Prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in middle-aged and elderly men, but it is not the only cause. There are many reasons for lower urinary tract symptoms (LUTS). Any structural or functional abnormalities in one or more parts of the lower urinary tract, including the bladder, bladder neck, prostate, external urethral sphincter, and urethra, will cause LUTS, such as BPH, overactive bladder, urinary system infection, urethral stricture, etc.; abnormalities in the nerve pathways that control the lower urinary tract, including the central and peripheral nervous systems, can also cause LUTS, such as neurogenic bladder. In addition, some cardiovascular diseases, respiratory diseases and renal insufficiency can also cause LUTS. Therefore, it is necessary to use a holistic concept to understand LUTS.
The differential diagnosis of benign prostatic hyperplasia (BPH) includes: overactive bladder, urethral stricture, neurogenic bladder, prostate cancer and other diseases that may produce lower urinary tract symptoms.
1. Overactive bladder (OAB) is a syndrome based on urgency, often accompanied by frequent urination and nocturia, with or without urge incontinence. In elderly men with lower urinary tract symptoms, if urgency and frequent urination are the main symptoms, obstruction symptoms are not obvious, or patients with BPH should consider OAB for OAB patients when frequent urination and urgency symptoms persist after treatment for BPH For the evaluation of patients, the subjective evaluation measure of urination diary can be selected, but there is no objective diagnosis method at present.
2. Urethral stricture is a common disease of the urinary system. For patients with previous urethral trauma, urinary system infection or history of transurethral surgery and operation, the possibility of urethral stricture should be considered. Especially those patients whose prostate volume does not match their obstruction symptoms. The diagnosis can be confirmed by urethral angiography (anterograde/retrograde) or cystoscopy.
3. Neurogenic bladder For patients with obvious neurological disease or diabetes, neurogenic bladder should be considered. All neurological disorders that may involve the physiological regulation of urine storage and/or urination.
4. Prostate cancer may coexist with benign prostatic hyperplasia and cannot be distinguished by symptoms. Screening methods for prostate cancer include digital rectal examination and PSA. If any of these two is abnormal, a prostate biopsy is recommended to determine whether there is prostate cancer.
Treatment of patients with benign prostatic hyperplasia:
Drug therapy: 1, 5a reductase inhibitors (5ARs): treat benign prostatic hyperplasia by inhibiting the conversion of testosterone to dihydrotestosterone. It is mainly used to treat patients with moderate or severe LUTS symptoms and prostate volume greater than 30-40ml, and also to prevent the progression of BPH disease. There are two 5ARls preparations, one is a selective 5a reductase type II inhibitor (finasteride), the other is a 5a reductase type I and type II inhibitor (dutasteride). The 5a reductase inhibitor has a relatively slow onset time, and the maximum effect is generally obtained after 6-12 months of use.
2. Alpha receptor blockers: mainly by blocking the adrenergic receptors distributed on the surface of the smooth muscle of the prostate and bladder neck, relax the smooth muscle, and achieve the effect of alleviating the dynamic obstruction of the bladder outlet. Alpha blockers can improve the patient's symptoms and maximum urine flow rate. Commonly used alpha receptor blockers for the treatment of BPH include: selective alpha 1 receptor blockers (doxazosin, alfurazosin, terazosin) and highly selective alpha 1 receptor blockers (tamsole Rosin, silodosin, naftopidil) and so on. Symptoms can be improved within a few hours to a few days after treatment with a-blockers. If there is no significant improvement in symptoms after continuous use of a-blockers for 1 month, you should not continue to use it.
3. Plant preparations and traditional Chinese medicine have been treated for a long time, but their efficacy lacks evidence-based medical evidence. The motherland's medicine is extensive and profound. I believe that good Chinese medicine may have good methods!
4. Ax1 receptor blocker combined with 5a reductase inhibitor: The combined treatment is suitable for BPH patients with moderate to severe lower urinary tract symptoms and the risk of prostate hyperplasia progression. Combination therapy is better than any single drug therapy in reducing the risk of clinical progression of prostate hyperplasia.
Surgical treatment of benign prostatic hyperplasia: BPH patients with moderate to severe lower urinary tract symptoms, poor drug treatment effect or unwilling to long-term medication. Repeated urinary retention; repeated gross hematuria, 5a reductase inhibitor treatment is ineffective; repeated urinary tract infections; bladder stones; secondary upper urinary tract hydrops (with or without renal impairment); BPH patients with large diverticulum, groin For hernias, severe hemorrhoids or prolapse of the anus, surgical treatment should be considered if the clinical judgment is not to relieve the lower urinary tract obstruction.