Overview.
Benign prostatic hyperplasia (BPH) is a common disease in older men, commonly known as prostatic hyperplasia. It develops mostly after the age of 50, and its incidence increases with age, and has become a common disease in urology.
Etiology.
Prostate enlargement is closely related to the imbalance of androgens and estrogens in the body. Testosterone, the main male androgen, is changed to dihydrotestosterone by the action of enzymes. Dihydrotestosterone is the active hormone that stimulates prostate enlargement by androgens. Estrogen also has an effect on prostatic hyperplasia.
Symptoms.
The symptoms of prostatic hyperplasia appear gradually with pathological changes, and various symptoms appear as the condition worsens.
1, urinary frequency, urinary urgency: the most common symptom is frequent urination, and gradually aggravated, especially the number of night urination increased.
2.Progressive urinary difficulty: mainly manifested as slow onset of urination, effortful urination, weakness of urine ejection, thin urine line, dripping urine stream, segmental urination and incomplete urination.
3.Urinary incontinence.
4.Acute urinary retention: cold, alcohol consumption, exertion and other factors can cause acute urinary retention. Main symptoms: patients have extreme bladder expansion, pain, frequent urination, tossing and turning, and difficulty in sleeping.
5, hematuria: the amount of bleeding varies, mostly intermittent, occasionally a large amount of bleeding, blood clots fill the bladder, must be treated urgently.
6.Symptoms of renal insufficiency: In late stage, due to long-term urinary tract obstruction, both kidneys become hypofunctional, manifested as loss of appetite, nausea, vomiting and anemia, etc.
7, other symptoms: relying on increased abdominal pressure to urinate due to long-term difficulty in urination can cause or aggravate hemorrhoids, prolapse and abdominal hernia, etc.
Examination.
1, rectal finger diagnosis: rectal finger diagnosis is an important step in the diagnosis of prostatic hyperplasia, can feel the prostate enlargement, smooth surface and medium hardness.
2, cystoscopy: cystoscopy can directly observe the hyperplasia of each lobe of the prostate, and can understand whether there are other lesions in the bladder, such as tumors, stones, diverticula, etc., so as to decide the way of surgical treatment.
3, residual urine lateral determination: the amount of bladder residual urine reflects the severity of bladder compensatory failure, thus this is one of the important diagnostic steps and one of the factors in deciding surgical treatment.
4.Cystography: In cases where cystoscopy is not possible, cystography is feasible, which can observe the presence of bladder stones, tumors, diverticula and ureteral reflux in addition to the filling defect of the bladder neck.
5, B-type ultrasonography: can determine the size of the prostate, including the transverse diameter, anterior and posterior diameter and upper and lower diameter.
6.Urodynamic examination: When prostatic hyperplasia causes lower urinary tract obstruction, the maximum urinary flow rate decreases and the intravesical pressure increases during urination.
7.Radioisotope nephrogram: It can understand the secretory function of the two kidneys and the drainage of the renal pelvis and ureter.
8, other tests: renal function tests and urine culture, etc. If surgery is needed, heart, lung and liver function tests should be done.
Treatment: In recent years, with the development of urology technology, many new methods have been developed to treat prostate enlargement, of which transurethral resection is currently the most advanced and widely used minimally invasive treatment method. This method is less invasive, quicker, safer and more reliable. It is known internationally as the “gold standard” for the treatment of BPH.