A. First of all, what is the role of the prostate in the human body? The prostate gland is an unpaired substantial organ, consisting of glandular and muscular tissues. The prostate gland has a transverse diameter of about 4cm, a vertical diameter of about 3cm, and an anterior and posterior diameter of about 2cm. the surface is covered with a fascial sheath called the prostate capsule. The prostate gland has a prostate vein plexus between the capsule and the prostate gland. The secretions of the prostate gland are the main component of semen. The prostate gland is a slightly flattened chestnut shape, with a wide upper end called the base of the prostate, adjacent to the bladder neck. The lower end, which is pointed and thin, is located on the urogenital septum and is called the tip of the prostate. The part between the base and the tip is called the body of the prostate. The back of the body is flat and has a longitudinal shallow groove on the median line called the prostatic groove. The male urethra penetrates the prostate near the anterior edge of the base of the gland, through the anterior part of the glandular parenchyma, and out by the prostatic apices. Near the posterior edge of the base, a pair of ejaculatory ducts penetrate the prostate and open on the seminal caruncle in the posterior wall of the prostatic part of the urethra. The excretory ducts of the prostate gland open into the posterior wall of the urethral prostate. The prostate is generally divided into five lobes: the anterior lobe, middle lobe, posterior lobe, and both lobes. The middle lobe is wedge-shaped and is located between the urethra and the ejaculatory duct. after the age of 40, the middle lobe becomes enlarged and bulges upwards against the bladder, causing a significant bulge in the bladder pouch and pressure on the urethra causing difficulty in urination. The prostate gland is located between the bladder and the original genital diaphragm. The base of the prostate gland is adjacent to the bladder neck, the seminal vesicle gland and the vas deferens. The pubic symphysis is anteriorly and the rectocele is posteriorly. The back of the prostate can be palpated during rectal palpation to diagnose whether the prostate is enlarged, and upward to the vas deferens and the seminal vesicle gland. In children, the prostate gland is very small and grows rapidly during sexual maturity. In old age, the prostate gland degenerates and atrophies. If the connective tissue in the gland is enlarged, the prostate gland becomes enlarged. The surface has a peritoneal layer. The prostate gland is composed of 30 to 50 complex vesicular glands, with 15 to 30 ducts opening on either side of the urethral seminal caruncle, which can be divided into mucosal glands, submucosal glands and main glands according to the distribution of the glands. Structural features: (1) the epithelium of the vesicle is unilamellar cuboidal, unilamellar columnar or pseudo-complex columnar, (2) variable morphology, irregular lumen of the gland (3) more interstitial, in addition to connective tissue, rich in elastic fibers and smooth muscle. (4) coagulum is common in the lumen of the glandular vesicles, and the secretions of the epithelial cells are concentrated. The prostate is located between the bladder neck and the urogenital diaphragm. The upper part of the prostate is wide, adjacent to the bladder neck, the front part of which is penetrated by the urethra, the rear part of which is penetrated by the left and right ejaculatory ducts downward; the lower end is pointed as the prostate tip, downward in contact with the urogenital diaphragm, both sides of which are bypassed by the prostatic levator muscle, and the urethra is penetrated from the tip. Between the tip and the bottom is the prostatic body, you have the anterior, posterior and lateral sides. The anterior side has the pubic prostatic ligament that connects the prostatic sheath to the pelvic surface of the pubic bone. The posterior side is flat and has a longitudinal shallow groove in the middle, called the prostatic groove, which is adjacent to the rectal bladder septum and the rectal jugular by means of the rectum. The prostate gland can be found in the size, shape, hardness and prostatic groove during rectal examination. The prostate is usually divided into five lobes: the anterior lobe, middle lobe, posterior lobe, and left and right lobes. The anterior lobe is very small, located in front of the urethra, and is of no clinical importance. The middle lobe is wedge-shaped, also known as the prostatic isthmus, and is located posterior to the urethra, between the anterior posterior lobe and the left and right lobes, just above the opening where the ejaculatory duct enters the urethra. In older adults, the middle lobe is often hypertrophic, and as it progresses upward, the mucosa behind the inner urethra bulges, easily causing difficulty in urination. The posterior lobe, located behind the ejaculatory duct, middle lobe and left and right lobes, is rarely hypertrophic, but is a good site for cancer. The left and right lobes are close to the lateral wall of the urethra and are located in front of the lateral part of the posterior lobe. The hypertrophy of the left and right lobes can also compress the urethra from both sides, which can easily cause difficulty in urination. The surface of the prostate parenchyma is wrapped with a thin and tough lamina propria, and there are branches of venous plexus, arteries and nerves between the prostate sheath, and the venous plexus receives the deep dorsal penile vein, and there are traffic branches that anastomose with the vesical plexus and converge with the internal iliac vein or its branches via the inferior vesical vein. Second, we often hear about prostatitis, so what is the relationship between prostatitis and prostate enlargement? The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you can find a lot of people who are not able to get a good deal on this. Long-term urinary tract obstruction can be complicated by urinary tract infection, bladder stones or even hernia, hemorrhoids, prolapse due to increased abdominal pressure, etc. V. What age group does it occur in? Prostatic hyperplasia is a common disease of the elderly. The natural history of prostatic hyperplasia can be divided into two periods, namely the pathological and clinical periods. The pathological phase is further divided into microscopic and naked eye prostatic hyperplasia. Almost all men have the possibility of developing microscopic prostatic hyperplasia (40% at the age of 50 and nearly 90% at the age of 80), of which 1/2 will develop into the visible prostatic hyperplasia: of the visible prostatic hyperplasia, about 1/2 will become the clinical stage prostatic hyperplasia. With the development of society, the people’s living standards continue to improve, medical conditions continue to improve, the aging of our population is becoming more serious, the elderly population is increasing, so the incidence of prostatic hyperplasia will also continue to increase. What are the symptoms of prostate hyperplasia? 1, frequent urination: the increase in nocturnal urination is the main initial symptom. In the early stage, it is caused by prostate congestion, and the frequency of urination increases when the obstruction increases and the residual urine increases. 2, difficult urination: progressive, is the main symptom, delayed start of urination, prolonged urination time, short range, thin and weak urine line, sometimes there are symptoms of interrupted urine flow and dripping. 3.Urinary retention: It occurs when the bladder function loses compensation and can be accompanied by overflow incontinence. 4.Hematuria: caused by capillary congestion, dilation or pulling on the mucosa of the prostate. 5.Urinary tract infection: When obstruction can be complicated by urinary tract infection. 6, bladder stones: more than 10% of complications of bladder stones. 7, renal function damage: already mentioned. 7. What are the causes of prostatic hyperplasia? The pathogenesis of prostatic hyperplasia has not yet been elucidated. There are many theories on the cause of prostate hyperplasia, the most recognized of which is the theory of imbalance in sex hormone balance. This is based on the fact that there are two necessary conditions for the occurrence of prostatic hyperplasia, one being that it is only seen in older men and the other being that there must be a functional testis. The first is that the prostatic hyperplasia will not occur when the testes are de-tested in youth. The actual fact is that you can find a lot of people who are not able to get a good deal on this. 1, the initial general use of drug therapy (1) a-adrenergic receptor antagonists: the first generation of non-selective a-blockers, such as dextran amine. Second generation selective long-acting a1-blockers, such as terazosin hydrochloride, doxazosin. Third-generation super-selective a1A-blockers. (2) Anti-androgens: estrogens (ethylene estradiol). Synthetic anti-androgens: 5-a-reductase inhibitors (Paulownia). 2, non-surgical interventions: (1) prostate thermotherapy including intracavitary microwave therapy, intracavitary radiofrequency therapy, transurethral needle ablation therapy, etc.. However, the exact efficacy needs to be further verified clinically. (2) Laser therapy: is the treatment of prostatic hyperplasia in recent years, divided into gas laser, solid laser, dye laser and semiconductor laser these means have less trauma, less painful point, the disadvantage is that the operation takes a long time, the cost is higher. 3, Surgery: Surgery is still the main treatment for prostate hyperplasia. Surgery should be considered if the patient has the following conditions: (1) symptoms seriously affect work and life, drug and non-surgical treatment is ineffective. (2) Recurrent urinary retention or hematuria in the naked eye. (3) The presence of secondary bladder stones. (4) Chronic urinary retention, upper urinary tract fluid accumulation and renal function damage. Open surgery: the most thorough treatment and the best efficacy, but it is a big blow to the patient, more painful, more complications and longer hospital stay for the patient. Transurethral vaporization prostatectomy: a new method that has emerged in recent years, which combines the advantages of electrodesection and laser in one. The previous transurethral resection of the prostate, the electric knife used is monopolar, there is no autologous reflux, saline cannot be used as a medium, the patient is at risk of closed nerve reflex and water toxicity, hyponatremia. The bipolar plasmonotomy knife we currently use is bipolar, has autologous reflux, does not conduct electricity, and can use saline as a medium, and saline is isotonic, so water toxicity and hyponatremia will not occur, and closed-hole reflexes are not likely to occur. In addition, the bipolar plasma electrosurgery knife can automatically identify the prostate body and its peritoneum, so the damage is small, the removal of the gland is more complete, the patient recovers quickly, there is no bladder spasm after surgery, less bleeding, safe, less complications, less patient pain and shorter hospital stay.