Diagnosis and treatment of benign prostatic hyperplasia: Management of urinary disorders in elderly men

Diagnosis and treatment of benign prostatic hyperplasia

The prostate is a solid organ composed of glands and muscles, shaped and sized like a chestnut, located below the bladder, with the urethra passing through the middle.

After middle age, men's prostate glands gradually enlarge, which can compress the urethra and cause urinary obstruction. This is what doctors call benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) is a serious obstructive disease of the urinary tract. Due to its long history, it can cause a series of consequences and is often accompanied by infection, sometimes secondary stones, and even death due to kidney damage.

The clinical manifestations of benign prostatic hyperplasia (BPH) are caused by urethral compression and bladder outlet narrowing, which affects the normal bladder function.

The main symptom is frequent urination.

Difficulty urinating and urinary retention.

This can lead to signs of complications.

Urinary dysfunction usually develops gradually and worsens over time.

Initially, patients are often unaware of it or think it is a natural phenomenon of the elderly and therefore do not pay attention to it.

The medical history is generally several to several decades, and patients often seek medical attention for acute urinary retention.

Frequent urination is a common symptom of this disease.

Initial urinary frequency may be related to prostate congestion and irritation; with prolonged illness, there will be an increase in residual urine in the bladder and an increase in the frequency of urination.

Frequent urination is especially common at night.

Difficulty urinating is characterized by straining or prolonged urination, requiring several minutes to urinate each time, a thin or weak urine stream, or even dribbling or interruption of urine flow.

Acute urinary retention refers to the inability to urinate, often caused by factors such as cold, alcohol consumption, overwork, or colds, which lead to pelvic congestion.

In cases of acute urinary retention, the bladder is highly distended, sometimes reaching as far as the navel.

Urinary dribbling or overflow incontinence occurs when the bladder is overfilled, causing urine to leak involuntarily from the urethra.

In addition, if there is a concurrent infection or stones, painful urination may occur.

Hematuria can occur due to a sudden increase or decrease in bladder pressure, or due to the rupture of blood vessels in the bladder caused by external force. Sometimes, severe hematuria and blood clots may be present.

Men with benign prostatic hyperplasia (BPH) are prone to urinary tract infections. These infections are often caused by contamination of the urine during catheterization when there is acute urinary retention. Symptoms may include bladder irritation. If the infection ascends to the kidneys, symptoms of acute pyelonephritis may appear, such as high fever, chills, and lower back pain.

Men with a long history of benign prostatic hyperplasia (BPH) may develop chronic renal failure.

Those with kidney failure may experience symptoms such as fatigue, loss of appetite, thirst, and anemia.

Increased non-protein nitrogen in the blood, decreased carbon dioxide combining power, low urine specific gravity, and often elevated blood pressure.

Benign prostatic hyperplasia (BPH) is relatively easy to diagnose. Men over 50 years of age who experience difficulty urinating or acute urinary retention should be considered for this condition.

Digital rectal examination is the primary diagnostic method.

Digital rectal examination is when a doctor inserts a gloved finger into the patient's anus to palpate.

If a digital rectal examination reveals an enlarged and protruding prostate with a smooth surface, neat edges, and an elastic, firm texture, and if the central groove is shallow, disappears, or protrudes, a diagnosis can be made based on the clinical manifestations.

In cases of isolated median lobe hypertrophy, digital rectal examination may be completely normal.

If there is doubt about the diagnosis, the following tests can be performed.

Cystoscopy allows direct observation of the bladder's interior. In cases of benign prostatic hyperplasia (BPH), a typical bulge of the internal urethral orifice can be observed. It also allows for observation of bladder diverticula or stones, and measurement of residual urine volume.

Cystography: The lower border of the bladder can be seen to be displaced upward above the level of the pubic symphysis, and a shadow defect can be seen in the bladder neck.

Residual urine volume measurement: The urine discharged immediately after the patient urinates is the residual urine volume.

The degree of obstruction can be inferred from the amount of residual urine.

Benign prostatic hyperplasia (BPH) must be differentiated from prostate cancer.

Early-stage prostate cancer often presents with no symptoms. During a digital rectal examination, irregular, hard nodules may be found on the prostate, with an uneven surface that can infiltrate surrounding tissues.

If bone metastasis occurs, there is often severe pain, especially at night.

The following are some treatment options for benign prostatic hyperplasia (BPH):

Hormone therapy: Hormone therapy can be used for early-stage cases of benign prostatic hyperplasia, patients with poor physical condition who cannot undergo surgery or refuse to undergo surgery.

Experiments have shown that female hormones have a close relationship with prostate tissue; female hormones can cause the prostate to shrink and reduce its size, thus improving symptoms.

The most commonly used female hormone is diethylstilbestrol, which is mostly taken orally and can be administered in bolus doses or small doses.

For patients with acute urinary retention, a bolus dose can be administered during the first week, with 10-15 mg daily on days 1-3, 5-10 mg daily on days 4-7, and 3 mg daily in subsequent weeks, for a total of approximately 10-150 mg. For patients with mild symptoms, such as urinary frequency or residual urine, 5-6 mg daily is administered during the first week, followed by 2-3 mg daily for the next three weeks, for a total of approximately 70-100 mg. One month constitutes one course of treatment.

The main side effects of diethylstilbestrol are breast tenderness and loss of appetite. The duration of administration and dosage can be determined according to the size of the breasts.

If symptoms do not improve, surgical treatment may be considered.

Acupuncture treatment: It also has a certain therapeutic effect on cases of benign prostatic hyperplasia.

For acute urinary retention, acupuncture can be performed at Qihai, Guanyuan, Shuidao, and Sanyinjiao.

Surgical treatment: Prostatectomy is the most effective treatment for this disease.

However, since patients with this disease are all elderly, anesthesia and surgery can pose life-threatening risks or induce serious complications. Therefore, the selection of surgical indications, preoperative preparation, and postoperative care must be carefully and meticulously considered.