Due to your disease, anticoagulant therapy with Warfarin is indicated. Warfarin has a significant effect on the anticoagulation system, so it should be closely monitored during the application process, and the following precautions should be strictly observed to reduce the occurrence of adverse reactions. 1, pay attention to the dose adjustment and review: In general, the average maintenance dose of warfarin is 3 mg, and its dose is mainly adjusted according to the international standardized ratio deviation from the target and the patient’s previous response to the dose adjustment of warfarin, in most cases, the dose of warfarin is increased or decreased by 5%-20%, and it is best to maintain its international standardized ratio above or below 2.0, and the prothrombin time is maintained at 18-30 seconds. Prothrombin activity should be at least 25%-40% of the normal value. The enzyme blood time, prothrombin activity and international normalized ratio should be checked once every 1 to 4 weeks. Take the medication at the same time every day, and do not change the dose or brand of the medication without the doctor’s permission. 2. Observe the tendency to bleed: The main adverse effect is the tendency to bleed. Pay attention to the usual epistaxis, bleeding from brushing teeth, skin petechiae, and symptoms such as frequent urination, urgent urination, increased nocturia and thinning of the urine line, shortening of the projectile, dribbling of urine and urinary retention commonly seen in elderly men, mostly attributed to prostatic hyperplasia, a viewpoint that has been accepted by the vast majority of clinicians. However, with the progressive understanding of urodynamics, more and more urologists are realizing that these symptoms are not solely due to prostate enlargement. This explains the lack of significant clinical improvement in patients’ urinary hesitation symptoms after prostate surgery. Normal urinary function depends on normal bladder function and normal urethral function, and the two must remain in harmony with each other. The normal voiding process is the contraction of the bladder accompanied by the opening of the urethra. If the urethra does not open for some mechanical reason when the bladder begins to contract, or if it opens very little, this results in a high bladder pressure and low flow rate during urodynamic testing, suggesting bladder outlet (organic) obstruction. Generally this is prostatic hyperplasia. If the urethra is already open and the bladder is not contracting or is very poorly contracted and still cannot urinate normally, then increased abdominal pressure is needed to urinate, this is what we call impaired or weak contraction of the detrusor muscle. There are two other conditions, one is a dysfunction of the bladder forceps and the urethral sphincter, which is characterized by a great effort when starting to urinate, an increase in bladder pressure can be seen at the beginning of the pressure measurement, and once urine is discharged the pressure drops rapidly, and a high flow rate can be maintained at a very low pressure. Secondly, it can show a high pressure and high flow rate curve, which we think is still the result of increased pressure in the bladder to overcome urethral resistance, and this type is more likely to produce vesicoureteral reflux and cause pelvic and ureteral effusion. The above four conditions especially the first two are the most common in clinical urodynamics examinations. It should be noted that it is difficult to differentiate between the processes that produce lower urinary tract symptoms without appropriate urodynamic testing. In clinical treatment work, in elderly male patients with LUTS symptoms, the prostate is objectively enlarged to varying degrees, but it is another question of recognition whether the enlarged prostate tissue is actually compressing the urethra and causing difficulty in urination. The prostate is a reproductive gland that surrounds the urethra below the bladder, and it is generally believed that after the age of 50, men begin to experience degeneration and hyperplasia of the gland due to changes in sex hormones in the body. However, by observation, not all older men present with significant urinary difficulties that require surgery or medication. This gives us a hint: ① The hyperplastic prostate tissue grows towards the periphery of the urethra and sometimes is so large that it can not compress the urethra or lightly compress it so that it can urinate normally through the compensatory mechanism of the bladder. ②The size of the prostate gland cannot be proportional to the symptoms of dyspareunia. A very small volume of prostatic hyperplastic tissue, growing toward the urethra, can easily compress the urethra and cause difficulty in urination. The strength of the contraction of the bladder force is another important reason for difficulty in urination. If the contraction of the bladder forcing muscle is poor, further surgical or conservative treatment for the prostate will be pointless, even if the prostate enlargement is obvious. This group of cases showed that of the 141 patients who clearly had prostatic hyperplasia, only 96 had bladder neck obstruction (68%) by urodynamic examination, and the remaining 45 had reduced bladder contractility (31%). Accordingly, 98 cases were treated surgically, two of which had hypocystic bladder contraction with a maximum force of the detrusor less than or equal to 40 cmH2O. Further illustrating the importance and necessity of preoperative assessment of bladder forceps function, forceps dysfunction would be the main cause of LUTS failure due to surgical treatment of prostate enlargement. There are several reasons to produce reduced contractility of the detrusor muscle: ① aging of the bladder itself in elderly patients with poor contractile function; ② impaired function of the detrusor muscle, mostly seen in female patients with a history of habitual urinary holding, and others such as patients with acute and chronic urinary retention can lead to varying degrees of impaired function of the detrusor muscle; ③ damage to the nerves around the bladder due to diabetes; ④ spinal cord injury and lesions, central neuropathy, multiple sclerosis, etc. . For patients with acute urinary retention and overfilled bladder with prostatic hyperplasia, the bladder is overfilled for a long time so that the bladder muscle is over-extended and gradually loses its tone and effective contraction ability. In patients with long term chronic urinary retention, if the urodynamic examination reveals incompetence of the bladder forcing muscle contraction, cystostomy or indwelling catheterization can be performed first, and then surgery can be performed after the function of the forcing muscle is restored on follow-up. Urodynamic examination is an important guide to the long-term outcome and perioperative management of BPH. In comparing the results of pressure-flow rate examination and the improvement of patient’s symptoms after surgery, we analyzed that the cut-off line is 40 cmH2O to 60 cmH2O of forceps pressure, and we do not recommend surgical treatment for forceps pressure less than or equal to 40 cmH2O. Preoperatively, patients should be informed that there may be a significant difference in the expected outcome. In patients with an unstable bladder combined with hypocompliant bladder (overactive bladder), preoperative and postoperative treatment with competitive M-cholinergic receptor blockers can prevent and control unstable bladder contractions, reduce postoperative spastic bleeding, and decrease the incidence of postoperative urinary frequency and urgency. Urethral pressure measurement can pre-consider the pressure change curve of the urethra in each prostate department between the bladder neck and the external urethral sphincter, thus obtaining data on the length of the urethra in the prostate department, as well as the distribution of the main obstructive areas, which provides an important clinical theoretical basis for surgical resection of the prostate by TURP. Although urodynamic testing is not a recommended test in the BPH guidelines, we still believe that it is important to perform urodynamic testing before prostate surgery. (1) It can distinguish the cause of LUTS from organic obstruction, and if it is not caused by organic obstruction, surgical treatment will be ineffective; (2) It cannot be ignored that bladder contraction weakness is another important cause of LUTS symptoms; (3) It provides a more realistic and powerful basis for evaluating the treatment effect and perioperative management; (4) Through urodynamic examination, it can truly reflect the relationship between bladder pressure The relationship with urethral resistance can increase the success rate of surgery and greatly reduce the occurrence of medical disputes. urine, vaginal bleeding, blood in the stool, bleeding from wounds and ulcers, etc. If the prothrombin time exceeds 2.5 times normal (i.e. more than 30 seconds, the normal value is 12 seconds), the prothrombin activity drops below 15% of normal, and the international normalized ratio is greater than 3.5, the drug should be discontinued immediately. In severe cases, 4-20 mg of vitamin K can be given orally or 10-20 mg can be injected slowly by sedation, and the prothrombin time can be restored to a safe level 6 hours after the drug is administered. If necessary, fresh whole blood, plasma or prothrombin complex can also be transfused. If there is bleeding, seek medical attention promptly, do not fall during the medication, do not damage the skin, do not drink alcohol, do not use the medication indiscriminately, tell the doctor that you are receiving anticoagulation therapy when you seek medical attention, and it is advisable to carry vitamin K1 tablets for backup during the medication period. 3. Do not stop the drug suddenly: the dosage should be gradually reduced in 3 to 4 weeks. 4. Contraindicated in patients with the following conditions: bleeding tendency, hemophilia, severe thrombocytopenic purpura, severe liver and kidney disease, active peptic ulcer, brain, spinal cord and ophthalmic surgery patients. 5. Use with caution in the following cases: cachexia, debility, fever, chronic alcoholism, active tuberculosis, severe hypertension, subacute bacterial endocarditis, menorrhagia, preterm abortion, etc. 6. Note for those who need to perform surgery in the near future: Vitamin K1 can be injected sedatively, and the drug should be stopped before central nervous system and ophthalmology surgery. After gastrointestinal surgery, fecal occult blood should be checked. Do not take other medications, including aspirin and cold medications, without your doctor’s permission while taking the medication. These drugs can interfere with the action of Warfarin and cause health hazards. 7, when combined with drugs that can enhance the effect of Warfarin, the dose of Warfarin should be reduced accordingly: (1) drugs with high binding power to plasma proteins such as aspirin, Protaxon, clofibrate and sulfonamides; (2) liver microsomal enzyme inhibitors such as chloramphenicol, metronidazole and cimetidine; (3) drugs that reduce the absorption of vitamin K and affect prothrombin synthesis such as various broad-spectrum antibacterial agents and clofibrate; (4) drugs that promote (5) drugs that interfere with platelet function and promote anticoagulation, such as chlorpromazine, diphenhydramine, prostaglandin synthase inhibitors, etc.; (6) oral hypoglycemic agents, adrenocorticotropic hormones, diazoxide, streptokinase and urokinase, etc. The most attention should be paid to non-steroidal anti-inflammatory drugs. 8, when combined with drugs that can reduce the anticoagulant effect of Warfarin, the dose of Warfarin should be increased accordingly: (1) drugs that inhibit its absorption, such as acidophilus; (2) hepatic enzyme inducers such as carbamazepine, phenobarbital and ashwagandha; (3) drugs that can promote the synthesis of coagulation factors II, VII, IX and X, such as vitamin K, oral contraceptives, estrogen, etc. 9, vitamin K-rich foods can reduce the efficacy of Warfarin: maintain a balanced, relatively regular diet and good eating habits, and keep in mind to eat less high-fat diet and foods rich in vitamin K such as: cabbage, cauliflower, asparagus, lettuce, green radish, fish, liver, etc. The following foods are rich in vitamin K. The content of vitamin K per 100g of dry food is: spinach 4.4mg, cabbage 3.2mg, cauliflower 3.0mg, peas 2.8mg, carrots 0.8mg, tomatoes 0.6mg, potatoes 0.16mg, pig liver 0.8mg, eggs 0.8mg. Although the above foods are rich in vitamin K, as long as a balanced diet, regular and Although the above foods are rich in vitamin K, as long as a balanced diet and regular measurement of prothrombin time and activity, it is possible to adjust the dose of anticoagulant drugs, there is no need to deliberately favor or prohibit certain foods. 10, pay attention to the impact of other diseases: diarrhea, vomiting can affect the absorption of drugs, heart failure or primary liver disease can reduce vitamin K synthesis, while reducing the metabolic rate of warfarin, the amount of warfarin should be reduced. Influenza vaccine increases the effect of anticoagulation. Check for bleeding within one month of vaccination. Fever, climatic fever, malnutrition and diarrhea can prolong the clotting time and cause bleeding. 11.Patients should tell the doctor that they are taking warfarin when they visit the clinic and carry a medical certificate with them indicating that they are receiving warfarin treatment.