The health of the elderly is getting more and more attention, many elderly men pay attention to heart disease, hypertension and cerebrovascular disease, but there are many misconceptions and incorrect understanding of prostate diseases that also threaten the health of elderly men, especially BPH surgery has a wrong understanding, resulting in delayed treatment, the use of inappropriate treatment, as well as too much expectation of surgery and poor results. This is a very important issue.
In order to give you a correct understanding of prostate disease in elderly men, to better cooperate with our doctors’ diagnosis and treatment, and to relieve your pain as soon as possible and effectively, we briefly introduce you to some knowledge of prostate disease in elderly men, especially the knowledge about pre-surgery preparation and surgery.
A. Understanding the general condition of the prostate
(a) What is the location of the prostate in the body?
Many older men do not have the correct knowledge of the location and function of the prostate gland and can easily be misled. The prostate is a unique organ for men, located in the pelvis of men, underneath the bladder outlet, a gland that is medically named the prostate. It has a shape much like a chestnut with the bottom side up and the tip down. It weighs about 20 grams in adulthood, and the prostate gland develops best after the age of 25. It is interesting to note that the urethra and the ejaculatory duct pass in the middle of the prostate, and the urethra wrapped in the prostate is called the urethra of the prostate.
It is because of this physiological anatomy that it is easy to understand why a lesion in the prostate gland must affect urinary function (as shown in the diagram, Bladder: bladder; Prostate: prostate; Urethra: urethra; Tumor: tumor). The prostate gland is close to the abdomen “belly” where there is a bone, medically known as the pubic bone; behind it, that is, near the back, is adjacent to the rectum; below it and the skin of the perineum is separated by the urethra, so the prostate gland cannot be touched from the skin surface.
(B) The internal structure of the prostate gland
The prostate gland is a glandular tissue, consisting of several vesicles, which finally converge into several excretory ducts, which discharge the vesicles secreting prostatic fluid into the urethra. The prostate is rich in blood vessels, lymphatic vessels and nerves, so inflammation elsewhere in the body can involve the prostate via blood vessels, and prostate cancer cells can spread throughout the body via blood vessels and lymphatic vessels.
There are different zones within the prostate gland depending on the embryonic tissue from which it originated during embryonic development. As shown in the diagram, the prostate gland has a peripheral urethral gland zone, a migratory zone, a central zone, a peripheral zone, and a fibromuscular zone. The peripheral urethral glandular zone and the migratory zone are the origin of benign prostatic hyperplasia, while the peripheral zone is the favored area for prostate cancer. Under normal conditions, the peripheral and central zones are the main areas of the prostate, while the migratory and periurethral glandular zones are small, accounting for only 5% of the entire prostate volume.
The main reason for this is that the prostate gland is growing in size, and it is mainly the migratory zone and the urethral peripheral gland area that are gradually increasing in size from the original 5% of the volume to the main component of the prostate, which eventually becomes benign prostatic hyperplasia. In the case of benign prostatic hyperplasia, the migratory zone and the periurethral gland area account for more than 95% of the entire prostate volume. In contrast, the peripheral and central areas of the prostate, which originally accounted for 95% of the entire volume, are gradually compressed by the migratory zone into a thin film, medically known as the “surgical membrane”. The procedure for any BPH is performed in addition to the surgical membrane, so BPH surgery does not remove the peripheral and central zones.
(C) The secretory function of the prostate gland
The normal function of the prostate gland is not fully understood. The prostate gland in adult men has a secretory function, and it continuously secretes a thin, white liquid called prostatic fluid. Prostate fluid is the main component of semen and contains a variety of substances that may be useful in protecting sperm and giving them energy.
(d) The relationship between the prostate and androgens
Androgens are the material basis of masculinity and are indispensable for men. The prostate is an androgen-dependent organ, which means that androgens maintain the growth, structure and functional integrity of the prostate. Therefore, androgens are required to be maintained at regular levels in the blood circulation. When it is lacking (e.g. depot or loss of testicular function due to disease), the prostate gland does not develop, atrophies, and decreases in function. In short, more and less androgens will have an effect on the prostate.
(E) Types of prostate disease
Prostate disease is a common disease unique to men, with a high incidence, long years of incidence, and a trend of increasing year by year. The common diseases are prostatitis syndrome, benign prostatic hyperplasia, prostate cancer, etc. The reason for the increase in the incidence of this disease is the stimulation of tobacco and alcohol, high-fat diet, sexual indulgence, especially the loss of control of “health care” products containing sex hormones, is also a factor in the increase in the incidence of prostate.
Benign prostatic hyperplasia, commonly known as prostate enlargement, is a common disease in elderly men. The majority of the onset of the disease is above the age of 50. The part where the hyperplasia occurs is the gland surrounding the urethra, the peripheral urethral gland area and the migratory area. The pathological changes in benign prostatic hyperplasia are mainly prostate tissue and epithelial hyperplasia, cystic expansion of the alveoli, and nodular hyperplasia of connective tissue and smooth muscle. Because of this, the prostate enlargement compresses the section of the urethra that passes through the prostate, causing urethral obstruction, difficulty urinating, and urinary retention.
What can cause prostate enlargement? Although many scholars have done a lot of research work, there is no definite conclusion yet. Most scholars now believe that it is related to an imbalance in the balance of the two sex hormones in the body. As mentioned earlier, because the growth of the prostate is closely related to the testes. During childhood, the prostate is very small and by puberty, the development matures and the prostate increases to normal size. By the age of 50, the prostate gland begins to enlarge again.
After some scientists injected androgens in animals, they found that the posterior urethral glands increased in size, causing urinary retention, and instead the prostate gland shrank when both testes were removed. In the past, eunuchs in the imperial palace had to be “castrated” when they entered the palace, which actually means that both testicles were removed. After liberation, Wu Jieping and others examined the eunuchs left behind and found that their prostates were shrinking, indicating the interconnection between the testicles and the prostate.
In recent years, some scholars have demonstrated that dihydrotestosterone in BPH tissue is 3 to 4 times higher than in normal prostate tissue. Dihydrotestosterone is converted from testosterone (androgen) in prostate cells by the action of an enzyme called 5α-reductase. The use of 5α-reductase inhibitors has also been proposed as a drug for the treatment of this disease.
It has also been discovered that there is a factor called alpha-adrenergic receptor in the bladder neck, prostatic envelope and posterior urethra, which causes spasm of smooth muscle in the bladder neck and posterior urethra, resulting in functional obstruction of the urethra, which leads to symptoms such as difficulty in urination. And the application of alpha-adrenergic receptor blockers was proposed as a drug to relieve the symptoms of prostate enlargement.
As the level of medical research continues to improve, many more factors have been found to be associated with prostate enlargement. It is believed that in the near future, the mystery of the pathogenesis of benign prostatic hyperplasia will be gradually unveiled.
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The development process of benign prostatic hyperplasia Benign prostatic hyperplasia is a long-term progressive disease process that can be divided into 3 phases according to the development of the disease and clinical symptoms.
The first stage (initial stage): the course of the disease develops slowly. The main symptom at the beginning is frequent urination, especially at night, the number of urination can increase from 1 to 3 times to 4 to 5 times, affecting the sleep and rest of the elderly. Later on, dyspareunia, weakness, bifurcation of the urine line and a short distance to shoot gradually appear. In this stage, the muscles of the bladder (bladder muscles) can still overcome the resistance caused by the pressure of the prostate enlargement on the posterior urethra and expel all the urine from the bladder, so there is no “residual urine” in the bladder.
The second stage (compensatory stage): Due to the gradual aggravation of the disease, the resistance of the posterior urethra is increasing, the frequency of urination is aggravated, urination is more difficult, the urine line is thin, urination is incomplete, and the abdominal pressure needs to be increased to help urinate. As the time of urination lengthens, the bladder muscles are unable to expel urine from the bladder completely, and a portion of urine remains in the bladder after each urination, which is called “residual urine”. The amount of residual urine increases with the development of the disease and can even exceed the capacity of the bladder itself, up to 400-500 ml. However, this stage does not yet affect the patient’s kidney function. Sometimes it can be combined with infection or stones, and painful urination, urgency, hematuria and interruption of urine flow can occur. Inguinal hernia, prolapse and internal hemorrhoids may also occur. These are all complications due to difficulty in urination and the need to increase abdominal pressure to urinate, caused by the long-term and repeated increase in internal abdominal pressure. In addition, it affects rest, consumes physical strength and leads to excessive mental stress, which can cause increased blood pressure and can induce heart failure or cerebrovascular accidents in severe cases.
The third stage (decompensated stage): The obstruction of the posterior urethra becomes more serious, and the urine cannot be formed into a line when urinating, and it is in a drip state. A mass – a distended bladder – can be felt in the lower abdomen. Unconscious dripping of urine from the urethra. At this time, due to the high pressure in the bladder, the urine in the ureter of the renal pelvis does not easily enter the bladder, so both the renal pelvis and ureter are under high pressure and begin to dilate and accumulate water, which eventually affects the kidney function, and the patient shows symptoms of chronic renal failure and eventually dies from uremia.