enlarged prostate
Introduction
Introduction Prostatic hypertrophy is one of the important lesions of male bladder neck obstruction. According to its pathology, it is more appropriate to call Prostatic Hypertrophy. However, the name of the prostatic hypertrophy is more popular, so the name is still used. In addition, there is the name of benign prostatic hypertrophy, which means that it is different from prostate malignant tumor. It does not seem to cause confusion and is therefore omitted. Prostatic hypertrophy is a common disease in older men. Under the great socialist system in our country, the people's living standards are constantly improving, the average life expectancy is prolonged, and the number of cases is bound to increase gradually. Although benign prostatic hyperplasia is a benign disease, it is caused by obstruction caused by urinary system, which affects urination and directly threatens kidney function, which brings serious harm to patients' health and life. And the prostate hypertrophy often requires surgery, and the elderly are often accompanied by high blood pressure, hardening of the arteries, cardiopulmonary dysfunction, etc., which indeed imposes a heavy burden on the patient. As far as the incidence of ethnic groups in the world is concerned, it is different. The incidence rate of yellow races is lower than that of Caucasians. Caucasians are almost the same as black races, and the age of onset is ten years earlier than that of yellow racers. The incidence is increasing with age; in the case of 40 to 49 years old, 10%, and 50 to 59 years old, 20%.
Cause
Cause
Prostatic hypertrophy is a degenerative disease. Generally, when the adult male is 30-40 years old, the prostate begins to have different degrees of hyperplasia, and symptoms appear after 50 years of age. Sex hormone levels decline, neuroendocrine disorders and dietary factors are the causes of the disease, it is a urinary tract obstruction caused by mechanical factors.
Prostatic hypertrophy can cause temporary hypersexuality. After the age of 55, men almost have different degrees of prostatic hypertrophy. At the beginning of prostatic hypertrophy, patients may have increased sexual desire that is not consistent with age, or consistent sexual desire is normal, but suddenly becomes intense stand up. This is due to prostatic hyperplasia, which causes prostate dysfunction, and feedback causes testicular function to be temporarily enhanced. Sexual life will aggravate prostatic hypertrophy, and sexual life itself will cause the prostate to be in a state of hyperemia for a long time, causing and aggravating prostatic hypertrophy.
Examine
an examination
Related inspection
Prostate B-check prostate examination
Laboratory inspection:
When long-term urinary retention affects renal function, creatinine and urea nitrogen are elevated. When combined with urinary tract infection, urine is routinely examined for red blood cells and pus cells.
PSA measurement: Although PSA can be increased at BPH, the significance of measuring PSA is not to diagnose BPH, but to detect prostate cancer at an early stage. Combined with free PSA, digital rectal examination, B-ultrasound can find most prostate cancer.
Other auxiliary inspections:
1. Imaging examination
(1) X-ray: In the IVU or bladder urethra angiography, the anterior and posterior and urinary conditions were taken. The bottom of the bladder was elevated, the arc density was reduced, and the length of the posterior urethra was increased. Such as the merger of diverticulum, tumors, stones can show filling defects. Late IVU can show vesicoureteral reflux, hydronephrosis or poorly developed kidneys or even no development.
(2) B-ultrasound: There are two methods of transrectal and transabdominal ultrasound, and transrectal B-ultrasound is preferred. The gland size, residual urine can be measured, and prostate cancer can be excluded according to the sonogram.
2. Cystoscopy: visible bladder neck protruding bulge, urethral orifice deformation. The bladder wall forms trabeculae, a small chamber, and even a diverticulum. For example, combined with bladder stones and bladder tumors can also be diagnosed together. This method is not routinely examined and is only performed when indicated.
3. Urodynamic examination: for non-invasive examination, the bladder volume should be >150ml when measured. The main indicators are: maximum urinary flow rate (Qmax, normal >15ml / s), bladder capacity (bladder capacity, normal male 350 ~ 750ml, female 250 ~ 550ml), detrusor contractility, etc., treatment options for benign prostatic hyperplasia And prognosis is important.
4. Determination of residual urine volume: After the patient urinates, the catheter is inserted into the urine, and the urine in the bladder is collected, and the volume of the urine is determined as the residual urine volume of the bladder. Ultrasound can also be used to measure the bladder capacity after urination and calculate the residual urine volume. Normal <50ml. When prostate hyperplasia occurs, the amount of residual urine often increases.
Diagnosis
Differential diagnosis
Differential diagnosis
The disease should be differentiated from prostate cancer, prostate tuberculosis, prostatic calculus, prostate cyst, bladder neck contracture (Marion's disease), ureteral hypertrophy, neuropathogenic bladder, bladder tumor, stones, foreign body and so on. The above diseases can be identified in most cases by physical examination, laboratory tests, anal finger examination and cystoscopy. Only prostate cancer in atypical cases, according to the aforementioned 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. It is 0.5 to 2 units, and its value is determined to be 0.7KA units since the new inspection method in 1950. More than half of patients with prostate cancer are above normal. Note that false positives can occur after applying 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 can be seen with narrow, irregular, marginal, or defective.
diagnosis
1 frequent urination, urgency, is an early symptom, the number of urination during the day and night increased, and gradually increased. If the bladder has inflammation, stones and other complications, the symptoms of urinary frequency can be aggravated, and urinary urgency and pain can occur.
2 dysuria, this is also an early manifestation, began to show urinary fistula, have to wait for a long time to discharge, and later with the increase of obstruction, develop into dysuria, urinary flow fine or urinary interruption, urinary dripping, urinary incontinence, urine Can not be lined up and drip.
3 urinary incontinence, mostly late symptoms, especially when the nighttime patient is asleep, the pelvic floor bones are loose, and it is easier for the urine to flow out by itself, so the patient sometimes has nocturnal enuresis.
4 hematuria, congestion of the bladder neck or inflammation of the bladder, stone tumors, different degrees of microscopic or gross hematuria, with the formation and blockage of blood clots, will make dysuria and urinary retention more serious, and also cause severe pain .
5 acute urinary retention, in patients with prostatic hypertrophy, about half of patients may have acute urinary retention, the common predisposing factors such as cold, upper respiratory tract infection, drinking or eating irritating food, sexual intercourse, fatigue and paralysis Excessive urinary urination, failure to urinate in time.
6 systemic symptoms, advanced urinary tract obstruction can cause renal damage, and a series of systemic uremia symptoms.
2) Chinese medicine diagnosis
Rectal examination can find out the size of the prostate, whether there are nodules, hardness, fullness, elasticity and the situation of the central ditch.
3) Laboratory and other inspections
It can be further diagnosed by residual urine measurement, cystoscopy, B-mode ultrasound, X-ray examination and urine flow rate examination.
