I. Physical examination: 1. Comprehensive physical examination: men over 50 years of age with frequent urination, increased nocturia, thin urine line, short projectile, especially progressive dysuria, urinary retention, should be considered as prostatic hyperplasia. Elderly patients with prostatic hyperplasia are often combined with other chronic diseases and should undergo a detailed physical examination, especially paying attention to cardiopulmonary function, such as hypertension, atherosclerosis, emphysema, and diabetes mellitus. If combined with hydronephrosis, attention should be paid to renal function, so a detailed physical examination, laboratory tests, cardiopulmonary and renal function tests are necessary. Systemic examination should pay attention to the patient’s general condition, such as whether the reaction is slow, whether there is anemia, edema, whether there is hypertension and cardiopulmonary function abnormalities. Examination of the vulva and urethral opening: It can visually check whether there is any deformity of the vulva, whether the position of the urethral opening is normal, and whether there is any narrowing of the urethral opening. The presence of urethral calculi can be checked by palpation. Abdominal examination pay attention to whether there is any mass in the upper abdomen, whether there is any mass formed in the lower abdomen due to overfilling of the bladder, whether there is any pressure and percussion pain in both renal regions, whether there is any inguinal hernia, whether there is any abnormality of anal sphincter tone, whether there is any hemorrhoid, and so on. 2.Diagnostic Rectal Examination (DRE): Diagnostic Rectal Examination is a simple and valuable method to diagnose prostatic hyperplasia, it should be carried out after emptying the bladder and urine, every patient needs to do diagnostic rectal examination and neurological examination, pay attention to the boundaries of the prostate gland, the size, the texture of the central groove of the depth of the prostate gland, the presence or absence of nodules, the degree of smoothness of the surface, the presence of tenderness and pressure pain, the spermatogonium can be palpated and the rectum with or without lumps, and at the same time, we need to Understand the rectal sphincter contraction force, in order to exclude the cause of similar symptoms of neurological diseases. The normal size of the prostate is about 4cm in the bottom transverse diameter, 3cm in the longitudinal diameter, and 2cm in the anterior and posterior diameters. In the case of prostatic hyperplasia, the transverse or longitudinal diameters of the gland can be palpated on rectal palpation, or both are enlarged, and the surface of the prostate gland is smooth, with a clear margin and a moderately hard texture, which is tough, elastic, and as full as a sphere. The central sulcus becomes shallow or disappears. In the clinic, different methods are used to describe and estimate the degree of prostatic hyperplasia, Rous (1985) proposed the rectal diagnosis of prostate size grading and weight estimation method, Ⅰdegree: the size of prostatic hyperplasia gland is up to 2 times of the normal gland, and the estimation of weight is 20-25g; Ⅱdegree: the size of hyperplasia gland is 2-3 times of the normal one, and the central sulcus may be shallow or disappear, and the estimation of weight is 25-50g; Ⅲdegree: the size of hyperplasia gland is 2 times of the normal one, and the estimation of weight is 25-50g; Ⅲdegree: the size of hyperplasia gland is 2 times of the normal one. Degree III: the hyperplastic gland is 3 to 4 times normal, palpation can barely touch the bottom of the prostate, the central sulcus disappears, the estimated weight is 50 to 70g; Degree IV; the hyperplastic gland is more than 4 times normal, palpation can no longer touch the bottom of the gland, and the estimated weight is more than 75g. Normal prostate is the size of a chestnut, pigeon egg is Ⅰ degree, egg is Ⅱ degree, duck egg is Ⅲ degree, and then Ⅳ degree. It must be pointed out that the estimation of the size of the prostate on rectal palpation and the actual size of the prostate has a certain error, in addition to the clinical experience of the examiner, the amount of residual urine also has a certain impact, such as increasing the prostate to the bladder protruding, that is, the so-called middle lobe enlargement, rectal palpation of the enlarged prostate is not obvious, so it must be diagnosed with the help of other methods combined with the history of the synthesis. If the prostate is hard, the surface is not smooth and uneven, and even nodules can be touched, it should be considered whether there is prostate cancer or prostatitis, and the diagnosis rate of prostate cancer by rectal diagnosis is not high, and prostate aspiration biopsy is feasible to make a clear diagnosis. If necessary, prostate puncture biopsy is feasible to make a clear diagnosis. Only 26%~34% of the prostate cancer patients found by histologic examination are suspected to be cancer during rectal diagnosis, but rectal diagnosis is still an indispensable examination method. Urine routine examination can determine whether there is hematuria, proteinuria, pusuria, urine sugar, etc. through urine analysis, which can reflect whether there is co-infection and kidney function damage. Third, serum prostate-specific antigen (PSA) determination Prostate cancer, BPH, prostatitis by rectal prostate ultrasound and cystoscopy may make the serum PSA rise. In addition, urinary tract infection, prostate puncture, acute urinary retention, indwelling catheterization and prostate massage can also affect the serum PSA value. Kidney function test Kidney function is a necessary test, generally can determine the blood creatinine, can reflect the prostate hyperplasia has caused renal impairment, the prognosis of the treatment has been estimated, and can choose the best treatment program. V. Imaging (1) ultrasonography: ultrasonography of the prostate can be performed through the abdominal, suprapubic, urethral and rectal routes, which can observe the morphology and structure of the prostate, the edge of the silhouette, the internal echogenicity, the volume of the volume of the estimated weight and the calculation of the amount of residual urine. Transabdominal ultrasonography can clearly show prostatic hyperplasia, especially the part of hyperplasia that protrudes into the bladder; the bladder needs to be filled during the examination, and the residual urine volume can be calculated by examining during filling and reexamining after urination, and the internal structure is poorly resolved by abdominal prostate examination, while transurethral ultrasonography can accurately distinguish the central adenoma from the non-adenomatous tissues and peritumoral membranes around the peripheral band, but it needs to be examined by electrodioptrosurgery. However, it needs to be inserted into the urethra with an electrosurgical scope, which is traumatizing, so it is less frequently used. Transrectal ultrasonic scanning is the most accurate, and it is more commonly used nowadays. Transabdominal ultrasonography: Since the prostate is located in the deep pelvis, the probe on the pubic bone needs to be angled caudally, and can only reach the prostate after passing through the pubic bone of the bladder, so it is difficult to observe the whole appearance of the gland and its internal structure. However, this kind of examination is simple and can be repeated for many times, and it is also easy to accept by the patients because of the lack of discomfort and injury, and it is very suitable to be carried out in the general hospitals. Through the ultrasound can be measured to the maximum anterior and posterior, up and down and transverse diameter of the prostate, due to the method of examination, experience and type of instrumentation, the ultrasound value also varies, but the normal transverse diameter of the prostate 3,5 ~ 4,5cm, anterior and posterior diameter of 1,5 ~ 2,5cm, up and down the diameter of about 3cm, prostate hyperplasia is more than anterior and posterior diameter of hyperplasia is dominated by a normal chestnut-type prostate if you look at it as a similar ellipsoid; by the Ultrasound measured by the value of the formula to calculate the volume of V = longitudinal diameter × transverse diameter × anterior and posterior diameter × 0, 523, if you look at the sphere, the formula for V = 4/3 π × radius of the cube, the normal weight of the prostate for 15 to 20g, greater than 40g is usually considered to increase, the formula for W = V × 1, 05, W for the weight, V for the volume of the prostate, 1, 05 for the specific gravity of the prostate. In recent years, with the development of ultrasound instruments and computer technology, the application of computer technology, analysis and processing of images, automatic measurement of prostate volume, and the application of three-dimensional reconstruction technology, prostate volume measurement, so that the accuracy has improved. Transabdominal ultrasound can measure residual urine, Szabo et al. used gray-scale ultrasound to measure residual urine in 26 patients with dysuria. The patient took the supine position, the probe on the pubic bone to measure the bladder above and below the diameter and transverse diameter, the average of the two diameters, according to the volume = 4/3 π × (the average of the two diameters of the cubic value), the amount of residual urine, and the actual amount of residual urine between the error is only 5 to 10 ml. Ultrasound determination of residual urine is non-invasive, avoiding the risk of infection caused by catheterization, and is easy to repeat many times. ② transrectal ultrasound: the examination procedure is to ask the patient to defecate first, if necessary, enema or bowel wash after the examination. Make the probe slowly inserted into the rectum 6cm, adjust the depth of the probe, starting from the bottom of the prostate, every 0, 5cm section scanning once, pay attention to measuring the height of the prostate protrusion to the bladder. Three radial values were obtained, and the envelope and internal reflection were recorded. From the sonogram of the patient with prostatic hyperplasia during urination it is possible to reveal deformations and displacements within the urethra, thus reflecting dynamic changes in bladder outlet obstruction. Through the ultrasonography can also understand the changes of the bladder, when the prostate hyperplasia lower urinary tract obstruction, the bladder can appear in the ultrasonographic manifestations: the bladder wall thickening, not smooth, there can be muscle trabeculae and diverticulum formation, the amount of residual urine in the bladder increased, and in severe cases, there can be double hydronephrosis, thinning of the renal parenchyma. (2) Urography: Urography is divided into intravenous pyelography and retrograde pyelography. Intravenous pyelography is the most common and valuable examination method for the urinary tract, while retrograde pyelography is used for patients with poor or uncomfortable intravenous pyelography. The purpose of intravenous pyelography in patients with prostatic hyperplasia is to rule out the presence of pyeloureteral dilatation due to lower urinary tract obstruction and to estimate renal function. At the same time, to understand the presence of trabecular hyperplasia and diverticulum in the bladder. (3) CT examination of the prostate: the normal CT cross sectional scan image of the prostate gland is located in the lower edge of the pubic symphysis, round or oval, with clear demarcation, uniform density, soft tissue density, and a CT value of about 40 Hu. CT scanning can not correctly and clearly distinguish the three parts of the structure of the prostate gland, and after scanning the prostate gland for 15-20 min after the prostate gland is injected with contrast medium, the gland can be classified into peripheral zone and central zone based on the difference in density. The gland can be divided into peripheral and central areas according to the density difference. (4) magnetic resonance imaging (MRI) of prostate hyperplasia: normal prostate MRI shows that: the prostate gland is like an inverted cone, the bottom of the widest is located in the bladder after the tip of the tail side and the urethra membrane adjacent to the front of the pubic symphysis, after the rectum, left and right symmetry, size, the normal transverse diameter at the base of the base of about 4cm, anterior and posterior diameter of 2cm, up and down the diameter (longitudinal diameter) of 3cm, not more than 1cm, in MRI, the pubic symphysis, the prostate gland can be divided into peripheral and central areas according to the density difference. 1cm, on MRI the prostate structure can be divided into 3 parts; that is, the peripheral zone, the central zone and the migratory zone, the peripheral zone accounts for 70% of the prostate; in the posterior exterior of the prostate, the tip is the thickest, and the migratory zone encircles the urethra peripherally, accounting for about 50%. Thus, on transverse axial scanning, the highest layer includes only the central zone, which atrophies with age, in contrast to the migratory zone, which increases in size with age. The vast majority of prostatic hyperplasia nodules occur in the migratory zone, which increases the volume of the prostate. MRI can measure the enlarged volume of the prostate, with T1W showing a slightly longer homogeneous low signal, and T2W showing an equal, low, or high signal, with or without punctate higher signal in the middle (hyperplasia nodules with predominantly myofibrillar components show low signal, and those with predominantly glandular components show high signal). Many hyperplastic nodules are often surrounded by atrophy due to compression, and T2W shows a ring-shaped signal band, which is the surgical envelope seen during surgery. Gradual enlargement of hyperplastic nodules in the migratory zone can result in compression and atrophy of the peripheral zone, which may not even show up on MRI.BPH not only enlarges the prostate in general, but can protrude anteriorly and superiorly into the bladder in the form of nodules, forming soft tissue at the base of the bladder, but it is nonspecific. The presence of vesicoureteral seminal vesicles can compress the anterior rectal wall, but maintain normal intervals. Sixth, prostate cystoscopy: cystoscopy is of great value in the diagnosis and differential diagnosis of prostatic hyperplasia, and in understanding the degree of lower urinary tract obstruction. Cystoscopy is more necessary when patients with prostatic hyperplasia have symptoms of lower urinary tract obstruction, when intravenous urography shows the generation of bladder trabeculae, when residual urine or pyeloureteral effusion occurs, and when the elderly are predominantly symptomatic with hematuria of the naked eye. Cystoscopy should be performed as part of the surgical plan so that the surgical procedure can be selected and performed as soon as possible after the diagnosis is confirmed. During cystoscopy, patients with prostatic hyperplasia can feel a lengthening of the urethra during insertion of the sheath. The distance from the seminal caruncle to the bladder neck is 2 cm in normal cases, but it can increase to more than 5 cm in cases of significant prostatic hyperplasia. The shape of the bladder neck changes with the degree of hyperplasia of each lobe. In the case of bilateral lobe hyperplasia, the normal concave surface of the bladder neck disappears, and the enlarged interlobular area of the gland becomes V or A shaped, and the lobes of the gland can be seen to increase to the front of the cystoscope’s receiving lens. When the middle lobe hyperplasia, the base of the bladder is concave, the posterior lip is obviously elevated, the inter-ureteral ridge is hypertrophied and elevated, and the formation of trabeculae and diverticula are all evidence for the diagnosis of lower urinary tract obstruction. Seventh, urodynamic examination Urodynamic examination of benign prostatic hyperplasia diagnosis is of great significance, can determine the degree of obstruction, the prostate part of the urethra and the internal and external sphincter resistance, forced urethral muscle function status. According to the measured uroflow rate, urethral pressure, urethral pressure curve, as well as sphincter electromyography and other data, we can analyze whether the prostate syndrome is caused by obstruction or provocation, and we can know whether there is urethral instability, impaired urethral contractile function and bladder compliance changes.