or ulcerated and bleeding forms delayed bleeding. Therefore, the patient should take orally the antibiotics excreted in the urine, such as levofloxacin, etc., within 2 to 3 weeks of discharge, and pay attention to rest and drink plenty of water.
2). Prevent bleeding. In addition to the above infection factors, bleeding is mainly caused by direct stimulation of the wound, such as dry stools, strenuous activities, especially exercises that directly stimulate the prostate fossa, as well as sexual life and drinking. It can cause local congestion and increase the risk of infection and bleeding.
3). Improve temporary urinary incontinence. Many patients will experience varying degrees of urinary incontinence after surgery for benign prostatic hyperplasia, which may be due to decreased posterior urethral resistance, uninhibited contraction of the bladder detrusor that manages bladder urination, and infection in the prostatic fossa Of course, true urinary incontinence caused by damage to the external urethral sphincter is very rare. Patients should develop the habit of urinating regularly, which can enhance the compliance of the bladder detrusor and increase the amount of urine carried by the bladder. The auxiliary use of drugs that increase the compliance of the bladder detrusor can also have a certain effect. . In addition, pelvic floor muscle contraction training, that is, levator anus training is also very important, and oral imipramine can also help to control urinary incontinence by enhancing the tension of the urethral sphincter and pelvic floor muscles. If the patient still has urinary incontinence after one year, he should go to a specialist for further treatment to determine whether it is true urinary incontinence.
4). Pay attention to nutrition and combine work with rest. In addition to the above-mentioned drinking more water and eating more fruits and vegetables, attention should be paid to the preparation of dietary nutrition, and the diet should pay attention to nutrition and be easily absorbed by the elderly.