Benign prostatic hyperplasia (BPH) is a common condition in elderly men, typically occurring after the age of 50. Its incidence increases with age and has become a prevalent disease in urology.

bubble_chart Etiology

Prostate hyperplasia is closely related to the imbalance between androgens and estrogens in the body. Testosterone, the primary male androgen, is converted into dihydrotestosterone under the action of enzymes. Dihydrotestosterone is the active hormone that stimulates prostate hyperplasia. Estrogens also have a certain influence on prostate hyperplasia.

bubble_chart Clinical Manifestations

The symptoms of benign prostatic hyperplasia appear gradually as the pathological changes progress. In the early stages, due to bladder compensation, the symptoms are not obvious, so patients often cannot accurately recall the duration of the condition. As the disease worsens, various symptoms emerge.

1. Frequent urination and urgency: The most common symptom is frequent urination, which gradually worsens, especially increased nocturia.
2. Progressive difficulty in urination: Mainly manifested as slow onset of urination, straining to urinate, weak urine stream, thin urine flow, dribbling, interrupted urination, and incomplete voiding.
3. Urinary incontinence.
4. Acute urinary retention: If triggered by factors such as cold exposure, alcohol consumption, or fatigue, leading to congestion and edema of the gland and bladder neck, acute urinary retention can occur. The patient's bladder becomes extremely distended, causing pain, frequent urges to urinate, restlessness, and difficulty sleeping.
5. Hematuria: The amount of bleeding varies, mostly intermittent, but occasionally severe bleeding may occur, filling the bladder with blood clots, requiring emergency treatment.
6. Symptoms of renal insufficiency: In the advanced stage, long-term urinary obstruction leads to decreased kidney function, manifesting as loss of appetite, nausea, vomiting, and anemia.
7. Other symptoms: Due to long-term difficulty in urination and reliance on increased abdominal pressure to urinate, it may cause or aggravate hemorrhoids, rectal prolapse, and hernias.

bubble_chart Treatment Measures

Benign prostatic hyperplasia does not require treatment if there are no symptoms of urinary tract obstruction or bladder and renal dysfunction. Treatment should be considered if it affects urination and normal life.

1. Management of acute urinary retention: Emergency measures must be taken:
   1. Use α-adrenergic receptor blockers to relax the bladder neck, facilitating urine discharge.
   2. Insert an indwelling catheter to drain urine. If necessary, a bladder fistula may be performed.
2. Non-surgical treatment: Suitable for those with mild urinary tract obstruction, or elderly and frail patients, or those with cardiopulmonary insufficiency who cannot tolerate surgery.
   1. Hormone therapy: Estrogen can shrink the prostate gland and improve urinary symptoms, but symptoms may recur after discontinuation.
   2. α-adrenergic receptor blocker therapy: Effective for early-stage benign prostatic hyperplasia with satisfactory results.
   3. Injection therapy: This method has unstable efficacy, a high recurrence rate, and may easily cause perineal pain.
3. Surgical treatment: Includes radical prostatectomy and conservative surgery, bilateral orchiectomy, or enucleation.
4. Cryotherapy: Domestic reports indicate an efficacy rate of up to 94%. However, the depth and extent of freezing are difficult to control, and complications such as bleeding, urinary incontinence, and rectal fistula may occur.
5. Microwave and radiofrequency therapy: Hyperplastic prostate tissue undergoes coagulative necrosis and sloughing after microwave and radiofrequency treatment, achieving therapeutic goals.
6. Laser therapy: Laser energy, delivered via optical fibers under endoscopic visualization, can transform hyperplastic prostate tissue to achieve therapeutic effects.
7. Metal pressure-resistant balloon dilation: Shows certain short-term efficacy.
8. Application of nickel-titanium shape-memory alloy spiral stents: Offers advantages such as simple operation, minimal pain, reduced injury, low cost, quick recovery, and avoidance of bladder fistula.