Elderly prostate problems, actively facing and not avoiding them
2024-06-28
This spring, Uncle Zhang and his wife, who had just retired, went on a trip to another city. Although the itinerary was tight in the first two days, they had a great time playing. On the third day, Uncle Zhang experienced frequent urination, urgency, and hematuria, just like strong tea. Uncle Zhang was extremely nervous. It was his first time encountering this situation, but fortunately, there was a hospital near the hotel. He went to the hospital for emergency treatment. The doctor carefully inquired about the old man's medical history and helped to check his urine, urinary ultrasound, and residual urine. It turned out that Uncle Zhang is usually weak in urination and has a habit of waking up at night. He always thought he was getting old, but this situation is normal and has not been taken seriously, let alone diagnosed and examined at the hospital. This examination found that it was elderly prostate hyperplasia with a small stone in the bladder, and Uncle Zhang had been taking aspirin anticoagulant drugs orally. After the patient explanation of the doctor, Uncle Zhang was no longer nervous, and the hospital helped to prepare some oral medication to continue his journey. The prostate is a male specific gonadal organ located at the junction of the bladder and urethra, similar to the relationship between the water tank and the lower water pipe at home. It is very important for male sexual function. The prostate fluid produced during youth is the main component of semen, so many young people with sedentary and urinary holding habits are prone to prostatitis. As male friends age, the prostate gland also quietly grows larger, medically known as benign prostatic hyperplasia, which has an outdated name: benign prostatic hyperplasia, but doctors no longer use it. Aging and stimulation by androgens are the main causes of prostate enlargement. Approximately 40% -50% of males over 50 years old have prostate enlargement, with a prevalence rate of over 60% for those over 69 years old and around 90% for those over 80 years old. What are the symptoms of benign prostatic hyperplasia? Overall, it is a gradual process of change, and sudden onset may occur under triggering factors such as alcohol consumption and holding urine. If an elderly person experiences progressive difficulty urinating, weakness, frequent urination, urgency, incomplete urination, and increased nocturia (more than 2 times), they should seek medical examination in a timely manner and see a urologist. Doctors may diagnose prostate hyperplasia through methods such as rectal digital examination, urine routine examination, prostate specific antigen (PSA) testing, and ultrasound examination. After a professional assessment of the patient's condition, the two most common questions can be answered: "Doctor, do I need to take medication?" "Doctor, do I need surgery?" For patients with mild symptoms or those that do not affect their quality of life, the doctor will suggest observing and waiting, and conducting regular examinations to adjust their lifestyle, such as reducing coffee and alcohol intake, avoiding strong tea, exercising appropriately, sitting soon, and not holding urine. If the above symptoms affect normal life, it is necessary to choose medication treatment. Common medications include: alpha 1 receptor blockers: by blocking the alpha 1 receptors in the prostate and bladder neck, it reduces prostate tension and bladder outlet obstruction, making urine flow smoother during urination, thereby alleviating symptoms. 5 alpha reductase inhibitors (5ARIs): By inhibiting the conversion of testosterone to dihydrotestosterone (DHT), the content of DHT in the prostate is reduced. Long term use can reduce prostate volume, and this process is relatively long, at least for more than half a year, or even longer. M-receptor antagonist: improves bladder storage function, significantly improves urinary frequency and nocturia, and is suitable for patients with obvious symptoms during the storage period. Traditional Chinese medicine in traditional Chinese medicine: according to the treatment based on the differentiation of symptoms and signs in traditional Chinese medicine, prostatic hyperplasia belongs to the category of urosis, located in the bladder seminal chamber, closely related to the liver, spleen and kidney. The pathogenesis is the downward injection of damp heat, mutual obstruction of phlegm and blood stasis, deficiency of spleen and kidney. Therefore, the treatment is based on the basic principle of clearing heat and removing dampness, removing blood stasis and resolving stagnation, and tonifying the spleen and kidney. Clinicians will choose different prescriptions or proprietary drugs according to the specific situation. There are also some patients with BPH whose symptoms are getting worse, who have obvious obstruction or complications, and who have moderate to severe BPH. When their quality of life is affected, they have recurrent urinary retention, recurrent hematuria, ineffective drug treatment, recurrent urinary tract infection, bladder stones, secondary hydronephrosis of the upper urinary tract, and so on. At this time, they need surgical treatment, mainly minimally invasive surgery. The classic surgical methods include transurethral resection of the prostate, transurethral prostatotomy, and lower abdominal laparoscopy and robot assisted lower prostate removal. At present, transurethral resection of the prostate remains the gold standard for the treatment of benign prostatic hyperplasia. Various surgical methods have similar or similar therapeutic effects to transurethral resection of the prostate, but there are risks of postoperative bleeding, urinary incontinence, urethral stricture, retrograde ejaculation, etc. With technological progress, the incidence rate is decreasing year by year. As an alternative treatment, transurethral vaporization of the prostate, transurethral plasma bipolar resection of the prostate, and transurethral plasma prostatectomy are also suitable for surgical treatment. Laser surgery currently includes transurethral holmium laser, green laser, blue laser, and thulium laser for anterior gland ablation or resection. Through lower abdominal laparoscopy or robot assisted surgery, with more precise surgical procedures, the prostate urethra and bladder neck are preserved, resulting in fewer complications such as urinary incontinence and stenosis. Transurethral resection of the prostate (TURP): As the standard surgical method for treating benign prostatic hyperplasia, it is suitable for patients with a prostate volume of 30-80 ml. Emerging treatment option: Prostatic Urethral Lift (PUL): A novel minimally invasive surgery that involves physical dilation of the prostate urethra through urethral implantation without removing tissue, suitable for patients who wish to preserve ejaculation function. Prostate artery embolization: By blocking the blood flow of the prostate, the prostate tissue shrinks, achieving the therapeutic goal. Steam energy ablation therapy: using high-temperature steam to ablate prostate tissue and reduce prostate volume. Image guided robot water jet ablation therapy: using robot technology for precise water jet therapy to reduce prostate volume. Preventive measures: Pay attention to rest, maintain a regular schedule, have a reasonable diet, exercise appropriately, limit the intake of alcohol and caffeinated drinks, and avoid prolonged cycling or motorcycle riding. Avoiding misunderstandings: Prostate health devices and products on the market are not helpful for prostate hyperplasia and should not be used blindly. Psychological factors: Prostate surgery may be influenced by the patient's psychological state, so maintaining a good mindset is important for postoperative recovery. Professional consultation: In the face of benign prostatic hyperplasia, it is important to promptly seek medical attention at a reputable hospital and follow the advice of a professional doctor. After the above explanation, I believe you have gained some understanding of prostate hyperplasia. Returning to the beginning of this article, Uncle Zhang, led by his family, immediately went to a tertiary hospital at his doorstep for further examination. Uncle Zhang stopped using aspirin for a week and underwent minimally invasive surgery for prostate hyperplasia and bladder stones at the Sixth People's Hospital of Shanghai. Minimally invasive surgery can preserve the prostate urethra, bladder neck, and urethral sphincter without damage, and there is no urinary incontinence or other troubles after the surgery. After one week, the urinary catheter is removed. Now, Lao Zhang doesn't have to wake up at night to go to the bathroom anymore. He has a happier time traveling and retiring in his later years. (Lai Xin She)
Edit：Xiong Dafei Responsible editor：Li Xiang
Source：WHB
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