1. Overview Benign prostatic hyperplasia (BPH) is a common disease in older men, with a prevalence of up to 60% in men aged 60-70 years, and the prevalence increases by 10% with every 10-year increase in age. The cause of prostatic hyperplasia is not known, and it may be related to the level of androgens. The hyperplastic glands mostly originate from the migrating area of the prostate and the periurethral area. 2. Diagnostic points (a) Clinical manifestations Symptoms of prostatic hyperplasia appear gradually with pathological changes. In the early stage, the symptoms are not obvious due to bladder compensation, so the patients often cannot accurately recall the duration of the disease, and various symptoms appear as the disease worsens. 1.Frequent urination, urinary urgency: the most common symptom in the early stage is frequent urination, and gradually aggravated, especially the number of night urination increases. The cause of frequent urination in the early stage is due to the bladder neck congestion caused by bladder detrusor hyperreflexia, and in the later stage is due to the urethral obstruction caused by hyperplastic prostate, which increases the residual urine in the bladder and reduces the effective capacity of the bladder. 2.Progressive urination difficulty: mainly manifested as slow starting urination, urination effort, weak ejaculation, thin urine line, dribbling urine stream, segmental urination and incomplete urination. 3.Urinary incontinence: advanced prostatic hyperplasia often leads to bladder compensatory function failure and enlargement, bladder residual urine volume is increasing. When a large amount of residual urine accumulates in the bladder, due to over distension of the bladder, the pressure in the bladder increases to more than the urethral resistance and the urine can overflow at any time, which is known as filling incontinence. At night, when you are asleep, the pelvic floor muscle relaxes, which makes it easier for the urine to flow out on its own, and urinary retention occurs. 4, acute urinary retention: on the basis of urinary difficulty, if cold, alcohol, exertion and other triggers and cause gland and bladder neck congestion and edema, acute urinary retention can occur. The patient’s bladder is extremely swollen, pain, frequent urination, tossing and turning, difficult to sleep. 5, hematuria: prostate hyperplasia tissue surface often have venous blood vessel expansion congestion, rupture can cause hematuria. The amount of bleeding is intermittent, occasionally there is a large amount of bleeding, blood clots fill the bladder, must be treated urgently. When hematuria occurs, it should be differentiated from inflammation, stone and tumor in the bladder. 6.Symptoms of renal insufficiency: azotemia occurs in the late stage due to long-term urinary tract obstruction which leads to the decompensation of both kidneys, manifested as loss of appetite, nausea, vomiting and anemia. 7, other symptoms: due to long-term urinary difficulties and rely on increasing abdominal pressure to urinate, can cause or aggravate hemorrhoids, prolapse and hernia. （Rectal diagnosis Rectal diagnosis is an important step in the diagnosis of prostatic hyperplasia, which can roughly estimate the size of the prostate gland and detect some prostate cancer. （Cystoscopy Cystoscopy can directly observe the hyperplasia of each lobe of the prostate, and can find out whether there are other lesions in the bladder, such as tumors, stones, diverticula, etc., so as to decide the way of surgical treatment. （The amount of residual urine in the bladder reflects the severity of compensatory bladder failure, thus it is one of the important diagnostic steps and one of the factors to decide the surgical treatment. (E) Cystography Cystography can be performed in cases where cystoscopy is not feasible. In addition to observing the filling defect of the bladder neck, it can also observe whether there are bladder stones, tumors, diverticula and ureteral reflux. (vi) B-mode ultrasonography can determine the size of the prostate, non-invasive and simple. (G) urodynamic examination When prostatic hyperplasia causes lower urinary tract obstruction, the maximum urinary flow rate decreases (<15ml/s), and the residual urine is 60 ml. it should be actively treated. 3, treatment Many people believe that the symptoms of BPH are a phenomenon of physiological aging rather than a disease. According to the survey, only about 1/3 of the patients will go to seek treatment, and only a few of them get treatment through regular channels. Many middle-aged and elderly men tend to go to the hospital only when the disease is at an advanced stage, or even when acute urinary retention occurs, thus missing the opportunity for rational treatment and having to be treated by surgery. By rational treatment of BPH, we mean that in the early and middle stages of the disease, medication can be used to target the source of the disease to treat the "root cause" and reduce the size of the prostate gland, thus reducing the incidence of acute urinary retention and surgery. This is the preferred method of treatment for BPH recognized by both domestic and international medical circles. According to the different symptoms of BPH patients, there are generally the following main treatment methods: BPH should pay attention to "vigilant observation". Mild BPH, which is asymptomatic or has very mild symptoms, needs to be examined regularly and closely monitored. Once the condition has progressed, it needs to be treated aggressively. Medication for BPH. In recent years, with the advent of medications to control prostate enlargement and improve urinary obstruction, it is widely recognized that medication should be the first line of treatment, thereby reducing the need for surgery. Among them, 5a reductase inhibitors (e.g. finasteride) to reduce the incidence of acute urinary retention and surgery is currently the only BPH treatment program that has been confirmed by numerous clinical studies to be effective in treating the "root cause" of BPH. 5a blockers have a good effect on symptomatic improvement, but they cannot reduce the size of the prostate, and they are an effective symptomatic treatment. At present, a large number of studies have confirmed that the above two types of drugs used in combination, the best effect, can achieve "both symptoms and root cause" of the efficacy. Plant-based drugs are also commonly used for prostatitis and prostate hyperplasia, which can relieve symptoms. However, the mechanism of the drug is still not very clear. Surgery for benign prostatic hyperplasia. Surgery is recommended for some patients with BPH, especially for patients with severe prostate enlargement causing complications. Currently, surgery is mainly performed by laparoscopic surgery, which has the advantages of no wound, little trauma, fast recovery and little pain. 4, Conclusion We recommend that men over 50 years old should have regular checkups. Once BPH is detected, early medical attention should be sought and appropriate treatment should be used according to the condition. Blind spots and delays in seeking medical attention for BPH patients with blind spots about the disease and BPH treatments are now common in all types of common and high-risk diseases.