Benign Prostatic Hyperplasia

　　There have been many studies on the pathogenesis of benign prostatic hyperplasia, but the etiology has not been elucidated to this day. It is currently known that benign prostatic hyperplasia must have functional testes and aging as two conditions. In recent years, attention has also been paid to the relationship between smoking, obesity, alcoholism, family history, race, and geographical environment and the occurrence of benign prostatic hyperplasia.

　　Although benign prostatic hyperplasia has a mild condition, if it is not treated in a timely manner, the condition may worsen, leading to the following complications:

　　1. During benign prostatic hyperplasia, due to prolonged difficulty in urination, patients may experience severe psychological burden and mental tension, affecting their rest and life. In addition, benign prostatic hyperplasia mostly occurs in middle-aged and elderly people, making it more likely to trigger a series of diseases such as hypertension, coronary heart disease, heart failure, cerebrovascular disease, and so on, which can threaten the quality and health of patients' lives, and in severe cases, even threaten life.

　　2. Benign prostatic hyperplasia can compress the prostatic part of the urethra, causing a series of urethral obstruction symptoms. Further, due to urinary tract obstruction, bladder numbness and renal function damage may occur, leading to a series of systemic uremic symptoms, ultimately resulting in renal failure.

　　3. During benign prostatic hyperplasia, due to urinary tract obstruction combined with urinary system infection and bladder dysfunction, urinary incontinence and urinary retention may occur, further exacerbating the condition of benign prostatic hyperplasia.

　　4. Benign prostatic hyperplasia can lead to infertility. Prolonged chronic inflammation changes the composition of prostatic fluid, affects the secretory function of the prostate, and further affects the liquefaction time of seminal fluid, reducing sperm vitality, which can lead to male infertility.

　　5. Benign prostatic hyperplasia can affect sexual function, leading to impotence and premature ejaculation. Because the disease has not been cured for a long time, various symptoms and discomforts are exacerbated after sexual intercourse, or can directly affect the sensation and quality of sexual life, causing a negative impact on the patient, leading to a sense of aversion and resulting in impotence and premature ejaculation.

　　In the early stages of benign prostatic hyperplasia, due to compensation, symptoms are atypical. As the obstruction of the lower urinary tract worsens, symptoms gradually become more pronounced, including symptoms during the storage phase, voiding phase, and post-voiding phase. Because the course of the disease progresses slowly, it is difficult to determine the onset time.

　　1. Symptoms during the storage phase

　　1. Frequent urination and increased night-time urination are early symptoms, initially characterized by an increase in the number of night-time urinations, but with a small amount of urine each time. After the detrusor muscle of the bladder fails to compensate, chronic urinary retention occurs, reducing the effective capacity of the bladder and shortening the interval between voidings. If accompanied by bladder stones or infection, frequent urination becomes more pronounced and is accompanied by urinary pain.

　　2. When there is lower urinary tract obstruction, 50% to 80% of patients have symptoms such as urgency or urgency incontinence.

　　Two, symptoms during urination

　　As the gland grows larger and the mechanical obstruction becomes more severe, the difficulty in urination also increases accordingly. The degree of lower urinary tract obstruction is not proportional to the size of the gland. Due to increased urethral resistance, patients may experience delayed initiation of urination, prolonged urination time, short range of urination, thin and weak urine stream, urinary divergence, and a feeling of incomplete urination. If the obstruction becomes more severe, patients must increase abdominal pressure to help urinate. The changes in abdominal pressure caused by breathing can lead to intermittent urine flow and dribbling.

　　Three, symptoms after urination

　　Patients with this disease have an increased number of cases of incomplete urination and residual urine: residual urine is the result of bladder detrusor muscle dysfunction. When the amount of residual urine is very large, the bladder becomes overly expanded and the pressure is very high, higher than the resistance of the urethra, urine leaks out of the urethra spontaneously, which is called overflow incontinence. Some patients may not have much residual urine during normal times, but acute urinary retention may occur suddenly when exposed to cold, alcohol, holding urine, taking medication, or due to other reasons that cause sympathetic nervous system excitement. The symptoms of urinary retention in patients may vary from time to time. Some patients may have acute urinary retention as the initial symptom.

　　Four, other symptoms

　　2. Hematuria: The capillaries and small blood vessels on the mucosa of the prostate become congested and dilated due to the traction of the enlarged gland or friction 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 male adults. Bladderoscopy, metal catheterization, and acute urinary retention catheterization can easily cause severe hematuria when the bladder is suddenly decompressed.

　　1. Urinary tract infection: Urinary retention often leads to urinary tract infection, which can cause symptoms such as urgency, frequency, difficulty in urination, and pain during urination. 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 white blood cells in the urine, or bacterial growth may be detected in urine culture. Treatment should be given before surgery.

　　2. Bladder stones: 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. When bladder stones occur, symptoms such as interrupted urine flow, pain at the end of urination, and the need to change body position before urination may occur.

　　3. Renal function damage: It is often caused by urinary tract reflux and renal积水 leading to renal function destruction. The main complaints of patients when they seek medical attention are loss of appetite, anemia, increased blood pressure, or drowsiness and delayed consciousness. Therefore, for male elderly adults with unknown causes of renal insufficiency symptoms, prostatic hyperplasia should be ruled out first.

　　Benign prostatic hyperplasia has become a very common disease in elderly male adults. Therefore, preventing prostatic hyperplasia is an important task facing middle-aged and elderly male adults. Studies show that regular and scientific living habits can effectively prevent prostatic hyperplasia:

　　1. Avoid catching a cold in spring and summer, and pay attention to keeping warm in autumn and winter. It is also necessary to prevent common cold and upper respiratory tract infections.

　　2. Absolutely avoid alcohol consumption, as it can cause the prostate to become congested and swollen, leading to hyperplasia.

　　3. Avoid spicy and fried foods as much as possible to prevent congestion of the sexual organs and pressure on the prostate.

　　4. Avoid overwork, pay attention to rest, but at the same time, avoid prolonged sitting and reduce perineal congestion.

　　In the early stage of benign prostatic hyperplasia, due to compensation, the symptoms are not typical, and it generally requires the following examination measures to confirm the diagnosis.

　　1. Physical examination

　　If the patient is weak, pale, drowsy, with high blood pressure, a rapid pulse, and deep breathing, the possibility of uremia should be considered. Abdominal examination may find enlarged kidneys with costovertebral angle tenderness, indicating secondary hydronephrosis. The suprapubic area should be checked for an enlarged bladder, and the surface of the retained urine bladder is smooth, soft, without nodules. Patients with a long history should pay attention to whether there is concurrent cancer, hemorrhoids, phimosis, and whether the urethra is normal.

　　2. Conduct blood and urine tests

　　This examination is to evaluate the patient's renal function and exclude the possibility of urinary tract infection. Because any infection in the male reproductive system or any part of the urinary system can cause difficulty in urination, some symptoms of benign prostatic hyperplasia are similar to prostatitis, which can easily lead to misdiagnosis.

　　3. Ultrasonic examination (also used for the diagnosis of prostate cancer)

　　Ultrasonic examination can monitor the size of the prostate in patients, and through a pressure-sensitive sensor, doctors can measure the strength of the urinary flow when patients are exerting to urinate. A decrease in urinary flow strength often suggests the possibility of benign prostatic hyperplasia.

　　4. Renal angiography (X-ray examination of the urinary system after intravenous injection of contrast agent)

　　Renal angiography is mainly used for the diagnosis of renal and ureteral diseases, but it also has certain diagnostic value for benign prostatic hyperplasia. Through renal pelvis angiography, doctors can find out whether there is any blockage or abnormal narrowing in the entire urinary tract of the patient, and the presence of urethral narrowing at the level of the prostate will highly suggest the possibility of benign prostatic hyperplasia.

　　5. Cystoscopy

　　Through cystoscopy, we can directly find the narrowing or blockage of the patient's urethra. Before performing cystoscopy, we should first inject a certain amount of anesthetic into the urethra through the urethral orifice, then insert the probe with a light source into the patient's urethra, so that we can search for the narrow areas within the patient's urethra through the monitor.

　　For patients with benign prostatic hyperplasia, the following foods can help improve the condition:

　　1. Eat eggs, beef, and seeds in moderation.

　　2. If there is heat in the bladder or涩痛in the urethra, green bean soup or green bean congee can be consumed, or black fungus can be decocted into a soup for drinking or eaten cold.

　　3. Douchiang (fermented soybean paste) is a good medicine to reduce the incidence of benign prostatic hyperplasia and colorectal cancer, and it is beneficial to eat.

　　4. Drink more green tea.

　　According to the different conditions of benign prostatic hyperplasia, its treatment can be roughly divided into the following methods:

　　1. Wait and observe

　　The symptoms of benign prostatic hyperplasia may not change significantly over a long period of time, or even improve. Therefore, patients with mild symptoms can wait and observe without treatment, but they must be followed closely. If the condition worsens, appropriate treatment methods should be chosen.

　　Second, Drug Treatment

　　1. Alpha-adrenergic Receptor Blockers.

　　2. 5α-Reductase Inhibitors.

　　3. Herbal Preparations.

　　4. Combination Therapy.

　　Third, Surgical Treatment

　　1. Transurethral Prostatic Resection (TURP): Known as the gold standard for the treatment of prostatic hyperplasia in Western countries. TURP has minimal trauma to the human body, rapid postoperative recovery, and can significantly shorten hospitalization time.

　　2. Open Surgery: Including suprapubic transvesical prostatectomy, retropubic prostatectomy, and retropubic urinary retention prostatectomy.

　　3. Transurethral Prostatic Vaporization (TVP): TVP has the ability to vaporize and remove tissue, as well as a similar coagulation effect to laser, so it is an improvement and development of TURP.

　　4. Transurethral Green Laser Prostate Vaporization: Laser treatment can be divided into two major categories: vaporization and coagulation according to the effect on tissue. Laser treatment for prostatic hyperplasia is safe and has an outstanding hemostatic effect, especially suitable for patients with coagulation dysfunction. In recent years, the application of holmium laser prostate enucleation and green laser prostate vaporization has become more and more common.

　　Fourth, Other Minimally Invasive Treatments

　　Minimally invasive treatment is mainly used for patients whose condition is not suitable for surgical treatment or who do not want to undergo surgical treatment, but the effect of drug treatment is not good.

　　1. Thermal Therapy: Utilizing the thermal and non-thermal effects of microwave to treat prostatic hyperplasia. According to the treatment route, it is divided into Transurethral Microwave Thermotherapy (TUMT) and Transrectal Microwave Thermotherapy (TRMT).

　　2. Transurethral Prostatic Needle Ablation (TUNA): A minimally invasive surgical method for treating prostatic hyperplasia. This method has the advantages of simple operation, no anesthesia required for patients, short operation time, and no damage to the urethral mucosa.

　　3. High-intensity focused ultrasound (HIFU): Using a dual-function rectal ultrasound probe with B-ultrasound positioning and HIFU treatment functions to destroy hyperplastic prostate tissue, which is excreted with urine.

　　4. Urethral Stent: Utilizing tubular stents made of various biocompatible materials to support the urethra compressed by hyperplastic prostate tissue, and relieve obstruction. For high-risk patients who cannot tolerate TURP or open surgery, it has become one of the preferred treatments.