The prostate tissue is located in the front of the exit of the bladder, such as guards guarding the bladder mouth, so called the prostate, is a unique male organ, its size and shape like a chestnut, its bottom horizontal diameter 4 cm, longitudinal diameter 3 cm, front and back diameter 2 cm. The weight of a normal adult is about 20 grams.
The prostate gland is located at the bottom of the pelvis, above it is the bladder, below it is the urethra, in front of it is the pubic bone, behind it is the rectum, the doctor can touch the prostate gland during rectal examination, the reason for it is here. The prostate gland is held in place by many ligaments and fascia, thus determining its hidden location. The prostate is located below the neck of the bladder, wrapped around the bladder opening and the urethra, and this part of the urethra is therefore called the “urethral prostate”, which means that the tube formed in the middle of the prostate forms the upper part of the urethra. The actual fact that the prostate gland is in control of the urethra is the reason why the prostate gland is first affected by urination.
The prostate is divided into five lobes, called the anterior lobe, the middle lobe, the posterior lobe and both lobes, of which the anterior lobe is very small, located between the left and right lobes and the urethra, clinically unimportant. The posterior lobe is located behind the middle lobe and both lobes, and this lobe is felt during rectal examination. There is a physiological central sulcus in the middle of it, and during rectal examination, it is often determined whether the prostate is enlarged based on whether this central sulcus becomes shallow or disappears. The main parts of the prostate that often produce hyperplasia are the middle lobe and the two lateral lobes.
The prostate is a male-specific organ and is the largest accessory gland in the male reproductive organs.
The pain and swelling in the abdomen, perineum, perianal area, testicles, epididymis, lumbosacral area, groin, suprapubic area, penis, inner thighs, frequent urination, urgent urination, hematuria, difficulty urinating, incomplete urination, waiting for urination, thinning and bifurcation of the urine stream, or even inability to urinate, causing urinary retention, pyelonephritis, renal failure. Weakness of the whole body, back pain, decreased physical strength, insomnia, sleeplessness, loss of energy, and extreme fatigue; reduced sexual function, impotence, premature ejaculation, painful ejaculation, and hematemesis.
Prostate hyperplasia is a common disease in elderly men, the age of onset is mostly after 50 years old, and its incidence is increasing with age. The pathological changes are mainly in the prostate tissue and epithelial hyperplasia, so called prostate hyperplasia. The average life expectancy of our people has reached 70 years, and prostate hyperplasia has become a common disease in urology, due to the obstruction caused by it in the urinary tract, affecting urination, directly threatening kidney function, bringing serious harm to the life and health of patients, so this disease is one of the important issues in geriatrics.
This is the first time that a person has a prostate enlargement, and it is the first time that a person has a prostate enlargement, and it is the first time that a person has a prostate enlargement, and it is the first time that a person has a prostate enlargement, and it is the first time that a person has a prostate enlargement. The prostate hyperplasia accounts for about 8-11% of urological inpatients and is second only to urinary stones in terms of incidence. it is rare for people to develop it before the age of 50, but it develops earlier in white and black people, i.e. after the age of 40.
Prostate enlargement is closely related to the imbalance of androgens and estrogens in the body. Testosterone, the main male androgen, is changed to dihydrotestosterone by the enzyme 5α reductase. 5α dihydrotestosterone is an active hormone produced by the prostate stimulated by androgens. It binds to receptors in prostate cells to form a complex and is transferred to the nucleus where it interacts with chromatin to produce differentiation and growth effects on cells. Recently, numerous studies have shown that estrogen also has an effect on prostate hyperplasia. In liver blood and prostate tissue, androgens can be converted to estrogens. Estrogen reduces the production of androgens by inhibiting the release of pituitary luteinizing hormone, while estradiol increases the uptake and conversion of dihydrotestosterone by the tissues. Estrogens also increase the binding of androgens to receptors. In recent years, an association between prostate enlargement and cholesterol has been proposed and needs to be further explored.
The prostate gland is composed of glands and smooth muscle. The glands are divided into two groups, the outer group called the prostate group, which constitutes the main body of the gland, and the inner group called the urethral gland group, which is distributed in the mucosa and submucosa of the urethra. The initial site of prostate hyperplasia is mostly thought to form nodules in the urethral gland group, which has both fibrous and smooth muscle tissue as well as glandular tissue, with different proportions of the three. The growth of the hyperplastic nodule causes the real prostate tissue around it to be compressed and pushed to the periphery to form what is called a surgical envelope. This envelope has clear boundaries between the hyperplastic prostate tissue and provides a favorable condition for surgical removal of the hyperplastic prostate.
Prostatic hyperplasia often occurs in both lobes and in the middle lobe, rarely in the anterior lobe and never in the posterior lobe. The enlarged portion, especially in the middle lobe and both sides, can protrude into the bladder, elevating the bladder outlet above the level of the bladder base, and this activation can cause bladder dysuria. The prostate and bladder neck are rich in alpha-adrenergic receptors. Prostate enlargement mainly causes mechanical obstruction of the urethra, but the symptoms of urinary obstruction are aggravated when alpha-adrenergic receptors are excited. The main danger of prostate enlargement is urethral obstruction, but the degree of obstruction is not necessarily proportional to the size of the prostate enlargement, but depends mainly on the degree of urethral compression by the enlarged prostate. In the early stages of obstruction the bladder has compensatory function and does not show residual urine. In the late stage, due to compensatory bladder failure, the bladder residual urine becomes more and more, which causes the ureteral dilatation and hydronephrosis due to the increase of intra-vesical pressure, which impairs the kidney function, and in serious cases, chronic renal failure can occur.
According to the literature and clinical summary, generally divided into three stages of prostatic hyperplasia.
The first stage: also known as the symptomatic stimulation stage, mainly has symptoms such as frequent nocturnal urination, posterior urethral perineal discomfort, prolonged urination time and thin urine line, etc. In this stage, the residual urine volume is less than 50 ml, and the uroflowmetry may show a normal curve.
The second stage: also known as residual urine occurrence stage, the above symptoms are aggravated, along with the need to forcefully bulge during urination, the residual urine volume is between 50 and 150 ml, and accompanied by the feeling of residual urine, sudden acute urinary retention or infection may occur, and the uroflowmeter shows a multi-waveform curve.
Stage 3: Also called loss of compensatory stage or bladder dilatation and urinary closure stage, the residual urine volume is greater than 150 ml, and there is urinary retention or overflow incontinence, renal insufficiency, etc., and the uroflowmeter shows a low flat curve.
In the treatment of the first stage, conservative treatment is mostly used; in the second stage, conservative treatment can be tried, and if the treatment is ineffective, surgery should be performed as early as possible; in the third stage, surgery should be preferred to release the obstruction and protect the kidney function.
Examination methods
(a) Rectal examination: rectal examination is an important means of diagnosing prostatic hyperplasia, which can be felt as an enlarged prostate with a clear and medium hard surface. The first degree of hyperplasia is an enlarged gland with a shallow central sulcus, the second degree of hyperplasia is a significantly enlarged gland with a disappearing or slightly protruding central sulcus, and the third degree of hyperplasia is a significantly enlarged gland with a significantly protruding central sulcus, and even the upper edge of the gland cannot be touched by the fingers. The presence of hyperplasia cannot be denied when the prostate is not large on rectal examination. If the prostate is enlarged or the enlarged gland protrudes into the bladder, the enlarged gland may not be palpable by finger palpation and other methods of examination are needed to confirm the diagnosis.
（The actual cystoscopy can directly observe the enlargement of each lobe of the prostate gland, and can find out if there are other lesions in the bladder, such as tumors, stones, diverticula, etc., so as to decide on the surgical treatment. Because of the obstruction of the posterior urethra due to prostatic hyperplasia, the cystoscope is sometimes not easy to insert, so sometimes the pain is heavier.
(iii) Lateral determination of residual urine: The amount of residual urine in the bladder reflects the severity of compensatory bladder failure, thus this is one of the important diagnostic steps and one of the factors that determine surgical treatment. Measurement methods are ① B-type ultrasound measurement method: this method is simple, easy to perform, non-invasive, but not accurate enough; ② catheterization method after urination: immediately after urination and all the urine exported that is the amount of residual urine, normal people should have 0-10ml of residual urine, this method is more accurate and reliable, but there is a chance of retrograde infection; ③ cystography method: intravenous urography, in the bladder area after urination to take a standing film, observe the bladder contained in the The amount of contrast agent contained in the bladder is the residual urine. The accuracy of this method is worse.
(D) Cystography: In cases where cystoscopy cannot be performed, cystography can be performed to observe the presence of bladder stones, tumors, diverticula and ureteral reflux in addition to filling defects in the bladder neck.
(E) B-type ultrasonography: the size of the prostate can be determined, including the transverse diameter, anterior and posterior diameter and upper and lower diameter, the normal transverse diameter of the prostate is 4 cm, the anterior and posterior diameter is about 2 cm, the morphology is oval-shaped, symmetrical. The prostate enlarges significantly, and the anterior and posterior diameters increase more significantly than the transverse diameter.
(f) Urodynamic examination: When prostatic hyperplasia causes lower urinary tract obstruction, the maximum urinary flow rate decreases (<10 ml/sec), and the intravesical pressure increases >9.3 kpa (70 mmhg) during voiding.
(vii) Radioisotope nephrogram: it can understand the secretory function of both kidneys and the drainage of renal pelvis and ureter.
(H) Other tests: there are renal function tests and urine culture, etc. If surgery is required, heart, lung and liver function tests should be performed.
Clinically, the common methods used to describe the size of the gland when the prostate is enlarged are
Normal size: The prostate gland resembles the size of a chestnut.
Degree I hyperplasia: prostate enlarges like an egg.
The prostate gland is enlarged like a duck egg.
The size of the prostate gland is the size of an egg. The prostate gland is enlarged like a goose egg. It is important to note that the size of the prostate estimated by rectal examination is not necessarily its actual size, for example, if the middle lobe is enlarged and the gland protrudes into the bladder, the enlarged prostate is not obvious during rectal examination. If the prostate gland is found to have increased hardness, uneven surface and suspicious hard nodes during rectal examination, it should be recommended that the hospital check the blood PSA and perform needle aspiration cytology to rule out prostate cancer, and also check the contraction function of the anal sphincter to differentiate it from neurogenic bladder urethral dysfunction.