Benign prostatic hyperplasia
1. Name: Benign prostatic hyperplasia
2. Alias: Prostate hypertrophy
3. English name: Benign prostatic hyperplasia, BPH
4. site of origin: prostate
5. Department: Urology
6. Prevalent population: men after 40 years old
7. mode of infection: (if not infectious, do not fill in)
8. picture: (not recommended to choose too bloody photos, please submit in the form of files, do not add directly in the word document)
9. Overview: Prostatic hyperplasia (BPH) is one of the common diseases of the male elderly, with the increasing incidence of global population aging. The incidence of prostatic hyperplasia increases with age, but there are not always clinical symptoms when there are hyperplastic lesions. The incidence is higher in urban than in rural areas, and ethnicity also affects the degree of hyperplasia.
The cause of prostate hyperplasia is still not clear. It is now known that prostate enlargement requires the presence of testes and ageing. The relationship between smoking, obesity and alcohol abuse, sexual function, family, ethnicity and geography on the occurrence of BPH has also been noted in recent years.
11. Pathogenesis: The prostate gland has the urethra running through the middle of it, so to speak, and the prostate is choking the urethra, so if the prostate is diseased, urination is affected first. The enlarged prostate gland makes the volume of the prostate gradually increase, compressing the urethra and bladder neck, making the bladder obstructed from emptying the urine. The enhanced contraction of the bladder to overcome the neck resistance causes compensatory hypertrophy of the muscles of the bladder wall, which appear as trabecular protrusions. The pressure in the bladder cavity increases and the bladder mucosa may bulge outward from the weak spot between the muscle bundles to form a diverticulum. The obstruction of the bladder neck continues to worsen, and each time you urinate, the bladder cannot empty the urine completely, and a portion of the urine remains in the bladder after urination. The presence of residual urine is the basis for the occurrence of urinary tract infections and secondary stones. If not actively treated, the prostate enlargement further develops, the pressure on the urethra gradually increases, the bladder’s ability to urinate further decreases, the residual urine in the bladder gradually increases, the pressure in the bladder rises, so that the urine in the bladder flows backwards to the ureter and renal pelvis, causing water retention in the upper urinary tract on both sides, and the pressure in the renal pelvis increases, causing ischemic atrophy of the kidney parenchyma, resulting in reduced kidney function.
12. clinical manifestations: the symptoms of prostate enlargement can be divided into two categories, one is the obstructive symptoms arising from the blockage of the urinary tract by the enlarged prostate; the other is the complications caused by urinary tract obstruction.
The symptoms of obstruction are mainly caused by the prostate enlargement blocking the urinary tract and compressing the bladder neck, and also include the bladder’s own response to overcome the obstruction. The first of these is the frequency of urination, which is an early sign of prostate enlargement, and is especially clinically significant when the number of nocturnal urinations increases. In general, the amount of nighttime urination often parallels the degree of prostate enlargement. The presence of 1 to 2 nocturnal urinations in elderly people who originally did not get up at night often reflects the onset of early obstruction, while the development from 2 times per night to 4 to 5 times per night or even more indicates the development and aggravation of the lesion.
② Weakness of urination, thinning of the urine line and dribbling of urine. Due to the obstruction of the enlarged prostate, the patient has to use more force to overcome the resistance to urination, so that it is difficult to urinate; the enlarged prostate deflates the urethra, resulting in a thin urinary line; as the disease develops, there may also be symptoms such as interruption of urination and dripping after urination.
③ Hematuria.
④ Urinary retention. In patients with heavy prostatic hyperplasia, acute urinary retention may occur when obstruction is severe due to cold, alcohol, holding urine for too long or infection, etc., resulting in inability to discharge urine.
13. Complications.
Complications of obstruction mainly include infection, bladder stones, hydronephrosis, uremia, etc.
① Infection Just as an unobstructed river is easily contaminated, an obstructed urinary tract at the bladder neck is very prone to combined acute urinary tract infections, manifesting as a sudden increase in the number of nocturnal urination, urinary urgency, painful urination, hematuria, and fever.
② hydronephrosis After a longer period of time, due to compensatory insufficiency of the bladder and upper urinary tract, hydronephrosis of the ureter and renal pelvis can be caused, and when the hydronephrosis is serious, a “lump” – a distended kidney – can be felt in the abdomen; a “lump” – a distended kidney – can also be felt in the lower abdomen when the bladder is full. When the bladder is full, you can also feel a “lump” in the lower abdomen – a distended bladder.
③ Uremia Patients with prostatic hyperplasia that develop into hydronephrosis can suffer from renal insufficiency – uremia – due to pressure on the kidney parenchyma. It manifests as loss of appetite, nausea, vomiting, and anemia. Because such symptoms are relatively insidious at first and lack specificity, they are easily overlooked or misdiagnosed as gastrointestinal diseases and delayed, or even not discovered until headache, sluggishness, drowsiness, or even coma occurs, which is worth being alert to.
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In addition, due to prostate enlargement causing patients to urinate due to difficulties, increased abdominal pressure, can also cause or aggravate hemorrhoids, hernia and other diseases.
14. Laboratory tests.
① Urinalysis: routine urine examination of patients with prostatic hyperplasia can sometimes be normal, and leukocyturia can be seen when present urinary tract infection occurs, and the presence of hematuria can also be determined.
② Measurement of serum prostate-specific antigen (PSA).
The PSA is an organ-specific indicator of the prostate, and its elevation can be seen in prostate cancer, prostate hyperplasia, acute urinary retention, prostate inflammation, massage of the prostate, insertion of instruments into the urethra, and ejaculatory activity prior to the PSA test. significantly elevated PSA is mainly seen in prostate cancer, but in patients with prostate hyperplasia, the PSA can also be elevated, but the rise is relatively small.
15. Other ancillary tests.
① Ultrasonography: It can find out whether there is fluid in both kidneys, whether there is diverticulum formation in the bladder, the size and shape of the prostate, and determine the amount of residual urine. The amount of residual urine can be increased in patients with prostatic hyperplasia, and measuring the amount of residual urine can help determine the degree of prostatic hyperplasia. Ultrasonography is currently the main method for measuring residual urine. After holding urine for routine bladder and prostate ultrasonography, the patient gets up to urinate, and after adequate urination, the bladder is observed again with ultrasound to measure the amount of residual urine in the bladder after urination.
② Intravenous urography and urethrography: Intravenous pyelography should be performed in patients with fruit prostatic hyperplasia who also have recurrent urinary tract infections, microscopic or naked eye hematuria, suspected hydronephrosis or dilated ureteral reflux, or urinary stones. It should be noted that intravenous urography is prohibited when the patient is allergic to the contrast agent or has renal insufficiency. Urethrography is recommended when urethral stricture is suspected.
16. Diagnosis.
It is mostly seen in elderly men over 50 years of age. The manifestations are frequent urination, urgent urination, increased nocturia, waiting for urination, weak and thin urine stream, urine dripping, and intermittent urination.
①rectal examination: enlarged prostate, tougher texture, smooth surface, and disappearance of central groove.
②Ultrasound examination: it can show enlarged prostate with increased residual urine.
③Urinal flow rate examination: decreased urinary flow rate.
17. Differential diagnosis: The disease should be differentiated from urethral stricture, prostate cancer, and neurogenic bladder dysfunction.
18. Treatment: (Commonly used treatments and departmental specialties) The danger of prostatic hyperplasia lies in the pathophysiological changes that result from causing lower urinary tract obstruction. The individual variability of the pathology is great, and not all of them are progressive in development. Some of the lesions do not progress beyond a certain point, so even mild obstructive symptoms do not always require surgery.
For mild symptoms, IPSS score of 7 or less can be observed and no treatment is needed.
②Drug treatment
(1) 5α-reductase inhibitors Commonly used drugs include finasteride and dutasteride
(2) α-blockers Commonly used drugs include Gottlieb, Santa, and Harle.
(3) Botanical drugs such as Pulsatilla, etc.
In summary, a comprehensive estimate of the disease should be made before drug treatment, and the side effects of drugs and the possibility of long-term drug use should be fully considered. Long-term follow-up should be conducted to observe the efficacy of drugs, and urodynamic examination should be performed regularly to avoid delaying the timing of surgery.
③ Surgical treatment
Surgery is still an important treatment for prostate enlargement. The indications for surgery are: repeated urinary retention (inability to urinate after at least one more extubation or twice; repeated hematuria and ineffective drug therapy; repeated urinary tract infections; bladder stones; secondary upper urinary tract fluid (with or without upper urinary tract damage). For patients with long-term urinary tract obstruction, obvious damage to renal function, severe urinary tract infection or acute urinary retention, a catheter should be left in place to relieve the obstruction, and surgery should be performed after the infection has been controlled and renal function has been restored. If the insertion of the catheter is difficult or if the long insertion time has caused urethritis, the procedure can be changed to suprapubic cystocentesis and fistula. The indications for emergency prostatectomy should be strictly controlled.
Surgical treatment of BPH includes classical surgical treatment, laser treatment, and other treatment modalities. Currently, transurethral resection of the prostate (TURP) is still the “gold standard” of BPH treatment. Although laser, cryo, microwave, and radiofrequency treatments have been developed in recent years, various TURP-based transurethral resections and electrovaporizations are still the main treatments.
Our hospital has been carrying out TURP since the 1990s, and so far has completed thousands of surgeries with good surgical results, few complications, less patient pain and quick recovery. In recent years, transurethral laser surgery of the prostate has been carried out, bringing good news to the majority of patients.
Therefore, in addition to the appropriate reduction of water at night to avoid overfilling the bladder after sleep, and should drink more water during the day. Less spicy food: spicy and irritating food can lead to congestion of sexual organs, but also aggravate the symptoms of hemorrhoids and constipation, compress the prostate and aggravate the difficulty of urination.
20. Prognosis: The prognosis of BPH depends on whether the patient’s condition has progressed clinically. The prognosis mainly includes: stable disease (no progression), progression requiring surgery, and poor prognosis due to renal impairment.