Benign prostatic hyperplasia
Introduction
Introduction to prostate hyperplasia Benign prostatic hyperplasia (BPH), formerly known as prostatic hypertrophy, is one of the common diseases of elderly men. It is a benign lesion of the prostate. The cause of the disease is related to the imbalance of androgen and estrogen in the human body. The lesion originates from the glandular tissue, connective tissue and smooth muscle tissue of the middle or lateral lobes of the posterior urethra, forming a mixed spherical nodule. The hyperplasia of the bilateral and middle lobe is obvious, and it protrudes into the bladder or urethra, compressing the bladder neck. Or the urethra, causing lower urinary tract obstruction. Long-term lesions can cause hydronephrosis and renal dysfunction. Can also be complicated by stones, infections, tumors and so on. basic knowledge Sickness ratio: 27% Susceptible people: good for older men Mode of infection: non-infectious Complications: urinary tract infections hemorrhoids hematuria bladder stones hydronephrosis
Cause
Cause of benign prostatic hyperplasia
Excessive sexual life (30%):
Repeated infection of bacteria, inflammatory stimulation can induce prostate hyperplasia; because the lower urinary tract is not smooth, it is easy to make the bladder too full of urine, thereby stimulating genital congestion.
Long-term tolerance (30%):
Many male patients like to endure urine. Because of frequent urinary bladder, it can cause obstruction of the urethra and cause lesions, such as urethral stricture, bladder or urethral stones, etc., affecting the smooth flow of the urinary tract, causing the bladder to be in a state of urine filling and causing adverse effects on the prostate. stimulate.
Environmental conditions (30%):
The cause of benign prostatic hyperplasia is also related to our living environment, and our living habits are also inseparable. We are in different living and working and learning environments, such as: cold, lifestyle, eating habits, transportation, culture. Different factors, such external environment, the stimulation of the prostate is also different.
Eating irritating food (10%):
Many male prostate patients have an important reason and drink and like to eat some spicy and other easily irritating foods, but also prone to benign prostatic hyperplasia. Alcohol is very harmful to the prostate. There are many long-term and large drinking history of benign prostatic hyperplasia.
Prevention
Prostatic hyperplasia prevention
Age is one of the basic conditions for the onset of benign prostatic hyperplasia. 40 years old is an important turning point for human development. As stated in the book "Yu Wen · Yin and Yang should be like the big theory": "Year 40, and yin is half a sigh "Family decline", indicating that after the age of 40, people's organs and organs are beginning to decline, such as human prostate tissue intermediate components are more active than epithelial tissue, the occurrence of benign prostatic hyperplasia, mainly manifested as mesenchymal hyperplasia, although The cause of benign prostatic hyperplasia has not been fully understood, but the following measures are still of value in reducing the condition and delaying the occurrence of the disease.
1. To prevent the weather from changing from the end of autumn to the early spring, the cold often makes the condition worse. Therefore, patients must pay attention to cold prevention, prevention of colds and upper respiratory tract infections.
2. Absolutely avoid alcohol, drinking can make the prostate and bladder neck congestion and edema and induce urinary retention.
3. Eat less spicy spicy food, which can lead to congestion of sexual organs, but also make hemorrhoids, constipation symptoms worse, oppress the prostate, and increase difficulty in urinating.
4. Do not rub urine and urine will cause over-filling of the bladder, weaken the bladder detrusor tension, difficulty in urinating, and easily induce acute urinary retention. Therefore, it is necessary to have urine.
5. Do not overwork and overwork will burn the gas, the lack of gas will cause urination, easy to cause urinary retention.
6. Avoid sedentary and often sedentary will aggravate hemorrhoids and other diseases, but also easy to make the perineal congestion, causing dysuria, often participate in cultural and sports activities and Qigong exercise, etc., help to alleviate symptoms.
7. Appropriate amount of drinking water too little will not only cause dehydration, but also unfavorable effect of urination on the urinary tract. It is also easy to cause the urine to concentrate and form insoluble stones. Therefore, in addition to reducing the drinking water at night, it is not necessary to overfill the bladder after sleep. Drinking water.
8. Use drugs with caution. Some drugs can increase the difficulty of urinating. When the dose is large, it can cause acute urinary retention. Among them, atropine, belladonna tablets and ephedrine tablets, isoproterenol, etc., in recent years, calcium blockers and Differently, it can promote the secretion of prolactin, and can weaken the contractile force of the detrusor muscle, and increase the difficulty of urinating. Therefore, it is advisable to use it with caution or preferably without some drugs.
9. Timely treatment should promptly and thoroughly treat prostatitis, cystitis and urethral stones.
10. Massage the lower abdomen to massage the lower abdomen, point the umbilical gas to the customs and other points, which is conducive to the recovery of bladder function. After a small pressure massage, it can promote bladder emptying and reduce residual fluid. It is worth reminding that the disease develops slowly. If the disease is long, if the prevention effect is better from middle age, in addition to the above measures, it should also prevent excessive sexual life, especially vigilance of sexual intercourse interruption and masturbation. According to clinical observation, most patients can adhere to self-care measures and Pay attention to timely treatment, the effect is very good, on the contrary, the effect of persisting poor is not ideal.
At present, the prevention of benign prostatic hyperplasia is divided into 3 levels:
1. Primary prevention means that in the population without prostate disease, vigorously carry out health education, mobilize the whole society to pay attention to men's health, and pay attention to men's health should start from the prostate, to improve the public's understanding of the importance of prostate health, "prostate It is difficult to cure, but it can be cured, and it is not terrible. The terrible thing is that the whole society is indifferent and ignorant of this potential threat." Of course, health education should run through the entire process of prevention and treatment of prostate diseases, disease-free prevention, and disease-promoting rehabilitation.
2. Secondary prevention means that as soon as possible after the treatment of prostate disease, it should be treated as soon as possible, thoroughly treated, without leaving sequelae and complications.
3. Three-level prevention is how to maintain its function after the disease has been qualitatively changed. For example, the prostate has been hypertrophied by the second degree. It is unrealistic to say that the drug can be eliminated and returned to normal. It restores the function of urination, so as to be unobstructed, smooth and natural, and maintain normal kidney function.
Complication
Prostatic hyperplasia complications Complications, urinary tract infection, hemorrhoids, hematuria, bladder stones, hydronephrosis
Complications of benign prostatic hyperplasia are:
1. Urinary tract infection Urinary tract obstruction is a prerequisite for infection, so prostatic hyperplasia is prone to bladder neck, posterior urethra and bladder inflammation.
2. Acute urinary retention, hematuria, bladder stones, hydronephrosis, renal hypertension and renal insufficiency.
3. Hemorrhoids, rectal prolapse due to dysuria, abdominal pressure increased for a long time, it is easy to cause complications such as hemorrhoids and rectal prolapse.
4. Others when prostatic hyperplasia causes difficulty in urinating, a history of hypertension is prone to cerebrovascular accidents and heart failure, should be paid attention to, when the prostate hyperplasia caused by kidney and ureter is obvious water, you can touch the enlarged kidney and There is tenderness. When the bladder is full, the cystic mass can be felt in the middle of the lower abdomen. Sometimes the mass in the waist may be an inflammatory infiltration around the kidney or an abscess around the kidney.
Symptom
Symptoms of benign prostatic hyperplasia Common symptoms Urinary urinary bladder emptying incomplete urinary frequency dysuria fatigue prostate pain hematuria ureteral spinal dysuria dysuria and urinary retention nausea
1. Frequent urination: Frequent urination is the earliest manifestation. First, it is frequent urination at night. Then there is frequent urination during the day. After the bladder detrusor decompensation, the residual urine increases, the effective volume of the bladder decreases, and the urinary frequency is more serious.
2. Difficulties in urination: progressive dysuria is a prominent feature of the disease. Symptoms can be divided into two types: obstruction and irritation; obstructive symptoms are urinary fistula, intermittent, terminal drip, fine and weak urinary line, urinary incontinence, etc. Symptoms are frequent urination, nocturia, urgency, dysuria, symptoms can be aggravated by cold, drinking and anticholinergic drugs, psychotic drugs, etc. Long-term obstruction can lead to uremia symptoms such as fatigue, lethargy, nausea and vomiting.
3. Hematuria: Capillary congestion and small blood vessel dilation on the prostate mucosa, and the bladder is filled, the contraction pulls and ruptures, and hematuria also occurs when the bladder tumor is combined.
4. International Prostate Symptom Score (IPSS): Ask the patient about 7 questions about urination, score each question according to the severity of the symptoms (0 to 5 points), the total score is 0 to 35 points (asymptomatic to very serious Symptoms), 0 to 7 are classified as mild symptoms; 8 to 19 are classified as moderate symptoms; 20 to 35 are classified as severe symptoms, although IPSS analysis attempts to quantify the degree of symptom change, but it is still subject to subjective factors.
Physical examination: acute urinary retention, lower abdomen bulging, upper pubic area touches the filling bladder, rectal examination, enlarged prostate, smooth surface, rich elasticity, central groove becomes shallow or disappears, according to the degree of gland enlargement The prostate hyperplasia is divided into 3 degrees, the degree of I is enlarged: the prostate is 1.5 to 2 times larger than normal, the central groove is shallow, and the distance from the rectum is 1 to 2 cm; the second degree is enlarged: the gland is moderately enlarged, larger than 2 to 3 times normal, the central sulcus disappears or slightly protrudes, and protrudes into the rectum 2 to 3 cm; III degree enlargement: the gland is swollen severely, and the rectum protrudes more than 3 cm, and the central groove is prominent. The finger cannot touch the upper edge during the examination.
Benign prostatic hyperplasia is a common disease in older men, caused by a variety of causes, hormones, growth factors, matrix and epithelial interactions, diagnosis based on symptoms and IPSS scores, digital rectal examination, B-ultrasound and urodynamics, Pressure-flow rate measurement is the gold standard for diagnosing bladder outlet obstruction.
Examine
Examination of benign prostatic hyperplasia
1. Check the abdomen: pay attention to the bladder with or without swelling, patients with enlarged prostate, often have a large amount of residual urine in the bladder, often touch the swollen bladder when palpation; but sometimes the disease is longer, the bladder is in a long-term chronic urinary retention state, swelling The texture of the big bladder is not easy to detect, and it can be determined by the method of diagnosis.
2. Anal finger examination: anal finger examination is an important step to diagnose this disease. Most cases of prostatic hypertrophy can be clearly diagnosed by this examination. The positive findings are prostatic enlargement, protrusion, central groove disappearing, both sides of the edge Widening, tough and smooth surface, according to these characteristics, can be differentiated from prostate cancer, tuberculosis, stones, but if the prostate is not large, it can not be based on this examination alone, except for the possibility of prostatic hypertrophy, such as simple middle lobe hypertrophy When the hypertrophy gland protrudes into the bladder, the anal finger examination can be completely undetectable. When the anal finger is examined, pay attention to the function of the anal sphincter, which is helpful for distinguishing from the neuropathogenic bladder urinary dysfunction.
3. X-ray: IVU or bladder urethra angiography in the anterior and posterior position and urinary state, showing the bottom of the bladder is elevated, there is a curved density to reduce the shadow, the length of the posterior urethra increases, such as combined diverticulum, tumor, stones can show filling defects Late IVU can show vesicoureteral reflux, poor hydronephrosis or kidney development or even no development.
4. Cystoscopy: This method is not used as a routine examination. It is only performed when there is indication. It can be seen that the bladder neck protrudes, the urethra is deformed, the bladder wall forms trabeculae, the chamber or even the diverticulum, such as bladder stones, bladder tumor. Can also be diagnosed together.
Cystoscopy is necessary for some cases, because it can be confirmed by this test whether the prostate is hypertrophy, hypertrophy and hypertrophy, and this can be used to understand the condition of the bladder and exclude other lesions, but the cystoscopy Patients with prostatic hypertrophy are prone to injury, bleeding, infection, etc., so they should be carefully selected for use. Care must be taken when handling. After inspection, it should be closely observed.
5. Determination of residual urine : Determination of residual urine has important significance for the disease. As mentioned above, the degree of glandular hypertrophy is not proportional to the severity of the disease, so it is not clinically meaningful to grade the gland according to the size of the gland; The amount of residual urine can indicate the severity of obstruction and is closely related to the condition. The methods for determining residual urine are as follows:
1 Ultrasound examination: simple and easy, the patient's burden is small, and the results can also explain the problem.
2 catheterization method: immediately after urinating, put into the catheter examination, can accurately determine the residual urine volume, and can obtain urine specimens for culture, and can be used for phenol red test and cystography, etc. Risk of injury, bleeding, etc., should be carried out with caution, and strict prevention. If a large amount of residual urine is measured, the catheter should be considered for indwelling drainage.
3 When performing intravenous pyelography, after releasing the last piece of the compressed abdominal band, let the patient empty the bladder and take another piece to show the residual urine.
6. Urodynamic examination : for non-invasive examination, the bladder volume should be >150ml, the main indicators are: maximum urine flow rate (Qmax, normal >15ml / s), bladder capacity (bladder capacity, normal male 350 ~ 750ml, Female 250 ~ 550ml), detrusor contractility, etc., is of great significance for the treatment options and prognosis of benign prostatic hyperplasia.
7. Other examinations: In addition to routine examination of hematuria, urine culture and renal function tests are also very important. For example, when considering surgical treatment, heart, lung, liver and blood vessel examinations and blood biochemical examinations should be performed.
Because long-term urinary retention affects renal function, creatinine and urea nitrogen are elevated. When combined with urinary tract infection, urine routine examination has red blood cells and pus cells.
PSA determination: PSA can be increased at BPH, but the significance of measuring PSA is not to diagnose BPH, but to find prostate cancer early, combined with free PSA, digital rectal examination, B ultrasound can find most prostate cancer.
Diagnosis
Diagnosis of benign prostatic hyperplasia
diagnosis
Benign prostatic hyperplasia is a common disease in older men, caused by a variety of causes, hormones, growth factors, matrix and epithelial interactions. The diagnosis was mainly based on symptoms and IPSS scores, digital rectal examination, B-ultrasound and urodynamics. Pressure-flow rate measurement is the gold standard for diagnosing bladder outlet obstruction.
Differential diagnosis
The disease should be differentiated from bladder neck contracture (Marion's disease), prostate cancer, neuropathogenic bladder, bladder tumor, prostate tuberculosis, prostatic calculus, prostate cyst, ureteral hypertrophy, stones, foreign body and so on.
1. Bladder neck contracture: bladder neck contracture secondary to inflammatory lesions, bladder neck smooth muscle is replaced by connective tissue, may also be abnormal during the development of the bladder neck muscles, so that the bladder can not open when the bladder detrusor contraction, During cystoscopy, the posterior lip of the bladder neck is raised, and the contraction of the posterior urethra and the bladder triangle becomes shorter.
2. Prostate cancer: The prostate has nodules, PSA>4ng/ml. The rectal ultrasound can be seen in the hypoechoic area of the prostate. CT can be seen that the shape of the prostate is irregular, the angle of the seminal vesicle disappears, and the shape of the seminal vesicle changes. The biopsy can confirm.
3. Neuropathic bladder: All ages can occur, with obvious history and signs of neurological damage, often accompanied by lower limb sensation and movement disorders, sometimes accompanied by anal sphincter relaxation and reflex disappearance, rectal examination of prostate Large, urodynamic tests can be performed.
4. Bladder cancer: Bladder cancer near the bladder neck can be manifested as bladder outlet obstruction, often with hematuria, cystoscopy can be identified.
5. Urethral stricture: more urinary tract damage, infection and other medical history.
The above diseases can be identified through physical examination, laboratory tests, anal finger examination and cystoscopy. Most cases can be identified only in atypical cases. According to the above-mentioned examination methods, it is difficult to draw conclusions. The following methods can be used to assist Differential diagnosis:
1. Determination of serum acid phosphatase: The prostate tissue contains high acid phosphatase, and when the cancer is cancerous, the content increases. This principle is used for this test. The normal value of serum acid phosphatase is 1 to 5 units according to King-Armsstrong, according to Bodansky. For 0.5 to 2 units, the value of 0.7KA units was determined from the new examination method in 1950, and more than half of the patients with prostate cancer were higher than the normal value. Note that false positives may occur after application of testosterone or prostate massage.
2. Serum phosphatase assay: When there is bone metastasis, serum phosphatase is elevated, normal value Bodahsky 2 ~ 4.5 units, King-Armstrong 8 ~ 14 units, but must pay attention to false positive.
3. Prostate biopsy: prostate biopsy can be performed by perineal or rectal.
4. Seminal ejaculation angiography: Prostate hypertrophy can only be seen with symmetry expansion, neat edges; prostate cancer is seen with narrow, irregular, uneven edges, or defects.
