Patient's question:
I recently don't know what's going on, my lower body is very uncomfortable, and I'm not getting morning erections anymore. What should I pay attention to when checking for benign prostatic hyperplasia?Doctor's answer:
In addition to routine blood and urine tests, urine culture and renal function tests are also very important. If surgical treatment is considered, cardiac, pulmonary, hepatic, and blood biochemical examinations should be conducted.◇ During intravenous pyelography, after removing the abdominal compression band and taking the final X-ray, the patient with prostatic hyperplasia should empty their bladder before taking another X-ray to display residual urine.
◇ Catheterization method: After the patient attempts to urinate, a catheter is immediately inserted for examination. This can accurately measure residual urine volume, obtain a urine sample for culture, and perform tests such as the phenol red test and cystography. However, there is a risk of injury, bleeding, and infection, so it should be performed with caution and strict prevention. If a large amount of residual urine is detected, it may be necessary to leave the catheter in place for drainage.
◇ Ultrasound examination method: It is simple, easy to perform, and imposes minimal burden on the patient, with results that are also informative.
Methods for measuring residual urine include:
【Measuring Residual Urine】Measuring residual urine is of great significance for this condition. As mentioned earlier, the degree of prostate hyperplasia does not necessarily correlate with the severity of the disease, so classifying the condition based on prostate size lacks clinical relevance. In contrast, the amount of residual urine can indicate the degree of obstruction and is closely related to the condition.
【Abdominal Examination】Pay attention to whether the bladder is distended. In patients with prostate hyperplasia, the bladder often contains a large amount of residual urine, which can usually be palpated as a distended bladder. However, in cases with a long history of chronic urinary retention, the bladder may be soft and atonic, making it difficult to detect. In such cases, percussion can be used to determine the condition.
【Cystoscopy】Cystoscopy is indeed necessary for certain cases, as it can confirm whether the prostate is hyperplastic, which lobe is affected, and the degree of hyperplasia. Additionally, this examination can provide insights into the bladder's condition and rule out other lesions. However, cystoscopy in patients with prostate hyperplasia can easily cause injury, bleeding, and infection, so it should be used with strict selection and careful, meticulous operation. Close observation is required after the examination.
【Digital Rectal Examination】Digital rectal examination is an important step in diagnosing this condition. In most cases of prostate hyperplasia, a definitive diagnosis can be made through this examination. Positive findings include an enlarged, protruding prostate, disappearance of the central sulcus, widened lateral margins, and a firm yet smooth surface. Based on these characteristics, it can be differentiated from tuberculosis, calculi, and other conditions. However, if the prostate is not enlarged, this examination alone should not rule out the possibility of prostate hyperplasia. For example, if only the median lobe is hyperplastic, the enlarged gland protrudes into the bladder, making it completely undetectable during the examination. During digital rectal examination, attention should be paid to the function of the anal sphincter, which helps differentiate neurogenic bladder dysfunction.