Lingxi has something to say: With the aging of society, more and more patients with prostate hyperplasia will appear, because for normal elderly men, prostate hyperplasia is almost inevitable. The only difference is the degree of hyperplasia and accompanying symptoms. . Today, Dr. Lin will decipher prostate hyperplasia for everyone:
First of all, it must be clearly distinguished that benign prostatic hyperplasia (BPH) and prostatitis are two concepts. Prostatitis tends to occur in young adults, while prostatic hyperplasia only occurs in middle-aged and elderly people. Every man, from the age of 40, will begin to have prostate hyperplasia. The speed of its proliferation and the degree of squeezing of the urethra determine the sooner or later clinical symptoms appear. As long as they are old enough, everyone will have symptoms of prostate hyperplasia.
There are many studies on the pathogenesis of prostate hyperplasia, but the etiology has not yet been clarified. It is currently known that prostate hyperplasia must have a functional testicle and age growth. Related factors include: androgens and their interactions with estrogen, prostatic mesenchymal-glandular epithelial cell interactions, growth factors, inflammatory factors, neurotransmitters and genetic factors. In recent years, we have also noticed the relationship between smoking, obesity and alcohol abuse, family history, race, and geographic environment. Domestic scholars investigated 26 Qing Dynasty eunuchs and found that 21 prostates were completely out of reach or were obviously atrophy. Therefore, androgen levels are positively correlated with prostate hyperplasia.
Clinical manifestations: The earliest occurrence of BPH is frequent nocturia, that is to say, when you are older than 40 years old and you start to have to urinate more than 2 times a night, it is probably the initial symptom of prostate hyperplasia. The detailed symptoms are as follows:
1. Symptoms during storage period: The early stage of prostate hyperplasia is due to compensation and atypical symptoms. As the lower urinary tract obstruction gets worse, the symptoms gradually become obvious. The clinical symptoms include symptoms during storage period, symptoms during urination, and symptoms after urination. Due to the slow progress of the disease, it is difficult to determine the time of onset.
(1) Frequent urination and increased nocturia. Frequent urination is an early symptom. First, the frequency of nocturia increases, but the urine output is not much each time. After the decompensation of the bladder detrusor, chronic urinary retention occurs, which reduces the effective volume of the bladder and shortens the interval between urination. If accompanied by bladder stones or infection, frequent urination becomes more obvious, and accompanied by painful urination.
(2) Urgency and urinary incontinence When lower urinary tract obstruction occurs, 50% to 80% of patients have urinary urgency or urge incontinence.
2. Symptoms during urination
Difficulty urinating: As the glands increase, mechanical obstruction and dysuria aggravate. The degree of lower urinary tract obstruction is not proportional to the size of the gland. Due to the increase in urethral resistance, the patient's urination onset is delayed, urination time is prolonged, the range is not far, and the urine line is thin and weak. Urine bifurcation, feeling of incomplete urination. If the obstruction worsens, the patient must increase abdominal pressure to help urinate. Breathing increases or decreases abdominal pressure, causing interrupted urine flow and dripping.
3. Symptoms after urination
Insufficient urine and increased residual urine: Residual urine is the result of decompensation of the bladder detrusor. When the residual urine volume is large, the bladder is over-inflated and the pressure is high, which is higher than the urethral resistance, urine will overflow from the urethra by itself, which is called overflow incontinence. Some patients usually do not have much residual urine, but acute urinary retention may suddenly occur when they are cold, drink alcohol, hold back urine, take drugs or cause sympathetic nerve excitement for other reasons. The patient's symptoms of urinary retention can go from time to time. Some patients may have acute urinary retention as the first symptom.
4. Other symptoms
(1) Hematuria The capillaries on the prostate mucosa are congested and small blood vessels expand and are pulled by enlarged glands or rubbed against the bladder. When the bladder contracts, it can cause microscopic or gross hematuria, which is one of the common causes of hematuria in elderly men. The sudden decompression of the bladder during cystoscopy, metal catheterization, and acute urinary retention catheterization can easily cause severe hematuria.
(2) Urinary tract infection Urinary retention often leads to urinary tract infection. Symptoms such as urgency, frequent urination, and dysuria may occur, accompanied by painful urination. When a secondary upper urinary tract infection occurs, symptoms of fever, low back pain, and systemic poisoning will occur. Although the patient usually has no symptoms of urinary tract infection, there may be more white blood cells in the urine, or bacterial growth in urine culture, and treatment should be performed before surgery.
(3) Bladder stones, lower urinary tract obstruction, especially when there is residual urine, the urine stays in the bladder for a longer time, and stones can gradually form. When accompanied by bladder stones, the urine line may be interrupted, pain at the end of urination, and urination can be performed after changing the position.
(4) Renal function damage is mostly due to ureteral reflux, and hydronephrosis causes renal function damage. The main complaints of patients when visiting a doctor are often loss of appetite, anemia, elevated blood pressure, or lethargy and unconsciousness. Therefore, for male elderly people with unexplained symptoms of renal insufficiency, prostate hyperplasia should be ruled out first.
(5) Long-term obstruction of the lower urinary tract may cause a mass in the lower abdomen caused by the filling of the bladder diverticulum or a mass in the upper abdomen caused by hydronephrosis. Long-term dependence on increasing abdominal pressure to help urination can cause hernias, hemorrhoids and prolapse.
The content of diagnosis and treatment is relatively professional, so I won’t repeat it. The key to diagnosis is to distinguish it from prostate cancer. In principle, the treatment of early prostate hyperplasia can wait for observation and oral medication to improve symptoms and control the progression of the disease. Progress, surgical treatment can be considered, and the current gold standard for prostate hyperplasia surgery is transurethral resection of the prostate (TURP). The surgery is performed through the urethra, minimally invasive and non-incision (pictured above).
When BPH causes the following complications, surgical treatment is recommended:
1. Repeated urinary retention (cannot urinate after at least one extubation or two urinary retention)
2. Repeated hematuria, 5α reductase inhibitor treatment is ineffective
3. Repeated urinary tract infections
4. Bladder stones
5. Secondary upper urinary tract hydrops (with or without renal impairment)
BPH patients with large diverticulum of the bladder, inguinal hernia, severe hemorrhoids or prolapse of the anus, if clinical judgment does not relieve the lower urinary tract obstruction, surgical treatment should be considered. The measurement of residual urine volume has a certain reference value for the degree of lower urinary tract obstruction caused by BPH, but it is currently believed that the upper limit of residual urine volume that can be used as a surgical indicator cannot be determined. However, if the residual urine increases significantly so that BPH patients with overflow incontinence should consider surgical treatment.
(Edited by Lingxi Yizhi)