1.Watchful waiting
For patients with mild symptoms and some moderate symptoms who do not require treatment. The observation period should be reviewed at least once a year.
2.Medication
Applicable to patients with mild to severe symptoms without absolute indication for surgery.
(1) 5a reductase inhibitors: can reduce the size of the prostate, improve the symptoms of bladder outlet obstruction, reduce the risk of acute urinary retention and surgery. It is more effective in patients with large prostate volume (>40ml) and/or high PSA levels (>1,4ng/ml).
(2) α-blockers: can relax the smooth muscle around the bladder neck and posterior urethra to relieve the symptoms of bladder outlet obstruction. Commonly used drugs are selective α1A receptor blockers (such as tamsulosin), selective α1 receptor blockers (such as doxazosin, alfuzosin, terazosin, etc.) and non-selective α receptor blockers (such as phencyclidine). The side effects of non-selective α-blockers such as hypotension and postural hypotension are more significant than those of selective α1A-blockers. α-blockers should be administered at low doses, and then the dose should be increased as needed depending on the side effects and efficacy.
(3) Botanical preparations: There are many types of these drugs, some are extracts of plants, some are processed directly from the roots, stems, leaves or seeds of plants, and also include some proprietary Chinese medicines. According to research, some botanical preparations do have a certain effect on relieving clinical symptoms of prostatic hyperplasia, but the long-term efficacy and safety are yet to be further studied.
3.Surgical treatment
(1) Indications for surgery.
(1) Absolute indications for surgery (one of the following):
A. Urinary retention (inability to urinate after at least one extubation or repeated urinary retention).
B. Repeated hematuria of the naked eye.
c. Secondary renal impairment.
D. Secondary bladder stones.
E.Secondary recurrent urinary tract infection.
F. Secondary to large bladder diverticula.
(2) Relative indications for surgery (one of the following):
A, moderate to severe symptoms, unwilling to receive other treatment requires surgery.
B, moderate to severe symptoms, the effect of drug treatment is not significant.
C. Maximum urinary flow rate <10ml/s.
D. Residual urine volume >60~100ml