Benign prostatic hyperplasia
1.Overview
Cao Chenghua, Department of Urology, Shanghai Tongji Hospital
If a man is over 50, if the number of nighttime urination increases, frequent and urgent urination cannot be tolerated, the flow of urine is weak, wetting the underwear… Only men have a prostate gland, which weighs about 20 grams and is the size of a walnut, and is located below the bladder, wrapping around the proximal urethra that connects to the bladder.
This is a common condition in men over the age of 50 and is associated with an excess of an androgen called dihydrotestosterone.
Although it is not a major life-threatening condition, it can significantly affect the patient’s physical activity and ability to socialize, thus seriously affecting his quality of life.
Age-related prostate size
Benign prostatic hyperplasia is not an infectious disease
There is no evidence of a genetic link.
The effect of food on the disease is also inconclusive
BPH affects approximately 50% of men over the age of 50
80% to 100% of men over the age of 80 have BPH
In China, between 1921 and 1935 (Peking Union Medical College Hospital), BPH accounted for only 6.6% of men over the age of 41, however, the incidence has increased dramatically over the decades.
According to a 1993 statistic from Shanghai, about 45.6% of men over the age of 50 had an enlarged prostate.
Benign prostatic hyperplasia is one of the most common diseases in urology
Benign prostatic hyperplasia is not cancer and will not turn into cancer. Benign prostatic hyperplasia grows slowly and does not spread to other parts of the body (inflammation of the prostate, which can be acute or chronic. The main symptoms include pain during urination, increased frequency of urination, etc. The acute stage can cause fever.
Prostate cancer has no special symptoms in the early stage, but when the cancer enlarges, it will squeeze the urethra and cause difficulty in urination.)
2.Benign prostatic hyperplasia symptoms
Beginning.
Frequent urination, increased frequency of urination
Frequent nocturnal urination
Urinary urgency, unable to hold urine
Incomplete urination (feeling of incomplete urination)
Delay in starting to urinate
Intermittent urination, weak urine flow
Painful urination
Urinary incontinence
May be followed by
Acute urinary retention
Urinary tract infection
Bladder stones
hydronephrosis
Renal failure
3. The doctor may recommend the following tests:
Rectal examination to determine the presence of prostate enlargement
Serum prostate-specific antigen (PSA) is a new diagnostic tool for the evaluation and management of BPH and is also an indicator for the diagnosis of prostate cancer.
Transabdominal or transrectal ultrasound of the prostate can determine the size of the prostate.
4. The overall score range is 0-35 (asymptomatic – very severe symptoms) – see table International Prostate Symptom Score (IPSS)
Total IPSS score =
Total IPSS score is obtained by adding up the scores of the answers to the selected 7 questions in the table, if the score is between
0 to 7 please show mild symptoms
8 to 19 for moderate symptoms
20 to 35 for severe symptoms
Any of the following symptoms in the past 1 month
No
Less than 1/5
Less than 1/2
About 1/2?
More than 1/2
Almost always
1.Feeling of incomplete urination
2.I need to urinate again within 2 hours
3.Multiple interruptions and starts when urinating
4.I can’t wait to urinate
5.Feeling of thinning of urine line
6.Feeling that it is hard to urinate
7.The number of times you get up to urinate at night while sleeping
Difficulty in urination caused by BPH can seriously interfere with daily life and affect the quality of life, for example.
Most people have to drink less water before going out
Don’t dare to drink water before going to bed
High frequency of nighttime urination interferes with sleep
Restricted access to places that lack public restrooms
Limited access to outdoor activities
According to the Olmsted survey, the risk of acute urinary retention increases significantly with age
According to the recommendations of the International Advisory Committee on Benign Prostatic Hyperplasia (1998), one of the following must be achieved in any treatment of this disease
improve symptoms
reduce obstruction
Prevention and treatment of distant comorbidities
5. Treatment.
Vigilant waiting
Surgical treatment
Interventional treatment
Medication
Benign prostatic hyperplasia can seriously affect the quality of life of older adults, but it is rarely life-threatening and a proportion of patients have symptoms that do not develop significantly. When a patient with BPH has no significant symptoms or has mild symptoms that do not affect quality of life, the doctor will recommend regular checkups and not give medication or surgery for the time being.
Surgical treatment
Open surgery
Transurethral resection of the prostate
Transurethral resection of the prostate
Possible side effects of surgery Bleeding, impotence, retrograde ejaculation Some patients may need to undergo surgery again
Other treatments.
Urethral stenting
Transurethral radiofrequency thermotherapy
Transurethral microwave thermotherapy
Transurethral needle ablation
Laser therapy
Drug therapy
According to a market survey conducted by ISIS in Beijing and Shanghai:
There are three main types of medications used to treat BPH:
1. 5a reductase inhibitors: Paulownia (finasteride), etc.
2. a-blockers
3., botanicals
Description.
Finasteride is a drug that targets the underlying cause of BPH, gradually shrinking the enlarged prostate and improving urinary symptoms.
Since BPH is a chronic progressive disease, the effect of finasteride in reducing the size of the prostate will only be apparent in about 3 months.
A blocker works by relaxing the urethra and improving urinary flow
a Blockers are effective in improving symptoms but not in reducing the size of the prostate.
Botanicals have been commonly used to treat prostatitis and BPH and can relieve symptoms. The mechanism of action of botanicals is not well understood
The above is only a general knowledge, the diagnosis and treatment of the disease still need to follow the medical advice of the specialist, each patient has individual differences, the treatment varies from person to person.