Prostatic hyperplasia is a common senile disease that occurs gradually with age. It usually occurs after the age of 40. It is more than 50% by the age of 60, and as high as 83% at the age of 80. As the age grows, symptoms such as dysuria also occur. Increase with it.
In the past 30 years, with the continuous updating of surgical instruments and the continuous improvement of surgical techniques, the surgical treatment of benign prostatic hyperplasia has gradually become popular in primary hospitals, from open surgery, transurethral monopolar resection, and transurethral plasma electroporation. Transurethral laser enucleation and vaporization surgery have been popular in recent years. When to choose surgery or which elderly people need surgery, this is a question.
Let's first understand a few basic conditions about prostate hyperplasia:
1. Pathophysiological changes of prostate
Prostatic hyperplasia leads to extension of the posterior urethra, compression and deformation, stricture and increased urethral resistance, causing bladder hypertension and related urination symptoms. With the increase of bladder pressure, compensatory hypertrophy of the bladder detrusor and instability of the detrusor appear and cause related urine storage symptoms. If the obstruction is not resolved for a long time, the detrusor will lose its ability to compensate. Upper urinary tract changes secondary to benign prostatic hyperplasia, such as hydronephrosis and renal dysfunction, are mainly due to increased pressure in the bladder.
2. Lower urinary tract symptoms (LUTS)
Including symptoms during storage, symptoms during urination, and symptoms after urination. Urinary storage symptoms include frequent urination, urgency, incontinence, and nocturia; urinary symptoms include hesitancy, dysuria, and intermittent urination; post-urination symptoms include incomplete urination, dripping after urination, etc.
3. Indications for classic benign prostatic hyperplasia surgery: patients with moderate to severe LUTS that have significantly affected their quality of life can choose surgical treatment, especially those who have poor drug effects or refuse to receive drug treatment.
1. Recommended surgery: (1) Repeated urinary retention (cannot urinate or urinary retention twice after at least one extubation); (2) Repeated hematuria, drug treatment is ineffective; (3) Repeated urinary tract infection; (4) Bladder stones ; (5) Secondary upper urinary tract hydrops (with or without renal impairment).
2. For prostate hyperplasia combined with inguinal hernia, severe hemorrhoids or prolapse of the anus, surgery should be considered if the clinical judgment is not to relieve the lower urinary tract obstruction.
3. Residual urine volume has a certain reference value. Patients with benign prostatic hyperplasia who have significantly increased residual urine and cause filling incontinence should consider surgery.
Thinking: After reading the above points, I believe we have a basic understanding of the timing of surgery for prostate hyperplasia. But for the classic surgical indications, can we make some adjustments? The current surgical indications are mainly concentrated in the period of bladder function decompensation. The protection of the bladder detrusor function is insufficient. "The hyperplasia is in the prostate, but the bladder is injured." The long-term bladder detrusor function is damaged or even irreversible. Even if the mechanical obstruction of prostate hyperplasia is solved, it is difficult to restore or reverse the function of bladder detrusor. Can we choose surgical treatment during the compensation period of the bladder detrusor? After appropriate drug treatment, we can easily obtain residual urine volume (continuous >20ml?), maximum urine flow rate (<10ml/sec), bladder volume (<150ml?) through B-ultrasound, urodynamic examinations, etc. , Prostate urethra length (>4.5cm), prostatic bladder penetration (>1cm), bladder wall thickness and other indicators are objectively evaluated, combined with subjective evaluations such as IPSS and Qol, and on the basis of adequate communication, some The timing of surgery for patients is advanced, and individualized treatment options can be selected to achieve better surgical results.