1. First, introduce the role of the prostate in the human body?
The prostate (prostate) is an unpaired parenchymal organ, composed of glandular tissue and muscle tissue. The transverse diameter of the upper end of the prostate is about 4cm, the vertical diameter is about 3cm, and the front and back diameter is about 2cm. The surface is covered with a fascial sheath, called the prostate capsule. There is a prostate venous plexus between the capsule and the prostate. Prostate secretions are the main component of semen. The prostate is slightly flattened chestnut shape, with a wide upper end called the base of the prostate, adjacent to the bladder neck. The lower end is tapered and located on the urogenital septum, called the tip of the prostate. The part between the base and the tip is called the body of the prostate. The back of the body is relatively flat, and there is a longitudinal shallow groove on the median line called the prostatic groove. The male urethra penetrates into the prostate near the anterior edge of the glandular base and passes through the anterior portion of the glandular parenchyma and exits from the tip of the prostate. At the posterior edge near the bottom, a pair of ejaculatory ducts penetrate the prostate and open on the seminal caruncle on the back wall of the prostate of the urethra. The opening of the excretory tube of the prostate dries the back wall of the prostate of the urethra.
The prostate is generally divided into 5 lobes: anterior, middle, posterior and bilateral lobes. The middle lobe is wedge-shaped and is located between the urethra and the ejaculatory duct. After 40 years of age, the middle lobe can become hypertrophic, protruding the bladder upward, causing the bladder to bulge significantly, and oppressing the urethra to cause dysuria. The prostate is located between the bladder and the genital diaphragm. The base of the prostate is adjacent to the bladder neck, seminal vesicle gland and vas deferens ampulla. The front is the symphysis pubis, and the rear is the rectal ampulla. The back of the prostate can be touched during digital rectal examination to diagnose whether the prostate is hypertrophy, etc., and the vas deferens and seminal vesicles can be touched upwards. Children's prostate is very small, and the glands grow rapidly during sexual maturity. In old age, the prostate regresses and shrinks. If the connective tissue in the gland is hyperplasia, the prostate is enlarged. There is a film on the surface. There are more elastic fibers and smooth muscles in it. These components can extend into the glands to form the stent of the prostate. The essence of the prostate is composed of 30-50 double-ducted alveolar glands, and a total of 15-30 ducts open in the urethral spermary According to the distribution of glands, the two sides can be divided into mucosal glands, submucosal glands and main glands.
Structural features: (1) The acinar epithelium is single-layered cubic, single-layer columnar or pseudo-multilayer columnar, (2) Different shapes and irregular glandular cavity (3) There are many interstitials, except for connective tissue, rich in elasticity Fiber and smooth muscle. (4) Condensed bodies are common in the acinar cavity, and the secretions of epithelial cells are concentrated.
Function: Secretions participate in the formation of semen, and secretion activities are regulated by androgens
1. The location and the adjacent prostate are located between the bladder neck and the urogenital diaphragm. The upper part is the base of the prostate, which is adjacent to the bladder neck. The front part has a urethra penetrating, and the back part has left and right ejaculatory ducts penetrating forward and downward; the lower end is the tip of the prostate, which is in contact with the urogenital diaphragm downwards. The levator prostatic muscle is bypassed, and the urethra passes through the tip. Between the tip and the bottom is the body of the prostate. You have front, back and lateral sides. There is the pubic prostate ligament in the front, connecting the prostate sheath with the pubic pelvic surface. The back is flat, with a longitudinal shallow groove in the middle, called the prostatic groove, which is adjacent to the rectal ampulla through the rectum-bladder septum. During digital rectal examination, the size, shape, hardness and prostatic groove of the prostate can be scanned forward.
2. The lobed prostate is usually divided into five lobes: anterior, middle, posterior, and left and right lobes. The anterior lobe is very small, located in front of the urethra, and has no clinical significance. The middle lobe is wedge-shaped, also known as the isthmus of the prostate, located behind the urethra, in front of the posterior lobe and between the left and right lobes, just above the opening of the ejaculatory duct into the urethra. The middle lobe of the elderly is often hypertrophy. When the middle lobe hypertrophy develops upward, the mucosa behind the inner mouth of the urethra bulges, which easily causes dysuria. The posterior lobe is located behind the ejaculatory duct, the middle lobe, and the left and right lobes. Hypertrophy rarely occurs, but it is the most common site for cancer. The left and right lobes are close to the side wall of the urethra and are located in front of the posterior lobe. The hypertrophy of the left and right lobes can also compress the urethra from both sides, which can easily cause difficulty in urination. The surface of the prostate parenchyma is covered with a thin and tough lamina propria. There are branches of venous plexus, arteries and nerves between the prostate sheath. The venous plexus receives the deep dorsal penis vein, and the communicating branch is anastomosed with the venous plexus of the bladder. Enter the internal iliac vein or its branch.
2. What we often hear is prostatitis, so what is the relationship between prostatitis and benign prostatic hyperplasia?
Prostatitis and benign prostatic hyperplasia are two completely different diseases. Prostatitis mostly occurs in the young and middle-aged, while prostatic hyperplasia mostly occurs in the elderly. Prostatitis is not a factor that causes prostatic hyperplasia, which means that prostatitis and prostatic hyperplasia are not inevitable. contact.
3. Are prostate hyperplasia and prostate enlargement the same thing?
Medically called prostate hyperplasia and normal prostate enlargement are actually the same disease.
4. How harmful is prostate hyperplasia to men's health?
Patients with benign prostatic hyperplasia, because of their increased nocturia and difficulty in urination, cause great inconvenience to the patient’s life, and serious urinary retention may occur. If the treatment is not timely, it may also cause the upper urinary tract to accumulate. Kidney function is impaired. Long-term urinary tract obstruction can be complicated by urinary system infections, bladder stones and even hernias, hemorrhoids, prolapse and so on due to increased abdominal pressure.
5. At what age does it occur?
Prostatic hyperplasia is a common disease of senile disease. The natural history of benign prostatic hyperplasia can be divided into two periods, the pathological period and the clinical period. The pathological stage is divided into microscopic and macroscopic benign prostatic hyperplasia. Almost all men are likely to have microscopic prostatic hyperplasia (40% at the age of 50 and nearly 90% at the age of 80), and 1/2 of them will develop into macroscopic benign prostatic hyperplasia: In macroscopic prostatic hyperplasia, About 1/2 will become clinical prostate hyperplasia. With the development of society, the continuous improvement of people's living standards, the continuous improvement of medical conditions, the aging of the population, and the increasing number of elderly people, the incidence of prostate hyperplasia will also continue to increase.
6. What are the symptoms of prostate hyperplasia?
1. Frequent urination: Nocturia is the primary symptom. In the early stage, it is caused by prostate congestion, and the obstruction and residual urine increase when the frequency of urination increases. 2. Difficulty urinating: It is progressive, the main symptom, the onset of urination is delayed, the urination time is prolonged, the range is short, the urine line is thin and weak, and sometimes there are symptoms of interrupted urine flow and dripping. 3. Urinary retention: It occurs when the bladder function is lost and can be accompanied by overflow incontinence. 4. Hematuria: The capillaries on the prostate mucosa are congested, dilated or stretched. 5. Urinary tract infection: urinary tract infection may be complicated by obstruction. 6. Bladder stones: more than 10% of them have bladder stones. 7. Impairment of renal function: mentioned above.
7. What are the causes of benign prostatic hyperplasia?
The pathogenesis of benign prostatic hyperplasia has not yet been elucidated. There are many theories about the cause of benign prostatic hyperplasia, among which the theory of sex hormone imbalance is the most recognized by people. This is based on two necessary conditions for the occurrence of benign prostatic hyperplasia, one is that it is only seen in elderly men, and the other is that it must have a functional testicle. When you are young, there will be no benign prostatic hyperplasia.
8. How to treat benign prostatic hyperplasia clinically?
1. General medication at the initial stage (1) a-adrenergic receptor antagonist: the first-generation non-selective a-receptor blocker, such as bamboo amine. The second generation of selective long-acting a1-receptor blockers, such as terazosin hydrochloride, doxazosin. The third generation superselective a1A-blocker. (2) Antiandrogen: estrogen (vinyestrol). Synthetic anti-androgen: 5-a reductase inhibitor (Protective).
2. Non-surgical interventional therapy: (1) Prostate hyperthermia includes intracavitary microwave therapy, intracavitary radiofrequency therapy, transurethral acupuncture and ablation therapy. However, the exact curative effect needs to be further verified in the clinic. (2) Laser treatment: It is the treatment of prostate hyperplasia in recent years. It is divided into gas laser, solid laser, dye laser and semiconductor laser. These methods have the advantages of less trauma and less pain. The disadvantage is that the operation time is long and the cost is higher.
3. Surgical treatment: At present, surgical treatment is still the main treatment method for benign prostatic hyperplasia. Surgical treatment should be considered if the patient has the following conditions: (1) The symptoms seriously affect work and life, and medication and non-surgical treatment are ineffective. (2) Recurrent urinary retention or gross hematuria. (3) Secondary bladder stones appear. (4) Chronic urinary retention, upper urinary tract hydrops and renal function damage occur.
Open surgery: The treatment is the most thorough and the effect is the best, but it is a big blow to the patient, more pain, more complications, and a long hospital stay.
Transurethral Vaporization of the Prostate: It is a new method that has emerged in recent years, which combines the advantages of electrosurgical resection and laser. In the past transurethral resection of the prostate, the electrosurgical unit used was unipolar, there was no autologous reflux, and normal saline could not be used as the medium. The patient was at risk of obturator nerve reflex, water intoxication, and hyponatremia. At present, the bipolar plasma electrocutter we use is bipolar, with self-reflux, and non-conductive. It can use normal saline as the medium, and normal saline is isotonic. It will not cause water intoxication and hyponatremia, and is not easy to occur Closed cell reflection. In addition, the bipolar plasma electrosurgical knife can automatically identify the prostate body and its capsule, so the damage is small, the glands are removed completely, the patient recovers quickly, there is no bladder spasm after the operation, there is less bleeding, safety, and fewer complications. , Short hospital stay.