With the aging of society, there will be more and more patients with prostate hyperplasia, because prostate hyperplasia is almost unavoidable for normal elderly men, the difference is only the degree of hyperplasia and the accompanying symptoms. Today, Dr. Lin will demystify prostate hyperplasia for you: First of all, it must be clear that prostate hyperplasia (benign prostatic hyperplasia, BPH) and prostatitis are two concepts. Prostatitis occurs in young adults, while prostate hyperplasia only occurs in middle-aged and old age. Every man, from the age of 40, will begin to appear prostate hyperplasia, its growth rate and the degree of extrusion on the urethra, determines the appearance of clinical symptoms sooner or later, as long as the age is old enough, everyone will appear symptoms of prostate hyperplasia. Etiology: There have been many studies on the pathogenesis of prostate enlargement, but the cause of the disease has not yet been elucidated. It is known that prostate enlargement requires both a functioning testis and aging. Associated factors include: androgens and their interactions with estrogen, prostate mesenchymal-glandular epithelial cell interactions, growth factors, inflammatory factors, neurotransmitters and genetic factors. In recent years, the relationship of smoking, obesity and alcoholism, family history, ethnicity and geography to the occurrence of BPH has also been noted. Domestic scholars investigated 26 eunuchs of the Qing Dynasty, and found that 21 prostate has been completely inaccessible, or significantly atrophied. Therefore, androgen levels are positively correlated with prostate enlargement. Clinical manifestations: The earliest appearance of BPH is frequent urination at night, that is to say, when you are older than 40 years old and start to appear to get up more than 2 times a night to urinate, it is probably the initial symptom of prostate hyperplasia. Detailed symptoms are as follows: 1, storage period symptoms prostate enlargement early due to compensation, symptoms are not typical, with the lower urinary tract obstruction aggravation, the symptoms are gradually obvious, clinical symptoms include storage period symptoms, urinary symptoms and urinary symptoms. Due to the slow progression of the disease, it is difficult to determine the time of onset. (1) Frequent urination, increased nocturia Frequent urination is an early symptom, starting with increased frequency of nocturia, but the amount of urine each time is not much. Chronic urinary retention occurs after the loss of compensation of the bladder’s detrusor muscle, which reduces the effective capacity of the bladder and shortens the time between urination. If accompanied by bladder stones or infections, the frequency of urination becomes more obvious, and accompanied by urinary pain. (2) Urgency, incontinence, lower urinary tract obstruction, 50% to 80% of patients with urinary urgency or urge incontinence. 2, urination stage symptoms of urinary difficulty: with the enlargement of the gland, the mechanical obstruction is aggravated, and the difficulty of urination is aggravated, and the degree of lower urinary tract obstruction is not proportional to the size of the gland. Due to the increase of urethral resistance, patients with delayed onset of urination, prolonged urination time, not far range, thin and weak urine line. The urine is divided and there is a feeling of incomplete urination. If the obstruction is further aggravated, the patient must increase abdominal pressure to help urinate. Breathing makes the abdominal pressure increase and decrease, there is an interruption of urine flow and dribbling. 3, after urination symptoms of incomplete urination, increased residual urine: residual urine is the result of bladder forced urinary muscle loss of compensation. When the amount of residual urine is very large, the bladder is overstuffed and the pressure is very high, higher than the urethral resistance, the urine will overflow from the urethra on its own, called overflow incontinence. Some patients usually do not have much residual urine, but in the cold, drinking, holding urine, taking drugs or other causes of sympathetic excitation, acute urinary retention can suddenly occur. The patient’s symptoms of urinary retention can come and go. Some patients may have acute urinary retention as the first symptom. 4, other symptoms (1) hematuria prostate mucosa capillary congestion and small blood vessels dilated and by the enlarged gland pull or friction with the bladder, when the bladder contraction can be caused by microscopic or naked eye hematuria, is one of the common causes of hematuria in elderly men. Cystoscopy, metal catheter catheterization, acute urinary retention catheterization when the bladder suddenly decompression, are prone to cause severe hematuria. (2) Urinary tract infection urinary retention often leads to urinary tract infection, which can present with symptoms such as urinary urgency, urinary frequency, difficulty in urination, and accompanied by urinary pain. When secondary to the upper urinary tract infection, there will be fever, back pain and systemic toxic symptoms. Normally, although patients do not have symptoms of urinary tract infection, but there can be more white blood cells in the urine, or urine culture with bacterial growth, which should be treated before surgery. (3) Bladder stones lower urinary tract obstruction, especially in the presence of residual urine, urine in the bladder to stay longer, can gradually form stones. When accompanied by bladder stones, there may be interruption of the urinary line, pain at the end of urination, and change of position before urination and other manifestations. (4) Renal function damage is mostly due to ureteric reflux, hydronephrosis leading to destruction of renal function, and the complaints of the patients at the time of consultation are often loss of appetite, anemia, elevated blood pressure, or lethargy and slowness of consciousness. Therefore, for male elderly with unexplained symptoms of renal insufficiency, prostate hyperplasia should be excluded first. (5) Prolonged lower urinary tract obstruction may present as a lower abdominal mass due to bladder diverticulum filling or an upper abdominal mass due to hydronephrosis. Prolonged reliance on increased abdominal pressure to assist urination can lead to hernia, hemorrhoids, and prolapse. Diagnosis and treatment of the content involved is more specialized, will not repeat, the key to diagnosis is to identify with prostate cancer, treatment principle, early prostate hyperplasia, you can wait for observation, oral medication, to improve the symptoms as well as to control the progression of the disease, when the disease is further progressed, you can consider surgical treatment, and the gold standard of the current prostate hyperplasia surgery is the transurethral resection of the prostate (TURP), the operation is performed through the urethra, minimally invasive and incision-free (incisionless), the operation is performed via the urethra. It is performed minimally invasively and without incisions (as shown above). Surgical treatment is recommended when BPH leads to the following complications: 1, recurrent urinary retention (inability to urinate after at least one extubation or two retentions) 2, recurrent hematuria, ineffective treatment with 5 alpha reductase inhibitors 3, recurrent urinary tract infections 4, bladder stones 5, secondary upper urinary tract hydrops (with or without renal impairment) Patients with BPH have combined with a large diverticulum of the bladder, inguinal hernia, severe hemorrhoids or prolapse Surgical treatment should be considered if the clinical judgment is that it is difficult to achieve therapeutic results without relieving lower urinary tract obstruction. Measurement of residual urine volume has a certain reference value for the degree of lower urinary tract obstruction caused by BPH, but it is currently considered impossible to determine the upper limit of residual urine volume that can be used as a guideline for surgery. However, surgical treatment should be considered in patients with BPH who have a significant increase in residual urine to the point of overflow incontinence.