The first thing you need to do is to get a good idea of what you’re doing. I’m afraid there is no more pleasant adjective than “benign” for many patients and doctors, and the bricklayer who concocted the aforementioned bullshit trilogy, I think, if it’s not a fiction, I’m afraid it can only be called ignorant and fearless, taking it for granted that the corresponding “benign I think if it’s not just a case of being ignorant, I’m afraid it’s just a case of being ignorant and thinking that there should be a “malignant” counterpart to “benign”. As a male disease, the development of BPH is closely related to androgens. Many years ago, the beloved Professor Wu Jieping took his place in the international medical community by investigating and reporting the basic atrophy of the prostate gland in eunuchs left over from the former Qing Dynasty, validating this theory. In addition, BPH is a typical age-related disease. Generally speaking, from the age of about 40, men may gradually experience an increase in prostate morphology without necessarily experiencing the corresponding clinical symptoms, and by the age of 80 or more, more than 80% of men will have various urinary symptoms associated with BPH to varying degrees. The next phrase I often use to “threaten” my male detractors is: watch out and report to me sooner or later. The possible symptoms of BPH include urinary irritation (frequent, urgent, painful urination, etc.), urinary obstruction (difficulty in urination, dripping after urination, thin urine line, etc.) and some other accompanying symptoms (hematuria, bladder stones and even renal impairment, etc.), while the first symptom is often an increase in urine. It is easy to see that there are many overlapping similarities between BPH and chronic prostatitis in terms of symptoms. In short, for younger patients we tend to consider prostatitis first, while for middle-aged and older patients over 50 years of age BPH is considered first, and of course it is not uncommon for BPH to be combined with inflammation, and clinicians will consider using antibiotics after obtaining clear evidence. When middle-aged or older patients present to the hospital with the above symptoms, they will basically undergo routine tests such as transrectal prostate examinations, serum prostate-specific antigen (PSA) and urological ultrasound. The doctor may also choose to perform specialist tests such as urography, urodynamics and cystoscopy as appropriate. By combining the results of these tests, the doctor will be able to make a clear diagnosis and make further treatment decisions. Since most patients with BPH are older, a thorough preoperative evaluation is necessary to rule out cardiopulmonary, cerebrovascular and diabetic diseases in the middle-aged and elderly patients who require surgery. For relatively young patients with mild symptoms, lifestyle modifications can be considered and awaited for observation. During regular review as prescribed by the physician, medication may be considered if symptoms do not improve. The first line of medications for BPH treatment includes the following three main categories: first, alpha-blockers, which have the advantage of rapid onset of action, with initial symptomatic improvement occurring 2-3 days after treatment, but should not be used continuously for more than 1 month without significant symptomatic improvement. Although postural hypotension has become less common with the improvement of drugs and dosage forms, care should still be taken in the process of use. The second is 5-alpha reductase inhibitors, which require more than 1 week of medication to see the first effect, the best effect is often seen in about 6 months of medication. The best results are often seen within 6 months of drug use. The advantages are that long-term use can reduce the size of the prostate, reduce postoperative bleeding and may significantly reduce the incidence of prostate cancer. However, nearly 10% of patients may suffer from “impotence” and decreased sex drive. Thirdly, botanicals have been shown to be as effective as the aforementioned drugs and have few side effects, but large clinical studies are still needed to further demonstrate this. Depending on the patient’s specific situation, the three aforementioned drugs can be considered for use alone or in combination in clinical applications. After 3-6 months of standard drug therapy, if the patient’s symptoms do not improve or even worsen, it is necessary to put surgical treatment on the agenda. In patients with BPH, whether initially diagnosed or after conservative treatment, surgical treatment becomes the preferred and necessary treatment when the following complications occur. They include: (i) recurrent urinary retention (inability to urinate after at least one extubation or two); (ii) recurrent hematuria, which is not treated with 5α-reductase inhibitors; (iii) recurrent urinary tract infections; (iv) bladder stones; and (v) secondary upper urinary tract fluid (with or without renal impairment). In addition, surgery has always been an option to be considered in the treatment of BPH, taking into account the specific conservative treatment results and the patient’s wishes. Today, more than 90% of BPH patients will be treated with minimally invasive surgery in technically mature medical institutions. The so-called minimally invasive means of prostate electrodes, plasma resection or various laser resections actually have a fundamental premise, which is the transurethral placement of an endoscopic system and then various types of resections are performed through this common carrier. The actual fact is that the actual prostate gland is particularly huge, especially when combined with bladder stones and bladder diverticula that need to be operated together, the traditional open surgery is more advantageous. The question that some patients like to ask is: Doctor, which is the best surgery?
My answer is that each procedure has its own characteristics, and it is an important quality of a surgeon to choose the appropriate treatment for each case, so there is no best, only the most appropriate. The most important thing is that you have to be able to get the best out of your surgery. The actual fact is that the doctor didn’t do the surgery properly.
In this regard, we need to make it clear that, unlike the radical surgery for prostate cancer that will be mentioned later, the surgery for BPH patients only removes the enlarged prostate. This is the reason why the prostate can still be examined after BPH surgery, and this is the reason why there is still a possibility of recurrence in the long term after BPH surgery. It also explains why bleeding is a major postoperative risk during minimally invasive or open prostate surgery: it is because of this surgical feature that blood leakage from the open prostate wound is inevitable during the intraoperative and early postoperative period, and continuous bladder irrigation is the main solution to this problem. In the postoperative period, many patients and families are often frightened by the buckets of blood that are flushed out. In fact, we need to know that 1 ml of blood in 1000 ml of urine can be visible to the naked eye, and a bucket of darker colored flushing fluid without clots generally does not contain too much blood. In most cases, as long as the flush is kept open, the bleeding from the trauma will gradually stop 1-2 days after surgery, and the bladder flush can be withdrawn accordingly. However, since complete healing of the trauma requires a longer process, patients should pay attention to keep the bowel movement unobstructed for about one month after surgery to avoid the transition of negative pressure to induce trauma breakage and bleeding. However, patients should not be alarmed by the mild hematuria that may occur occasionally during this period. Also, because of the time required for wound healing and edema to subside, some patients’ urinary symptoms may not subside immediately or may be worse than before surgery in the early postoperative period, so it is worthwhile to be patient, as these phenomena often improve gradually within 1-2 weeks. In addition, possible more serious postoperative complications include urinary incontinence, sexual dysfunction, urethral stricture, etc. Although the chance of occurrence is not high, once it occurs, it may indeed bring long-term problems to patients.