Prostatic hyperplasia

Prostatic hyperplasia (BPH), also known as prostatic hyperplasia in ancient times, is one of the common diseases in elderly men and is a kind of benign prostatic disease in men. The cause of the disease is related to the imbalance of male hormones and female hormones in the human body. The disease begins in the glandular tissue, connective tissue and smooth muscle tissue of the middle or lateral lobe under the mucosa of the posterior urethra, producing a mixed spherical mass.

The hyperplasia of the lateral lobes and mid-section is prominent, invading the bladder or urethral opening, compressing the bladder neck or urethral opening, causing lower urinary tract obstruction. When prostatic hyperplasia causes obstruction, the detrusor muscle of the bladder becomes thicker, and the mucosa has posterior capsules, chambers and diverticula. Long-term urinary obstruction increases the bladder height-to-width ratio, softens the bladder wall, increases bladder air pressure, and loses its valve function at the tail end of the urethra, causing bladder urethral reflux.

1. Frequent urination and urgency Frequent urination and urgency are the first and main manifestations, first at night, and then during the day. In the later stage, the detrusor muscle of the bladder fails, the residual urine increases, the effective bladder capacity decreases, and the frequent urination and urgency become more serious.

2. Dysuria Idiopathic dysuria is a distinctive feature of this disease, the main manifestations of which are slowed down urination, narrowing of urine flow, reduced effective range, and dripping after urination.

3. Hematuria: The capillary hematoma and small capillary dilation on the male prostate mucosa cause the bladder to rupture and bleed due to the stretching of the bladder filling and contraction. Hematuria can also occur when there is a bladder tumor.

4. The International Prostatic Symptom Score (IPSS) asks the patient 7 questions about urination, and scores each question (0 to 5 points) according to the severity of the symptoms, with a total score of 0 to 35 points (no symptoms to very severe symptoms). Among them, 0 to 7 points are mild symptoms; 8 to 19 points are mild to moderate symptoms; 20 to 35 points are moderate to severe symptoms. Although the IPSS analysis attempts to quantify the degree of symptom change, it is still affected by subjective factors.

Physical examination: When urine is retained, the lower abdomen bulges. The upper area of ​​the toes touches the bladder with blood flow. Rectal examination shows enlarged prostate, smooth surface, elasticity, and the central groove becomes light or disappears. Prostatic hyperplasia can be divided into 3 degrees according to the degree of enlargement of the gland duct. Grade I swelling: The male prostate is 1.5 to 2 times larger than normal, the central groove becomes faint, and the distance into the duodenum is 1 to 2 cm; Grade II swelling: The glandular duct is mildly to moderately swollen, 2 to 3 times larger than normal, the central groove disappears or is slightly prominent, and it penetrates 2 to 3 cm into the duodenum; Grade III swelling: The glandular duct is more severely swollen, penetrating more than 3 cm into the duodenum, and the central groove is significantly prominent. The upper edge cannot be touched by fingers during examination (Table 1).