Patient's question:
I am a 70-year-old male who has been retired for 10 years. For over a decade, every physical examination has indicated benign prostatic hyperplasia (BPH), but it was never taken seriously. Occasionally, I have taken medications like (Prostatic Capsule), and I often eat raw pumpkin seeds.More than two years ago, during a physical examination in Beijing, it was discovered that I had hydronephrosis. However, the exact primary cause has not been identified. I have also researched this online and know that BPH can also lead to hydronephrosis. I have tried screening for other potential causes of hydronephrosis in the urinary system, such as checking for stones in the kidneys, ureters, and bladder via ultrasound. The examination is still ongoing, but BPH is confirmed.
In the past six months, I have been taking medication for BPH. Overall, there has been improvement in urinary frequency and urgency. I now urinate about once during the night, which I am quite satisfied with, and plan to continue the treatment. However, I have experienced two episodes of hematuria (blood in urine) during exercise recently. The ultrasound results showed that the prostate has enlarged to 4.6×3.9×3.3 cm, with a relatively normal shape and a central sulcus still present. The internal echo points were slightly uneven, with visible bright spots. The bladder was full, with rough and thickened walls, and visible trabeculations and small cavities. No abnormal low-echo or solid masses were observed in the bladder. Both kidneys were of normal size and shape, with intact renal capsules and uniform renal parenchymal echoes. The renal system showed separated light point clusters, with a fluid-dark area of approximately 2.1 cm in both front and back. Both ureters were dilated, with a larger inner diameter of about 1.0 cm, and no visible bright spots or low-echo areas.
Additionally, more than a year ago, I had my post-void residual (PVR) measured, which was around 70 mL, indicating a relatively large amount. This should also be a surgical indication.
Furthermore, I had hernia surgery last summer. I understand that, in addition to excluding factors like urinary system stones, hydronephrosis and hernia are likely complications of my BPH.
Doctor's answer:
1. Hydronephrosis, hematuria, urinary retention, and hernia are all indications for prostate surgery, and surgical treatment is generally recommended.2. Although you feel that urination is normal, changes in bladder trabecular cavities and an increase in residual urine suggest lower urinary tract obstruction. It is recommended to re-examine with a urinary system ultrasound + residual urine test, as well as a uroflowmetry test.
3. The prostate volume is approximately 30ml, which is not too large. It is recommended to check PSA to understand the possibility of prostate tumors.
4. If the hydronephrosis is caused by obstruction, it is recommended to leave a urinary catheter to first alleviate the hydronephrosis and protect renal function.
5. Continue taking medication. If hydronephrosis reappears after the catheter is removed, conservative treatment is not recommended.