Last time we talked about prostate hyperplasia, commonly known as "prostatic hypertrophy". Its main symptom is progressive dysuria, especially frequent nocturia. Severe symptoms can even lead to urinary retention and hydronephrosis. Today, let's talk about how to treat prostate hyperplasia.
Lower urinary tract symptoms and the resulting decline in quality of life are the main reasons for patients with prostate hyperplasia to seek treatment. According to the patient's symptoms and willingness to treat, it can be divided into the following treatment methods.
1. Watch and wait
Patients with mild lower urinary tract symptoms and moderate or higher symptoms (using a special score for evaluation, can be filled in by a urologist at the hospital), and patients whose quality of life has not been significantly affected can use watchful waiting. However, regular follow-ups are required. If symptoms worsen during the waiting period, you should go to the hospital in time.
2. Drug treatment
1. A receptor blocker
Representative α-blockers such as tamsulosin, alfurazosin, terazosin, and doxazosin have similar effects.
The adverse reactions of a receptor blockers are mainly cardiovascular and sexual functions. Cardiovascular adverse reactions are mainly dizziness and orthostatic hypotension. Orthostatic hypotension is more likely to occur in elderly patients with hypertension. Therefore, when taking a-blockers, it is necessary to take more than one hour between antihypertensive drugs. It is recommended to take a receptor blocker before going to bed, which can reduce the occurrence of orthostatic hypotension. The main adverse reaction in sexual function is abnormal ejaculation, manifested as reverse ejaculation, decreased semen volume and non-ejaculation.
2, 5a reductase inhibitor
Representative drugs are finasteride and dutasteride. 5a reductase inhibitors have a slower onset, and patients with long-term use have obvious benefits. The main adverse events related to 5a reductase inhibitors include sexual dysfunction, breast enlargement, and skin rash. For relatively young patients and patients with sexual function needs, medication should be used with caution.
3. Combination medication
Combination medication mainly refers to the combined application of alpha receptor blockers and 5a reductase inhibitors. At present, a mixture of highly selective α-receptor blocker tamsulosin and finasteride or dutasteride has appeared internationally, and long-term treatment is maintained and the number of patients taking drugs is reduced.
The second combination therapy refers to the combined application of alpha receptor blockers and M receptor antagonists. It is mainly used to treat patients with benign prostatic hyperplasia with symptoms during the storage period.
4. Plant preparations and Chinese medicine
At present, there are many kinds of plant preparations and traditional Chinese medicines for the treatment of prostate hyperplasia, which have certain clinical effects. There are also many related studies at home and abroad. It is generally believed that the main advantage of such drugs is that they have fewer side effects, but due to the complex components of such drugs, the relevant treatment mechanism has not been clarified.
Three, surgical treatment
1. Indications for surgical treatment
Patients with moderate/severe prostate hyperplasia whose lower urinary tract symptoms have significantly affected the patient’s quality of life may choose surgical treatment, especially those who have poor drug treatment or who refuse to receive drug treatment, may consider surgical treatment.
When prostatic hyperplasia causes the following complications, surgical treatment is recommended: ① Repeated urine retention (at least one time after extubation can not urinate or two urinary retention); ② Repeated hematuria, 5a reductase inhibitor treatment is invalid; ③ Repeated urinary system Infection; ④ Bladder stones; ⑤ Secondary upper urinary tract hydrops (with or without renal impairment).
Patients with benign prostatic hyperplasia combined with a large diverticulum of the bladder, inguinal hernia, severe hemorrhoids or prolapse of the anus, if clinically judged that the lower urinary tract obstruction cannot be cured, surgical treatment should be considered.
Surgical treatment should be considered in patients with benign prostatic hyperplasia whose residual urine volume is significantly increased, resulting in overflow incontinence.
2. Surgical treatment
At present, the commonly used surgical methods include transurethral resection of the prostate, open prostatectomy, plasma bipolar resection, transurethral holmium laser enucleation of the prostate, transurethral laser vaporization of the prostate, transurethral laser coagulation of the prostate, and transurethral laser coagulation of the prostate. Microwave hyperthermia for urethra.