2020年11月12日星期四

hemorrhoids icd 10,Holmium laser enucleation of prostate

    Prostatic hyperplasia (prostatic hyperplasia) is a common disease in elderly men. The age of onset is mostly after the age of 50. The growth of the prostate is very slow after birth, and it grows faster after entering puberty. The volume remains constant until middle age, about 4 cm × 3 Cm × 2 cm size. With age, some people's prostate tends to proliferate and the glands gradually increase. When the hyperplastic prostate reaches a certain level, it compresses the urethra, causing a series of symptoms such as dysuria. With the continuous improvement of people's living standards and sanitary conditions, the average life expectancy of the people has reached 70 years. Prostatic hyperplasia has become a common disease in urology. Due to its obstruction in the urinary system, it affects urination and directly threatens kidney function. Prostatic hyperplasia occurs in elderly men, usually after the age of 50, and the incidence gradually increases with age. According to domestic statistics, about 36-38% of the elderly over the age of 50 have prostate hyperplasia.

    Because the prostate is located exactly at the exit of the bladder and a special location surrounding the urethra, once hyperplasia occurs, it will compress the urethra from all directions, blocking the discharge of urine in the bladder and causing a series of pathological changes in the urinary system.

    The bladder adjacent to the prostate bears the brunt. Due to the obstruction of the discharge of urine, the bladder must use more force to discharge the urine through the narrowed urethra. Therefore, the bladder wall is thickened compensatoryly. At this time, although the urine can still be completely discharged , But the patient began to have symptoms of frequent urination, urgency, especially nocturia. As the prostate continues to proliferate and the urethra becomes narrower, the strength of the bladder wall can no longer completely discharge urine. Not only will urine remain in the bladder, but the weakened bladder wall will bulge out, forming a disease called diverticulum in medicine. . Prostatic hyperplasia progresses further, the bladder wall becomes more dilated, thinner, and weaker. At this time, patients will experience enuresis, which is medically called filling incontinence.

    The upper urinary tract is then affected. Because the bladder is often filled and cannot effectively discharge urine, the urine produced by the kidney cannot be transported to the bladder through the ureter in time. This will inevitably lead to water accumulation in the renal pelvis (the hollow part of the kidney). It also oppresses the renal parenchymal tissue and impairs kidney function.

    After the obstruction of the entire urinary tract occurred, complications of infection and stones followed. This is just like the unobstructed drainage pipes are clean and smooth, and the blocked pipes are overflowing with sediment. The obstruction of the urinary tract makes it easy for bacteria to multiply and stones gradually form. .

    The early stage of benign prostatic hyperplasia is manifested by increased frequency of urination, especially frequent urination at night, ranging from 3 to 4 times at least and 7 to 8 times at most. Urgent urination, but can not be discharged in time, need to wait for some time, gradually exert force to discharge. Gradually, the range of urination is not far, and the urine flow becomes thinner. In the later stage, the urine flow cannot be linear and is dripping. Sudden inability to urinate may occur, the lower abdomen is distended and painful, and the urge to urinate is strong but cannot be discharged. The increase in abdominal pressure caused by long-term dysuria can also cause hemorrhoids, prolapse of the anus, blood in the stool, hernia, etc. During the examination, the doctor usually divides the prostatic hyperplasia into three degrees according to the size of the hyperplasia through the digital anus examination. Some doctors also use another way to describe the degree of prostate hyperplasia: normal prostate is chestnut-sized, the first degree of hypertrophy is the size of pigeon eggs; the second degree of hypertrophy is the size of eggs; the third degree of hypertrophy is that of goose eggs.

    It is an art to formulate correct and individualized treatment plans according to the different conditions of patients. Elderly men with enlarged prostate should receive treatment after uncomfortable conditions. There are more treatments available for patients with benign prostatic hyperplasia. Make a selection. Because each individual has a different cause of disease, the disease situation is also very complicated, and the treatment cannot be the same. The doctor must conduct a comprehensive assessment of the disease, and fully consider the patient's acceptability of a certain treatment method and the possible effects of the treatment. Therefore, discuss with the patient and let the patient actively participate in the selection of treatment options. According to the patient's wishes, some patients with severe symptoms may be willing to choose surgical treatment, while other patients may choose medical treatment. The choice of the treatment method for benign prostatic hyperplasia should be based on the standards proposed by the International Prostate Advisory Committee, in which five examinations including symptom score, quality of life score, maximum urine flow rate, prostate volume, and residual urine volume are essential. There are many treatment methods for prostate hyperplasia. After years of exploration, we have summarized the following experience: Generally speaking, for those who cannot tolerate surgery in the early stage of the disease or the very elderly (greater than 95 years old), drug treatment is the first method of choice. At present, the main drugs for clinical treatment of benign prostatic hyperplasia are 5α-reductase II inhibitors. The most commonly used in clinical treatment is Prosperity. Prostate does not affect sexual desire and can shrink the prostate. Clinical observations show that the application of Prostaglandin can reduce the volume of the prostate, increase the flow of urine, improve the symptoms of obstructed urination, and have small side effects. However, the maximum effect does not appear until half a year after the medication.

    When you have the following conditions, it is recommended that you use surgery

    1. Severely troubled by symptoms, drug treatment is ineffective;

    2. Recurrent acute urinary retention, unable to urinate;

    3. Recurrent urinary tract infection or blood in urine;

    4. Complicated with hydronephrosis and renal damage;

    5. Combined with bladder stones, bladder diverticulum or inguinal hernia.

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