Benign prostatic hyperplasia is a slowly progressing benign disease of the prostate. Clinically, it mainly manifests as symptoms of storage period and urination period. The former includes frequent urination, urgency and incomplete urination, and the latter includes waiting for urination and changing urine line. Small, bifurcated urine flow, interrupted urination, etc., some patients will also be accompanied by increased nocturia.
Friends must be very concerned about the treatment of benign prostatic hyperplasia. At present, the main treatment methods include watchful waiting, drug treatment and surgical treatment.
Watchful waiting is a non-drug, non-surgical treatment measure, including patient education, lifestyle guidance, and regular monitoring. Patients with mild lower urinary tract symptoms, or patients with moderate or above symptoms but whose quality of life has not been significantly affected, can use watchful waiting therapy. The contents of watchful waiting are as follows: (1) Doctors should inform patients of BPH-related knowledge, especially the effect and prognosis of watchful waiting. Because benign prostatic hyperplasia may be accompanied by prostate cancer, patients should also be aware of the knowledge of prostate tumors. (2) Doctors should also guide the patient’s lifestyle, such as avoiding or reducing the intake of diuretic and irritating foods such as caffeine, alcohol, and spicy to alleviate related symptoms; appropriately restricting drinking water and adjusting drinking time can help reduce The frequency of urination during the day and night. (3) Instruct patients to optimize urination habits. If there are symptoms of incomplete urination, measures such as relaxed urination, second urination and urethral squeezing after urination can be adopted. (4) Mental relaxation training: Patients with symptoms of urinary urgency can use distracting feelings of urination to divert their attention from the desire to urinate.
Patients will be followed up for the first time six months after the start of the watchful waiting, and then once a year thereafter. The content of the follow-up is the same as the content of the initial diagnosis and evaluation. The purpose is to understand the patient's disease progression and whether there are related complications, and use this as a basis for changing the treatment.
Drugs are an important part of the treatment of benign prostatic hyperplasia. Commonly used drugs include α-receptor blockers, 5α-reductase inhibitors and M receptor blockers.
Alpha-blockers can reduce the muscle tension of the prostate and bladder neck, relax the muscles, and achieve the effect of alleviating the urethral obstruction caused by benign prostatic hyperplasia. Commonly used drugs include doxazosin, alfurazosin, terazosin, tamsulosin and xylodosin.
These drugs are suitable for patients with benign prostatic hyperplasia with moderate to severe symptoms. Relevant studies have shown that the above-mentioned different kinds of drugs can significantly improve the symptoms of patients, with an average improvement of 30-40%, while increasing the maximum urination rate by 16-25% . α1 blockers generally take effect within 48 hours after treatment. If there is no obvious improvement in symptoms after continuous use of α1 blockers for 1 month, they should not be used again, and it is not recommended that patients take two or more at the same time The alpha-blockers, which not only cannot increase the therapeutic effect, but also cause more adverse drug reactions.
Common adverse reactions of alpha 1 blockers include dizziness, headache, fatigue, drowsiness, orthostatic hypotension, abnormal ejaculation, etc. Orthostatic hypotension is more likely to occur in elderly patients, patients with cardiovascular disease or patients who take vasoactive drugs at the same time in. Patients taking α1 blockers may develop iris relaxation syndrome during cataract surgery. Therefore, it is recommended to stop α1 blockers before cataract surgery.
(2) 5α-reductase inhibitor: by inhibiting the conversion of testosterone to dihydrotestosterone (DHT) in the patient's body, thereby reducing the content of dihydrotestosterone in the prostate, achieving the therapeutic purpose of reducing prostate volume and improving lower urinary tract symptoms .
In the human body, it contains two kinds of 5α-reductase. Type I is mainly distributed in tissues other than the prostate (for example: skin or liver); Type II is mainly distributed in the prostate. Finasteride, as a classic 5α-reductase inhibitor, mainly inhibits type II 5α-reductase, while another representative drug dutasteride can inhibit both type I and type II 5α-reductase. The reduction in DHT levels in the prostate is 85-90%. 5α-reductase inhibitors can reduce the volume of the prostate by 20%-30%, while significantly reducing the probability of patients with acute urinary retention and undergoing prostate surgery. 5α-reductase inhibitors are suitable for the treatment of patients with large prostate size and moderate to severe symptoms.
Compared with α1 receptor blockers, 5α-reductase inhibitors have a relatively slow onset time, and generally obtain the maximum effect after 6-12 months of use. The most common side effects include erectile dysfunction, abnormal ejaculation, Low libido and other such as male breast feminization, breast pain, etc.
(3) M receptor antagonist
Some patients with benign prostatic hyperplasia have frequent urination, urgency and incomplete urination as the main clinical manifestations. M receptor antagonists can relieve the excessive contraction of bladder muscles and reduce bladder sensitivity, thereby improving the above symptoms. Currently, commonly used drugs include Tolterodine and Solinasine. Because the application of the above drugs may cause increased residual urine volume and acute urinary retention, the changes in residual urine volume should be closely followed during the treatment process, especially when the patient’s residual urine volume is greater than 200ml, M receptor antagonists should be used with caution; M Adverse reactions of receptor antagonists include dry mouth, dizziness, constipation, dysuria and blurred vision, etc., which mostly occur within 2 weeks of medication and patients aged >66 years. Those who are allergic to M receptor antagonists are contraindicated in urinary retention, gastric retention, narrow-angle glaucoma and patients allergic to the drug.
(4) Plant preparations and Chinese herbal medicine
Studies have shown that plant preparations (including Chinese herbal medicines) are suitable for the treatment of BPH and related lower urinary tract symptoms, with obvious curative effects and low incidence of side effects. However, the mechanism of action of botanical preparations (Chinese herbal medicine) is complicated, and it is currently difficult to judge the correlation between the biological activity and curative effect of specific ingredients.
Finally, surgery is also one of the important methods for the treatment of benign prostatic hyperplasia.
Because BPH is a clinically progressive disease, some patients will eventually need surgery to relieve the symptoms of the lower urinary tract and its impact and complications on the quality of life.
Indications for surgery: BPH patients with moderate to severe symptoms that have significantly affected their quality of life can choose surgery, especially those who have poor drug treatment or who refuse to receive drug treatment. Surgical treatment is recommended when prostatic hyperplasia has repeated urinary retention, repeated hematuria, repeated urinary tract infections, bladder stones and secondary upper urinary tract hydrops. In BPH patients with inguinal hernia, severe hemorrhoids or prolapse, surgical treatment should be considered if it is difficult to achieve the therapeutic effect if the clinical judgment does not relieve the lower urinary tract obstruction.
Purpose of operation: Surgery can remove the hyperplastic prostate tissue (but not all of the prostate) to relieve lower urinary tract obstruction and improve urination symptoms.
Transurethral resection of the prostate (TURP) used to be the first choice for the treatment of BPH. It is a minimally invasive surgery. There is no incision. Surgical instruments reach the prostate from the outer opening of the urethra. TURP is mainly used to treat prostate volume. For patients with BPH below 80ml, skilled surgeons can appropriately relax the restriction on prostate volume. Since the flushing fluid in TURP does not contain electrolytes, prolonged operation will lead to increased blood volume and dilutional hyponatremia, which is called transurethral resection syndrome (TURS). The application of this procedure has been Gradually reduced, hospitals in economically developed areas have basically been eliminated.
In recent years, with the advancement of surgical equipment and technology, transurethral laser surgery has become an important treatment for BPH. The laser can vaporize and cut prostate hyperplasia tissues, and achieve the purpose of removing the lower urinary tract obstruction. At the same time, the laser has the characteristics of good hemostatic effect and non-conductive characteristics, which significantly reduces the risks and complications during the operation. Especially suitable for patients with high risk factors (old age, anemia, decreased function of important organs, etc.). In addition to the above-mentioned surgical methods, minimally invasive treatment methods such as microwave, radio frequency, and prostate stents can also be selected according to the specific conditions of the patient.