Benign prostatic hyperplasia in the elderly

　　There have been many studies on the pathogenesis of benign prostatic hyperplasia, but the etiology has not been elucidated yet. It is currently known that benign prostatic hyperplasia requires two conditions: functional testicles and aging. In recent years, smoking, obesity, alcoholism, family history, race, and geographical environment have also been noted to be related to the occurrence of benign prostatic hyperplasia.

　　Benign prostatic hyperplasia is prone to the following complications, which can cause serious harm to patients.

　　1. The urinary tract obstruction caused by benign prostatic hyperplasia is a prerequisite for infection, so it is prone to recurrent inflammation of the urinary tract, bladder neck, and bladder inflammation, etc.

　　2. Hematuria is often intermittent, and it can be microscopic hematuria or gross hematuria, most often appearing after urination.

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

　　The size of benign prostatic hyperplasia is not proportional to the symptoms that appear. Patients generally appear symptoms after 50 years old, and the symptoms depend on the degree of obstruction, the speed of lesion development, and whether there is a complication of infection and stones. The symptoms are sometimes light and sometimes severe.

　　1. Bladder Irritation Symptoms

　　Bladder irritation symptoms include frequent urination, urgency, increased nocturnal urination, and urgency incontinence, etc. These symptoms of benign prostatic hyperplasia are irritation and obstructive symptoms caused by the complex interaction between the prostate and the bladder.

　　2. Obstructive Symptoms

　　As the prostate continues to grow, the resistance of the urethra increases, leading to bladder outlet obstruction. When the bladder is difficult to compensate, symptoms such as hesitant urination, thin and weak urinary stream, difficult urination, intermittent urinary flow, terminal dripping, prolonged urination time, incomplete emptying, urinary retention, and overflow incontinence may occur. All of these are obstructive symptoms of benign prostatic hyperplasia.

　　3. Other Clinical Symptoms

　　Other clinical symptoms include hematuria, urinary system infection symptoms, stones, detrusor compensation insufficiency symptoms, acute urinary retention, and renal function damage, etc.

　　Preventive medicine is a focus of continuous attention in many medical fields, especially in preventive cardiology, where it is applied well. At present, it has also begun to attract attention in urology and gynecology. The common preventive strategies for this disease currently include the following points:

　　1. Screening Strategies

　　A general survey of the symptoms of benign prostatic hyperplasia is beneficial for prevention, which can strengthen health publicity and education for community residents, increase self-examination among the masses, and promote early detection of diseases and awareness of seeking medical treatment. At the same time, improve the level of medical treatment of community medical personnel, correctly guide the community masses to prevent diseases, transfer relevant patients to higher-level hospitals for further diagnosis and treatment, and suggest that men over 50 should have regular related examinations every year.

　　2. Avoiding Risk Factors

　　Since there are many risk factors that can affect the occurrence of benign prostatic hyperplasia, avoiding these risk factors has become a corresponding strategy for prevention. However, factors such as youth and genetics are clear and cannot be avoided. We can avoid potential risk factors, such as improving bad living habits, having a balanced diet, paying attention to psychological balance, carrying out health education, advocating self-care, and so on.

　　3. Chemical Prevention

　　Since benign prostatic hyperplasia takes a long time from onset to development, there is a possibility to prevent its occurrence chemically. Avodart is a drug that inhibits the conversion of testosterone to dihydrotestosterone (DHT), which is active in the prostate. Therefore, theoretically, Avodart can affect the proliferative effect of testosterone on prostate cells.

　　The symptoms of this disease are not typical, and it is generally necessary to use the following examination methods to make a diagnosis:

　　1, Urinalysis

　　Urine analysis can determine the presence of hematuria, proteinuria, pyuria, uric sugar, etc., reflecting whether there is concurrent infection and renal function damage.

　　2, Renal function examination

　　Renal function is an essential examination item, which can generally determine blood creatinine, reflecting whether benign prostatic hyperplasia has caused renal function damage, and can estimate the prognosis of treatment and choose the best treatment plan.

　　3, Imaging examination

　　Including ultrasonic examination, urinary tract imaging, prostatic imaging, prostatic CT examination, MRI of prostatic hyperplasia, and prostatic cystoscopy and other methods.

　　4, Urodynamic examination

　　Urodynamic examination is of great significance for the diagnosis of benign prostatic hyperplasia, and can determine the degree of obstruction, resistance of the prostatic urethra and internal and external sphincters, and detrusor function. According to the measured urine flow rate, detrusor pressure, urethral pressure curve, and electromyogram of the sphincter, it can be analyzed whether the prostatic syndrome is caused by obstruction or irritation, and whether there is detrusor instability, detrusor contraction function damage, and bladder compliance changes.

　　5, Isotope examination

　　Radionuclide renal imaging can determine renal tubular function and show whether there is obstruction in the upper urinary tract, which is a semi-quantitative or quantitative renal function test.

　　In daily life, to reduce the occurrence of prostatic diseases, it is recommended to try the following foods:

　　1, Pumpkin Seeds

　　Eating pumpkin seeds regularly is enough.

　　2, Cinnamon Porridge

　　Cinnamon 5 grams, plantain seed 30 grams, glutinous rice 50 grams. First decoct cinnamon and plantain seed, remove the dregs and take the juice, then add glutinous rice to cook porridge, add brown sugar after it is cooked, eat on an empty stomach, this recipe can warm Yang and promote urination.

　　3, Diuretic Cucumber Soup

　　Cucumber 1, herbaceous ephedra 10 grams, appropriate amount of monosodium glutamate, salt, and sesame oil. First decoct the herbaceous ephedra, remove the dregs and take the juice, reboil the juice, blanch the cucumber slices, add spices, cool and it is ready to eat.

　　4, Almond Pear Stone Clover Drink

　　Bitter almonds 10 grams, stone clover 12 grams, plantain seed 15 grams, one large pear, a little rock sugar. Peel and crush the almonds, cut the pear into pieces and remove the core, boil with stone clover and plantain seed with appropriate amount of water, add rock sugar when cooked. It can be taken as tea, this recipe can relieve lung fire and promote urination.

　　5, Codonopsis and Astragalus Winter Melon Soup

　　Codonopsis 15 grams, Astragalus 20 grams, winter melon 50 grams, appropriate amount of monosodium glutamate, sesame oil, and salt. Put codonopsis and astragalus in a pot, add water and boil for 15 minutes, remove the dregs and filter, add winter melon slices while hot, continue to cook until the winter melon is edible, add spices and it is ready to eat. It can be used as a side dish, this recipe can strengthen the spleen and Qi, and promote the flow of urine.

　　The harmfulness of benign prostatic hyperplasia lies in the pathological and physiological changes caused by lower urinary tract obstruction. The pathological individual differences are very large, and not all show progressive development. Some lesions stop developing at a certain degree, so even if there are mild obstruction symptoms, not all require surgery.

　　One, Watch and Wait

　　For mild symptoms, those with an IPSS score of 7 points or less can be observed without treatment.

　　Two, Medication Treatment

　　1. Research on 5α-reductase inhibitors has found that 5α-reductase is an important enzyme for the conversion of testosterone to dihydrotestosterone. Dihydrotestosterone plays a certain role in benign prostatic hyperplasia, so the use of 5α-reductase inhibitors can provide certain inhibition of hyperplasia.

　　2. Alpha-adrenergic blockers are currently believed to improve urinary tract dynamic obstruction, reduce resistance to improve symptoms, and commonly used drugs include Gao Deting, etc.

　　3. The most widely used anti-androgen drugs are progestin drugs. They can inhibit the cell binding and nuclear uptake of androgens, or inhibit 5α-reductase to interfere with the formation of dihydrotestosterone.

　　Three, Surgical Treatment

　　Surgery is still an important treatment method for benign prostatic hyperplasia. For patients with long-term urinary tract obstruction, obvious renal function damage, severe urinary tract infection, or acute urinary retention, it is necessary to first insert a urinary catheter to relieve obstruction, wait for the infection to be controlled, and then perform surgery after renal function recovery. If it is difficult to insert a urinary catheter or the catheter insertion time is long, leading to urethritis, it can be changed to suprapubic bladder puncture and stenting. The indications for emergency prostatectomy should be strictly controlled.

　　Four, Minimally Invasive Treatment

　　1. Transurethral prostate electrovaporization is mainly an innovation in electrode metal materials.

　　2. Transurethral prostate plasma bipolar resection and transurethral plasma prostate enucleation are surgical procedures using a plasma bipolar resection system and performed in a manner similar to monopolar TURP to perform transurethral prostatectomy.

　　3. Cryotherapy is to cause the prostate to necrotic and desquamate after deep hypothermic freezing, thus achieving the purpose of cryoablation of the prostate.

　　4. Microwave therapy utilizes the thermal coagulation principle of microwave on biological tissue to achieve therapeutic purposes. The placement of microwave emitting electrodes can be located by rectal ultrasound or under direct vision of the urethroscope. The latter can accurately avoid the external sphincter of the urethra, reducing the incidence of complications such as urinary incontinence.

　　5. Laser therapy utilizes the thermal effect of laser to coagulate, vaporize, or excise prostate tissue, with a method similar to transurethral endoscopic manipulation.

　　6. Radiofrequency ablation uses radiofrequency waves to produce local thermal effects to cause coagulative necrosis of the prostate tissue.