I. Definition.
Benign prostatic hyperplasia is one of the most common benign diseases causing urinary disturbances in middle-aged and elderly men. The main manifestations are histological hyperplasia of the interstitial and glandular components of the prostate, anatomical enlargement of the prostate, clinical symptoms mainly in the lower urinary tract, and urodynamic obstruction of the bladder outlet. two important conditions must be present for BPH to occur: aging and a functioning testicle.
Second, epidemiology.
Histologically the incidence of BPH increases with age, usually occurring initially after the age of 40 years, to >50% by the age of 60 years and up to 83% by the age of 80 years. Similar to the histologic presentation, symptoms such as dyspareunia increase with age. Approximately 50% of men with a histologic diagnosis of BPH have moderate to severe lower urinary tract symptoms.
Third, pathophysiological changes.
Prostatic hyperplasia causes lengthening of the posterior urethra, distortion by pressure, narrowing and increased urethral resistance, causing bladder hypertension and associated voiding phase symptoms. With the increase of bladder pressure, compensatory hypertrophy of the bladder forced urinary muscle, instability of forced urinary muscle and related symptoms of urinary storage period appear. If the obstruction is not relieved for a long time, the forceps muscle loses its compensatory capacity. The main causes of upper urinary tract changes secondary to BPH, such as hydronephrosis and impaired renal function, are urinary retention due to bladder hypertension and ureteral reflux.
Fourth, the clinical progressiveness of BPH.
BPH is a slowly progressive benign prostate disease, the symptoms of which progressively worsen with the age of the patient, and the corresponding complications. clinical progression of BPH includes: worsening of lower urinary tract symptoms leading to a decrease in the patient’s quality of life, progressive decrease in the maximum urinary flow rate, acute urinary retention, recurrent hematuria, recurrent urinary tract infections, and renal impairment, etc. BPH patients undergo surgical Treatment is the ultimate manifestation of disease progression.
Evaluation indicators of clinical progressiveness of BPH.
1, aggravation of lower urinary tract symptoms is mainly evaluated by the method of I-PSS score.
2, Progressive decrease in maximum urinary flow rate.
3, The occurrence of BPH-related complications, of which acute urinary retention and renal function impairment are the main indicators.
4. Increased risk of surgical treatment and increased probability of surgery.
V. Surgical treatment.
1, the purpose of surgical treatment.
BPH is a progressive disease, and some patients eventually need surgical treatment to relieve the lower urinary tract symptoms and their impact on the quality of life and complications.
2, surgical treatment indications.
Patients with severe BPH or those whose lower urinary tract symptoms have significantly affected their quality of life may opt for surgical treatment, especially for those who do not have good results with medication or refuse to receive medication.
Surgical treatment is recommended when BPH leads to the following complications.
(1) Recurrent urinary retention with inability to urinate after at least one extubation or two urinary retention.
(2) Recurrent hematuria and ineffective treatment with 5α-reductase inhibitors.
(3) Recurrent urinary tract infections.
(4) Bladder stones.
(5) Secondary upper urinary tract hydrocele with or without renal impairment.
Patients with BPH combined with large bladder diverticula, inguinal hernia, severe hemorrhoids or prolapse, who are clinically judged to be difficult to achieve therapeutic effect without relieving lower urinary tract obstruction, should consider surgical treatment.