Benign prostatic hyperplasia

　　Benign prostatic hyperplasia is one of the common diseases in elderly men, and its incidence is increasing with the aging of the global population. The incidence of benign prostatic hyperplasia increases with age, but not all cases with hyperplastic lesions have clinical symptoms. Urban areas have higher incidence than rural areas, and ethnicity also affects the degree of hyperplasia. There have been many studies on the pathogenesis of benign prostatic hyperplasia, but the cause has not yet been elucidated. Currently, it is known that benign prostatic hyperplasia must have the presence of testicles and increased age as two conditions. In recent years, attention has also been paid to the relationship between smoking, obesity, alcoholism, sexual function, family history, ethnicity, and geographical environment in the occurrence of BPH. Below is a specific introduction to the possible causes of benign prostatic hyperplasia.

　　1. Neglecting diet

　　People who like spicy food, greasy food, smoking, and drinking are more prone to benign prostatic hyperplasia because spicy foods and alcohol can stimulate the prostate and urethra, causing discomfort or vascular dilation that leads to congestion and edema of the prostate, thereby reducing the resistance of the prostate. There is also research showing that obesity caused by excessive nutrition is related to benign prostatic hyperplasia, and the consumption of rich foods such as fats, meats, and dairy products can increase the chance of developing benign prostatic hyperplasia. Therefore, it is recommended to eat more fruits and vegetables in daily diet. Additionally, vitamin D can be supplemented to reduce the chance of developing benign prostatic hyperplasia.

　　2. Lack of hormones

　　In general, testicles produce both male and female hormones, but male hormones are more abundant while female hormones are less so. A certain proportion between the two is considered normal, while benign prostatic hyperplasia occurs due to the gradual atrophy of the testicles, a decrease in estrogen secretion, and the resulting increased sensitivity of the prostate to estrogen.

　　3. Unrestrained sexual activity

　　Excessive sexual activity can lead to congestion of the sexual organs, and the prostate may also enlarge due to persistent congestion. Prolonged and excessive congestion can increase the risk of benign prostatic hyperplasia. Moreover, unclean sexual activity can cause infections of the sexual organs, thereby reducing resistance. In addition, attention should be paid to the cleanliness of the prostate area, as the scrotum and prepuce are prone to accumulating dirt and bacteria, which may take advantage of this to enter and lead to prostate diseases.

　　4, Lack of good defecation habits

　　Some people have the habit of holding in urine, which is a very bad habit. Frequent holding in urine will cause the toxins in urine to deposit, which will directly harm the prostate and lead to related prostatic diseases. Since the prostate is close to the anal and rectal area, frequent holding in feces or constipation can lead to excessive feces in the rectum, which will compress the prostate, causing congestion, and will also increase the chance of benign prostatic hyperplasia.

　　5, Lack of exercise

　　People who sit for long periods of time and lack exercise are prone to arteriosclerosis, which will also cause local blood circulation obstruction in the prostate. Sitting for a long time will make a large part of the weight of the upper body press on the prostate, causing poor blood circulation, which is not conducive to the excretion of prostatic fluid and will increase the chance of benign prostatic hyperplasia. Both are related; more exercise reduces sitting time.

　　6, Other diseases induced

　　Incomplete cure of prostatitis can lead to benign prostatic hyperplasia, and urogonorrhea, seminal vesiculitis, and other reproductive system diseases can also cause benign prostatic hyperplasia due to excessive congestion.

　　7, Endocrine disorders

　　With the increase of age, the imbalance of sex hormone secretion, the accumulation of excessive androgen and cholesterol in the prostate is the main cause of benign prostatic hyperplasia. Therefore, if there is significant enlargement, symptoms, and it affects normal life, it is recommended to pay attention to adjusting endocrine balance to restore normal levels.

　　Benign prostatic hyperplasia is a common and frequent disease in elderly males in China. Many patients often seek standardized treatment only after very serious symptoms or complications occur. Unfortunately, more than 70% of severe patients lose the best surgical opportunity due to untimely treatment. Because benign prostatic hyperplasia is prone to complications of the following diseases, causing extremely serious consequences:

　　1, Infection

　　The urinary tract obstruction caused by benign prostatic hyperplasia is a prerequisite for infection, so it is easy to repeatedly occur in posterior urethra, bladder neck, and cystitis, and other urinary system inflammations.

　　2, Hematuria

　　This hematuria is often intermittent, can be microscopic hematuria, or gross hematuria, and most often appears after urination.

　　3, Bladder stones

　　Due to urinary tract obstruction, there is residual urine in the bladder, which is prone to secondary infection and the formation of bladder stones.

　　4, Acute urinary retention

　　The increased urinary tract obstruction caused by benign prostatic hyperplasia leads to the inability to urinate spontaneously.

　　5, Uremia

　　As the degree of obstruction gradually worsens, it is easy to develop renal积水 and renal insufficiency, leading to clinical symptoms of uremia. In addition, renal hypertension may also occur.

　　6, Hernia, hemorrhoids, and rectal prolapse

　　Due to the difficulty in urination, the long-term increase in abdominal pressure.

　　7, Patients with a history of hypertension

　　Due to the frequent need for forceful urination, it is easy to have cardiovascular and cerebrovascular accidents and heart failure. Some elderly people may suffer from myocardial infarction, stroke, or sudden death due to the effortful urination and increased abdominal pressure during urination.

　　8, Other

　　When there is long-term difficulty in urination due to benign prostatic hyperplasia, it is often accompanied by increased abdominal pressure, which may lead to the formation of vesical trabeculae, small chambers, and vesical diverticula. This can result in weak contraction of the bladder and urethral sphincter muscles, and even overflow incontinence.

　　The early stage of benign prostatic hyperplasia may not be typical due to compensation, but as the lower urinary tract obstruction worsens, symptoms gradually become more obvious. The following is a specific introduction to the common symptoms of benign prostatic hyperplasia.

　　1, Frequency of Urination

　　Frequency of urination is an early symptom, initially characterized by an increase in the number of nocturnal voidings, but with little urine each time. In cases of lower urinary tract obstruction, 50% to 80% of patients have urgency or urge incontinence. After the bladder detrusor muscle fails to compensate, chronic urinary retention occurs, reducing the effective bladder capacity, and shortening the interval between voidings. If accompanied by bladder stones or infection, urinary frequency becomes more pronounced, accompanied by pain.

　　2, Difficulty in Urination

　　The enlargement of the gland, the aggravation of mechanical obstruction, and the onset of symptoms of difficulty in urination are found. The degree of lower urinary tract obstruction is not proportional to the size of the gland. Due to the increased urethral resistance, the patient's onset of urination is delayed, the duration of urination is prolonged, the射程不远，the urinary line is thin and weak. Urinary incontinence occurs, and there is a feeling of incomplete urination. If the obstruction is further exacerbated, the patient must increase abdominal pressure to help urinate. Breathing causes changes in abdominal pressure, resulting in intermittent urinary flow and dribbling.

　　Residual urine is the result of bladder detrusor muscle compensation failure. When the amount of residual urine is very large, the bladder is overdistended and the pressure is very high, higher than the urethral resistance, urine automatically leaks out from the urethra, which is called overflow incontinence. After a night of deep sleep, the pelvic floor muscles relax, and urine is more likely to leak out spontaneously, resulting in nocturnal enuresis. Some patients have little residual urine during normal times, but they may suddenly develop acute urinary retention after catching a cold, drinking alcohol, holding urine, taking medicine, or for other reasons that cause sympathetic nervous system excitation. The symptoms of urinary retention in patients may vary from time to time.

　　3, Hematuria

　　The mucosal capillaries and small blood vessels of the prostate gland are congested and dilated, and are stretched or rubbed by the enlarged gland or with the bladder. When the bladder contracts, it can cause microscopic or gross hematuria, which is one of the common causes of hematuria in elderly males. Occasionally, there may be a large amount of hematuria. Bladder catheterization, metal catheterization, and acute urinary retention catheterization when the bladder is suddenly decompressed are all easy to cause severe hematuria.

　　4, Urinary Tract Infection

　　Lower urinary tract obstruction is caused by urinary retention leading to urinary tract infection, which can cause symptoms such as urgency, frequency, and difficulty in urination, accompanied by pain. When secondary upper urinary tract infection occurs, symptoms such as fever, back pain, and systemic toxic symptoms may appear. Although patients may not have symptoms of urinary tract infection, there may be a large number of leukocytes in the urine, or bacteria may grow in urine culture, and treatment should be given before surgery.

　　5, Bladder Stones

　　Lower urinary tract obstruction, especially when there is residual urine, can cause urine to stay in the bladder for a longer period of time, which can gradually form stones. The incidence of bladder stones can reach more than 10%. Symptoms such as urinary line interruption, pain at the end of urination, and the need to change position before urination may occur.

　　6, Renal Function Damage

　　Due to ureteral reflux, hydronephrosis can lead to renal function damage, and the patient's main complaints when seeking medical attention are loss of appetite, anemia, increased blood pressure, or drowsiness and delayed consciousness. Therefore, for male elderly patients with unknown causes of renal insufficiency symptoms, the first thing to consider is the exclusion of benign prostatic hyperplasia.

　　7, Other

　　Due to long-term lower urinary tract obstruction, lower abdominal masses caused by bladder diverticula distension or upper abdominal masses caused by hydronephrosis can occur. Long-term reliance on increasing abdominal pressure to help urination can lead to hernias, hemorrhoids, and rectal prolapse.

　　Age is one of the basic conditions for the onset of benign prostatic hyperplasia. 40 years old is an important turning point in human development. After the age of 40, various tissues and organs in humans begin to decline. For example, the intermediate component of the prostate tissue is relatively more active than the epithelial tissue. When benign prostatic hyperplasia occurs, the main manifestation is stromal hyperplasia. Although the etiology of benign prostatic hyperplasia has not been fully understood, the following measures still have certain value in alleviating the condition and delaying the onset of the disease.

　　1. Prevent colds. From the end of autumn to the beginning of spring, the weather changes frequently, and coldness often worsens the condition. Therefore, patients must pay attention to keeping warm and preventing colds and upper respiratory tract infections.

　　2. Reduce the intake of spicy and刺激性 food. It can lead to congestion of the sexual organs and exacerbate symptoms of hemorrhoids, constipation, and compress the prostate, making urinary difficulties worse.

　　3. Avoid holding urine. Holding urine can cause the bladder to become overly full, weaken the detrusor muscle tension, and make urination difficult, which is easy to trigger acute urinary retention. Therefore, it is important to urinate as soon as possible when the need arises.

　　4. Avoid overexertion. Overexertion can exhaust the middle qi, leading to weak urination and an increased risk of urinary retention.

　　5. Absolutely avoid alcohol consumption, as it can cause congestion and edema of the prostate and bladder neck, leading to urinary retention.

　　6. Treatment should be timely and thorough for prostatitis, cystitis, and urethral calculi.

　　7. Massaging the lower abdomen, pressing the Qihai acupoint and other points below the navel, is beneficial for the recovery of bladder function. A slight pressure massage after urination can promote bladder emptying and reduce residual fluid. It is worth reminding that this condition develops slowly and has a long course. If prevention can start from middle age, the effect is better. In addition to taking the above measures, it is also necessary to prevent excessive sexual activity, especially to be vigilant about the behavior of sexual interruption and masturbation. According to clinical observations, most patients can achieve good results as long as they can persist in implementing self-care measures and pay attention to timely treatment. Conversely, poor adherence results in unsatisfactory effects.

　　8. Avoid prolonged sitting. Prolonged sitting can exacerbate hemorrhoids and other diseases, and it is also easy to cause congestion in the perineum, leading to urinary difficulties. Regular participation in cultural and sports activities and qigong exercises can help alleviate symptoms.

　　9. Insufficient water intake not only causes dehydration but also hinders the flushing effect of urine on the urinary tract, and it is easy to lead to the formation of insoluble stones due to urine concentration. Therefore, in addition to reducing water intake appropriately at night to prevent the bladder from being overly full after sleep, more water should be consumed during the day.

　　10. Some drugs can worsen urinary difficulties, and large doses can cause acute urinary retention. The main ones include atropine, belladonna tablets, ephedrine tablets, isoprenaline, and recently discovered calcium channel blockers and verapamil, which can promote prolactin secretion and weaken the contraction of the detrusor muscle, making urinary difficulties worse. Therefore, it is advisable to use or avoid certain drugs as much as possible.

　　11. Pay attention to the frequency of sexual life. Clinical studies have shown that regular sexual life can alleviate prostatic diseases, and the best way to empty the prostate is through regular sexual life. However, many middle-aged and elderly couples tend to lose interest in sexual life and reduce the frequency of sexual activity, which is very unfavorable for prostate health.

　　The examination of benign prostatic hyperplasia includes urinalysis, determination of serum prostate-specific antigen (PSA), urine flow rate examination, ultrasound examination, digital rectal examination, intravenous urography, and urethral angiography. The following will be explained in detail the role of each examination.

　　1. Urinalysis

　　Urinalysis of patients with benign prostatic hyperplasia may sometimes be normal. When urinary tract infection occurs, leukocyte urine can be seen, and it can also be judged whether there is hematuria.

　　2. Determination of serum prostate-specific antigen (PSA)

　　PSA is a specific indicator of the prostate organ. Its elevation can be seen in prostate cancer, benign prostatic hyperplasia, acute urinary retention, prostatic inflammation, and conditions such as prostate massage, urethral insertion of instruments, and seminal emission before checking PSA. A significant increase in PSA is mainly seen in prostate cancer. In patients with benign prostatic hyperplasia, PSA can also increase, but the increase range is relatively small.

　　3. Urine flow rate examination

　　This examination can calculate the speed of urine excretion. Changes in urine flow rate can know the overall changes in urinary function of patients, and these changes may be caused by lesions in organs such as the prostate, urethra, and bladder. Patients with benign prostatic hyperplasia may have an enlarged prostate compressing the urethra, causing resistance to the excretion of bladder urine, manifested as a decrease in the speed of urine excretion, that is, a decrease in urine flow rate. Urine flow rate examination is very important for patients with benign prostatic hyperplasia, without pain, and can reflect the severity of urinary difficulty. Therefore, it can be measured to judge the efficacy at the initial diagnosis, during treatment, and after treatment. Based on the non-invasiveness and clinical value of this examination, it should be measured before, during, and after treatment where conditions permit.

　　4. Ultrasound examination

　　It can understand whether there is hydronephrosis in the kidneys, whether there is diverticula formation in the bladder, the size and shape of the prostate, and measure the residual urine volume. Patients with benign prostatic hyperplasia may have an increase in residual urine volume, and measuring the amount of residual urine can help judge the degree of benign prostatic hyperplasia. Ultrasound examination is currently the main method for measuring residual urine. After patients perform routine bladder and prostate ultrasound examinations while holding their urine, they should get up to urinate, fully urinate, and then use ultrasound to observe the bladder again to measure the residual urine volume in the bladder after urination.

　　5. Digital rectal examination

　　It can be found that the prostate is enlarged, the middle groove is disappeared or bulging, and attention should be paid to whether there are hard nodules and whether there is prostate cancer.

　　6. Intravenous urography and urethral angiography

　　If patients with benign prostatic hyperplasia have recurrent urinary tract infections, microscopic or gross hematuria, suspected renal积水 or ureteral dilation reflux, or urinary tract stones, intravenous pyelography should be performed. It should be noted that when patients have allergic reactions to contrast agents or renal insufficiency, intravenous urography should be prohibited. If there is a suspicion of urethral stricture, urethral angiography is recommended.

　　Benign prostatic hyperplasia, also known as prostatic hypertrophy, mainly manifests as abnormal urination symptoms, which can be divided into obstruction and irritation. A reasonable diet can help patients recover. So, how should patients with benign prostatic hyperplasia eat?

　　1. Watermelons

　　Watermelons are sweet and have the main functions of clearing heat and removing summer heat, generating juice and promoting diuresis, which are very suitable for patients with benign prostatic hyperplasia and patients with prostate-related diseases.

　　2. Bananas

　　Bananas are rich in dietary fiber, sugar, and other nutritional components, and have the effect of moistening the intestines and promoting defecation. It is a fruit that is especially suitable for patients with benign prostatic hyperplasia who have constipation.

　　3. Grapes

　　Grapes have a sweet and sour taste and have the effects of nourishing yin and generating juice, invigorating Qi and promoting diuresis, which is suitable for patients with chronic benign prostatic hyperplasia. Those with Qi and blood deficiency, shortness of breath, dry throat, dribbling urine, and distension of the lower abdomen can eat it regularly.

　　4. Kiwi

　　Kiwi is sweet and sour, can invigorate the spleen and regulate the middle, reduce swelling and detoxify. Not only does the kiwi contain abundant nutritional components, but it also contains anti-tumor components. Regular consumption can help prevent prostate cancer in patients with benign prostatic hyperplasia. Patients with symptoms such as dribbling,涩痛, hematuria, and other symptoms can all eat it.

　　5. Sugarcane

　　Sugarcane is sweet and has the effects of reducing fire and detoxifying, relieving restlessness and thirst. Drinking sugarcane juice often has a good effect on treating urinary system infections.

　　Benign prostatic hyperplasia is generally divided into acute and chronic benign prostatic hyperplasia. The etiology and pathogenesis of benign prostatic hyperplasia are different, and it is also divided into acute and chronic bacterial benign prostatic hyperplasia, acute and chronic non-bacterial benign prostatic hyperplasia, and chronic refractory benign prostatic hyperplasia, etc. Then, what are the treatment methods for benign prostatic hyperplasia?

　　1. Conservative Treatment

　　For patients with weak hearts, liver, and kidney failure, or those with acute cerebrovascular accidents that have not recovered and are not suitable for surgery, conservative therapy should be adopted as a treatment for benign prostatic hyperplasia to alleviate urinary retention and discomfort caused by obstruction. Placing a catheter or performing artificial bladder surgery can relieve the pain of urinary retention, and after a few days, further treatment can be done after the condition of prostatic congestion improves and the bladder tension returns to normal.

　　2. Surgical Treatment

　　Transurethral resection of the prostate is the most commonly used treatment for benign prostatic hyperplasia, which involves inserting a surgical resectoscope through the urethra under cystoscopy to remove the hyperplastic tissue of the prostate. This operation has no abdominal incision, the operation time is short, bleeding is less, the recovery is rapid after surgery, complications are few, and the safety is high.