Benign prostatic hyperplasia, commonly known as prostate enlargement, is a common disease in older men. The age of onset is mostly over 50 years old. The part of the prostate that undergoes hyperplasia is the gland that surrounds the urethra. Because of this, the enlarged prostate compresses the section of the urethra that passes through the prostate, causing urethral obstruction, difficulty urinating, and urinary retention.
What can cause prostate enlargement?
Most scholars now believe that it is related to an imbalance in the balance of the two sex hormones in the body. This is because the growth of the prostate gland is closely related to the testicles. In the past, the eunuchs in the palace had to be “castrated” when they entered the palace, which actually means that both testicles were removed. The actual fact that the testicles and the prostate gland are interconnected is evident from the fact that the eunuchs were examined by Wu Jieping after liberation and found that their prostates were atrophied.
Benign prostatic hyperplasia is a long-term progressive disease process that can be divided into 3 stages based on the progression of the disease and clinical symptoms.
Phase I.
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 1-3 to 4-5 times, affecting the sleep and rest of the elderly. Later on, the symptoms of dyspareunia, weakness, bifurcation of the urine line, and short distance to the bladder gradually appear. In this stage, there is no “residual urine” in the bladder.
Stage 2.
The disease gradually worsens, the resistance of the posterior urethra increases, the frequency of urination increases, urination becomes more difficult, the urine line is thin, the urine is incomplete, and the pressure on the abdomen needs to be increased to help urinate. The duration of urination lengthens and the urine in the bladder cannot be completely expelled, and a part of the urine remains in the bladder after each urination with “residual urine”. The amount of residual urine increases as the disease progresses. This stage does not yet affect the kidney function of the patient. Sometimes infection or stones may be combined with painful urination, urgency, hematuria and interruption of urine flow. Inguinal hernia, prolapse and internal hemorrhoids may also occur. These are all complications due to the 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 tension, which can cause increased blood pressure and can induce heart failure or cerebrovascular accidents in severe cases.
Third stage.
Urethral obstruction becomes more serious, the urine cannot be formed into a line when urinating, and the residual urine volume in the bladder is more than 500 ml, and the phenomenon of “bedwetting” may appear at night. A mass (i.e. distended bladder) can be felt in the lower abdomen. Unconscious dripping of urine from the urethra. This is because the pressure in the bladder is high, the urine in the ureter of the renal pelvis is not easy to enter the bladder, so the renal pelvis and ureter begin to expand water, and eventually affect the kidney function, the patient is chronic renal failure symptoms, and finally can die from uremia. There is no absolute correlation between the size of the prostate and the symptoms of benign prostatic hyperplasia. There are many clinical cases where the prostate size may be normal or slightly larger despite the symptoms. In contrast, it is possible for the prostate to be large, even over 100 grams, in cases with mild symptoms. Therefore, attention should be paid to symptoms rather than excessive attention to prostate size.The IPSS of the Benign Prostatic Hyperplasia Symptom Index was unanimously endorsed in 1993 by the International Coordinating Committee in Paris, sponsored by the World Health Organization, as the official worldwide symptom score for patients with prostate disease.
Quality of life score.
The International Coordinating Committee used a question as an assessment of quality of life. The answers to this question ranged from very good to very painful, i.e., a score of 0-6. Although this question alone does not fully reflect the impact of BPH symptoms on quality of life, it is still relevant when physicians and patients begin to discuss this important element.
So this question is: If you were to urinate as you are now, how do you feel your quality of life would be in the future?
A score of 0: very good.
1 point: good.
2 points: mostly satisfactory.
3 points: half satisfied and half dissatisfied.
4 points: mostly unsatisfactory.
5 points: unpleasant.
6 points: very painful.
Third, how to diagnose benign prostatic hyperplasia?
There are many ways to check for BPH, what should be checked and what should be checked first, in addition to the doctor’s arrangement, the patient should also have a good idea.
1. General examination.
You should state your urination to the doctor so that the doctor can assess the patient’s symptoms. And also state whether there is a history of previous surgeries (especially those involving the genitourinary tract), and the medications being taken, etc. The abdominal examination should pay attention to the degree of bladder distension, the presence of bladder swelling and pressure pain in the suprapubic area after urination.
2. Laboratory tests.
In order to know whether there is urinary tract infection and renal function damage, blood, urine routine and blood biochemical tests should be done.
3. Prostate-specific antigen (PSA) test.
Prostate-specific antigen is a substance secreted by the prostate gland, and its concentration can be detected in men’s blood. In prostate cancer patients, its concentration is significantly higher than normal. Therefore, in order to screen for prostate cancer, PSA test should be performed on every man over 40 years old.
4. Residual urine measurement.
There are two methods for this test, one is the catheterization method, which is painful during the test but reliable. First, urinate and then insert the catheter in time to release the residual urine in the bladder. The other is the ultrasound measurement method, which is painless and simple, but less accurate. The bladder and prostate can be examined at the same time. The amount of residual urine in a normal person is 0 to 10 ml.
5.Ultrasonic examination.
There are two methods for this examination: one is abdominal ultrasound; the other is transrectal ultrasound.
6.Urodynamic examination.
Although dyspareunia is the main manifestation of BPH, it is not a unique symptom, there are many diseases that also show this symptom, such as “neurogenic bladder” caused by neuropathy can also have this manifestation. A urodynamic test can diagnose whether prostatic hyperplasia is causing urethral obstruction, the degree of obstruction, and the complications of bladder function. It is also possible to identify the presence of other diseases.
(1) Treatment objectives.
Improve symptoms; reduce obstruction; prevent and control the occurrence of long-term complications (such as renal failure, acute urinary retention, etc.). Thus, to maximize the quality of life of patients.
(2) Wait and see.
Benign prostatic hyperplasia should be considered as one of the physiological aging processes in older men. According to scientists, studies have shown that 60% of cadaveric examinations of men over 60 years of age reveal prostatic hyperplasia, with an incidence of 90% in those over 80 years of age. However, less than 25% of patients have symptoms that require treatment, so even if the examination confirms a diagnosis of BPH and there are no symptoms or only very mild symptoms, i.e. patients with an IPSS score of less than 7 do not need treatment, but only regular (e.g. annual) hospital check-ups. If the symptoms worsen, they should be treated promptly.
(3) Pharmacological treatment.
Alpha-adrenergic receptor blockers: There are a large number of alpha-adrenergic receptors at the bladder neck, prostate and posterior urethral smooth muscle, which can cause an increase in smooth muscle tissue tone and increase the resistance of the posterior urethra. Therefore, clinical application of alpha adrenergic receptor blockers for the treatment of prostatic hyperplasia can improve urination. The current application of alpha blockers are terazosin (Gottlieb, Mashani), Santaprost and Harle. However, these drugs have the side effect of lowering blood pressure, dizziness, palpitations and shortness of breath, weakness, etc. If the above symptoms occur, you should promptly lie down and rest for a period of time before moving around, and the drug should be reduced appropriately and gradually increased after complete adaptation. 5α reductase inhibitors: can inhibit the conversion of androgen-testosterone to dihydrotestosterone in the prostate, causing the enlarged prostate tissue to shrink. The 5α reductase inhibitor currently in use is Pauligy. Botanical drugs: such as sernitone, retention of urine, etc.
Medication is chosen according to the patient’s condition, mostly combined medication, should be taken for a long time after taking effective, can not stop, otherwise the side symptoms aggravate again. At present, the side effects of the drugs are light and it is safe to take them for a long time.
(4) Minimally invasive treatment
Heat therapy.
It is a new therapy in the 90s, including microwave, radiofrequency, infrared and high-intensity focused ultrasound. However, some of these therapies have poor long-term effects and require continuous improvement, and are still under further research.
Stenting.
A stent is placed in the urethra of the prostate under direct cystoscopic view. The goal is to relieve the obstruction. It is generally used in patients who are elderly, at high risk and have difficulty in urination, and who cannot be treated by other methods. Recently, memory alloy mesh stent tubes have been used, which have the advantage of being easy to place, less reactive and can be placed for a long time.
Anhydrous alcohol injection therapy.
Using a special intraurethral syringe, an amount of anhydrous alcohol is injected into the gland of the prostate under direct vision through a special urethral cystoscope, causing necrosis and atrophy of the prostate tissue and widening of the urethra, thus relieving the obstruction. This method is also used for patients of advanced age, high risk and difficult urination, and those who cannot be treated by other methods.
(5) Surgical treatment
Surgical method: The choice of surgical method should be a joint consultation between the doctor and the patient, and the patient can consider the surgical method according to his or her condition.
The currently recognized surgeries are: open surgery: these surgeries are accessed through skin incisions, with greater surgical damage, slower post-operative recovery, and longer post-operative bed rest and catheterization time. This procedure is suitable for patients with larger prostates. This is the best surgical method at home and abroad, and has the name of “gold standard”. This procedure has no skin incision, little damage, quick recovery, and short bed rest and urethral catheter time. In recent years, many new, less invasive transurethral surgical methods have been invented to reduce bleeding during and after surgery, such as electrosurgery, laser vaporization and resection.
Which of the above surgical methods should be used can be said to have its own advantages and disadvantages.
The decision is made from the patient’s safety, efficacy and prognosis, based on the patient’s physical state and condition, after weighing various aspects, and then taking into account the strength of the hospital such as equipment and technical level. Patients are a little worried about the surgery, not to mention that it is a difficult procedure. As far as we can see, the safety of the surgery is still high due to the development of science and technology and the continuous improvement of doctors’ business skills. If you are in good physical condition, it is even safer. It should be noted that some old and weak, with obvious heart, lung, liver, kidney and other diseases, or coagulation problems, the safety should be poor, so you do not have to do the complete removal of the surgery reluctantly, otherwise it will cause the so-called: “the operation is successful, death is inevitable”, and what is the value? So you should choose a treatment that is safe and effective.
The surgery for BPH is not a “prostatectomy”.
The procedure for benign prostatic hyperplasia is not to remove the entire prostate gland, but to remove the hyperplastic prostate tissue to achieve the treatment goals described earlier. Therefore, the non-hyperplastic prostate tissue remains in the body after surgery, which is why the prostate is still present on post-operative ultrasound, just like removing a ripe orange and leaving the peel behind. Why not have a total prostatectomy? The reason is that BPH is a benign lesion, and the purpose of treatment is to make the patient urinate freely, and this can be achieved by removing the hyperplastic tissue, without the need for total prostate removal. The procedure for benign prostatic hyperplasia should therefore be a hyperplastic adenomectomy. The surgery for benign prostatic hyperplasia removes only the tissue of the prostate that causes obstruction, so there will be the possibility of re-growth and cancer in the future, so the patient should also have regular examinations about the prostate after the surgery.
Possible post-operative problems.
The main reason for the prostate surgery is to relieve the obstruction at the bladder outlet and to make the urination flow smoothly after the surgery, it can be said that most of them can achieve this purpose and also restore the health of the past. The actual fact is that you can find a lot of people who have been in the business for a long time. There are also individual patients whose urine is passed after surgery, but leaves irremediable sequelae, commonly sexual dysfunction. However, as technology continues to improve and treatment methods continue to improve, the side effects of surgery will become less and less frequent.
Why do I still have frequent urination after surgery?
The bladder muscle thickens and the bladder wall thickens due to urethral obstruction during the onset of prostatic hyperplasia. As the disease continues to develop and causes a reduction in bladder capacity and bladder nerve function, and this change in bladder function is not restored by the success of the surgery, it is an irrecoverable change, therefore, due to the decrease in bladder capacity, resulting in persistent urinary frequency and even urgency after surgery, although urination is clear. This is a problem that has yet to be solved in medical research.
V. Relationship between benign prostatic hyperplasia and prostate cancer
Prostatic hyperplasia and prostate cancer occur in two different parts of the prostate gland, with prostatic hyperplasia occurring in the periurethral glands and prostate cancer occurring in the subperitoneal glands. There is no difference in hormone levels between the two diseases and between healthy individuals from numerous experimental studies, suggesting that there is no definite relationship between the two. The pathological histological changes in prostatic hyperplasia remain similar to normal prostate tissue, except that the cells become larger, whereas prostate cancer cells appear to be mutated (malignant), a finding that strongly supports the idea that prostatic hyperplasia and prostate cancer are unrelated diseases. In conclusion, prostatic hyperplasia and prostate cancer are common diseases in older men that develop under similar endocrine, pathogenetic or environmental influences, but occur in different parts of the prostate and often occur simultaneously, but may not be related to each other.
VI. Prevention of benign prostatic hyperplasia
The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular items. It is absolutely forbidden to drink alcohol or eat stimulating food. The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular items. You can’t hold back urine or hold it in. You need to urinate promptly, and you need to urinate before watching movies or plays. Before attending a meeting or party, you should also be prepared to avoid holding urine for too long during this period and causing urinary retention. Sexual activity should not be overly frequent, frequent sexual impulses can congest the prostate. When traveling long distances, you should intermittently stand up and move around to avoid pelvic congestion and increased difficulty in urination. Avoid taking atropine, belladonna and 654-2 type drugs.