The first is that if you are a male patient over 45 years of age, you should first consider prostate hyperplasia. This is the first time that the prostate gland has increased in size, which produces a certain amount of pressure on the urethra, which is a resistance in the urethra, and the bladder needs to use more force to overcome the resistance in the urethra when urinating, which makes the effective pressure of urination drop, and therefore makes it hard to urinate. At the same time, accompanied by frequent urination, urinary urgency, bifurcation of urination, increased nocturia and other phenomena, it is recommended that the urological system ultrasound to confirm the diagnosis. Second, urethral stones, when the stones are discharged into the urethra and not discharged out of the body and obstructed in the urethra, there may be difficulty in urination, accompanied by hematuria and pain in the urethra. Urethral stones are highly suspected in patients with a history of stone obstruction. It is recommended to perform urethroscopy or pelvic radiography to find out if there are urethral stones. Thirdly, tumor of the urethra or tumor of the bladder neck. When a tumor occurs, it can block the urethra and cause symptoms such as difficulty in urination. At the same time, it may be accompanied by blood in the urine and pain in the urethra. For elderly patients, such as those over 60 years of age, who have painless hematuria with straining to urinate, it is important to consider whether there are tumors of the urethra and tumors of the bladder neck that block the bladder neck opening and cause straining to urinate.