Benign prostatic hyperplasia is referred to as prostatic hyperplasia. It is a common disease in older men. The cause is unknown and may be related to hormone levels. The hyperplastic glands mostly originate in the migratory zone of the prostate (lateral lobe hyperplasia) and the periurethral zone (middle lobe hyperplasia). The disease belongs to the category of Chinese medicine essence retention.
I. Diagnosis
1. Clinical manifestations: The typical manifestations are delayed urination, intermittent urination, thin and weak urine stream, short range, terminal dripping, and prolonged urination time. If the obstruction is serious, there is often a sense of incomplete urination at the end of urination, and even urinary retention.
2, rectal finger retrieval: the enlarged prostate can be palpated, the surface is smooth, tough, elastic, the edge is clear, the central groove becomes shallow or disappears.
3. Auxiliary examinations: ultrasound, PSA, urodynamics, IVU and cystoscopy should be performed if there is hematuria to exclude urological tumors.
II. Differential diagnosis
1.Bladder neck contracture
2.Prostate cancer
3.Urethral stricture
4.Neurogenic bladder dysfunction
Treatment
1. Wait and see: If the long-term symptoms of prostatic hyperplasia are mild and do not affect life and sleep, there is generally no need for treatment and can wait and see.
2, drug treatment: a a receptor blocker, such as terazosin. b 5-a reductase inhibitors, such as finasteride.
3, Chinese medicine treatment (diagnosis and treatment).
A Damp-heat infusion evidence: treatment method Clear heat and dampness, formula with Bazheng San plus or minus.
B. Spleen and kidney Qi deficiency: tonifying the spleen and benefiting Qi, warming the kidney and promoting diuresis. The formula is based on the formula of tonifying Zhong Yi Qi Tang with Cuscuta sinensis, Cistanches, Boneset and Psyllium.
C. Qi stagnation and blood stasis: treatment: Promote Qi and blood circulation, promote diuresis. The formula is based on Shen Xiang San with addition and reduction.
D Deficiency of kidney yin: treatment: tonify kidney yin, promote diuresis. The formula is based on Zhi Bai Wan plus Dan Shen, Amber, Wang Bu Liu Xing, Di Long, etc.
E Deficiency of kidney yang: treatment Wet tonify kidney yang, promote diuresis. The formula is Jisheng Kidney Qi Pill.
4.Surgical treatment
Indications: Recurrent urinary retention. Repeated hematuria, 5-a reductase inhibitor treatment is ineffective. Repeated urinary tract infection. Combined with bladder stone, inguinal hernia. Secondary upper urinary tract hydrocele (with or without renal impairment).
Contraindications: severe cardiopulmonary insufficiency
Pre-operative preparation: for chronic urinary retention resulting in renal insufficiency, bladder urine needs to be drained to improve renal function. For those with urinary tract infection, drugs should be used to control the inflammation. Before surgery, systemic examination should be performed, paying special attention to cardiovascular and pulmonary conditions; poor cardiopulmonary function requires medical management and surgery after improvement. Pay attention to the clotting time. Pre-operative blood preparation.
5.Surgical procedure: transurethral electrodesiccation of prostate, transcystic prostate removal
6. Postoperative anti-infection, hemostasis, nutritional support therapy, continuous rapid bladder irrigation, and keeping each catheter open.
7. Discharge medical advice: avoid excessive activity for three months. Avoid hot water sitz bath. Keep the bowel movement smooth.