Post Date December, 03 2023
Benign adenomatous hyperplasia of the prostate around the urethra leads to varying degrees of bladder outflow obstruction.
The main difficulty in determining the prevalence of benign prostatic hyperplasia is the lack of a common definition. According to autopsy, the prevalence of benign prostatic hyperplasia diagnosed by histology is 8% among men aged 31 to 40 years old, 40% to 50% among men aged 51 to 60 years old, and more than 80% among men aged over 80 years old. According to clinical standards, i.e. prostate volume>30ml and high international prostate symptom scores, the prevalence of benign prostatic hyperplasia in men aged 55-74 years who do not have prostate cancer is 19%. If the prostate volume>30ml, the score is high, the maximum urine flow rate<10ml/s and the residual urine volume after urination>50ml are used as the criteria, the incidence rate is only 4%.
When benign prostatic hyperplasia is accompanied by urinary tract infection or azotemia due to bladder outflow tract obstruction, initial medical treatment should be directed towards stabilizing renal function, discontinuing anticholinergic and sympathomimetic drugs, and eliminating infection. Urethral or suprapubic catheter drainage should be used for advanced bladder outflow tract obstruction. Chronic obstructive and dilated bladder should be slowly decompressed to avoid post obstructive diuresis. For patients with mild or moderate obstructive symptoms, use α- Adrenergic blockers such as terazosin can improve urination. five α- The reductase inhibitor finasteride can reduce the volume of the prostate and improve urination over a period of time (months), especially for patients with large prostate sizes (>40ml). All these patients should avoid using anticholinergics and anesthetics to avoid causing obstruction.
The final treatment is surgery. Although it is usually possible to preserve sexual capacity and control urination after surgery, approximately 5% to 10% of patients will experience some postoperative problems. Transurethral resection of the prostate (TURP) is the most commonly used surgical method. Larger prostates (often>75g) may require an open suprapubic or retropubic approach to remove adenomatous tissue from the surgical capsule. The incidence of impotence and urinary incontinence is much higher than that of transurethral resection of the prostate. All surgical methods require postoperative catheter drainage for 1 to 5 days. Other surgical methods include urethral stenting, microwave hyperthermia, high intensity ultrasound hyperthermia, laser ablation, electrovaporization, and radio frequency steam therapy, but their effects have not been determined.
