Patient's question:
Detailed medical condition and consultation purpose: Nocturia 3-4 times. Prostate hyperplasia. Swelling and discomfort in the perineum, sometimes with a burning sensation. How to treat?Duration and course of the current illness: Over 10 days. Prostate hyperplasia has been causing nocturia for 45 days.
Current general condition: Same as before.
Medical history: Same as before.
Previous diagnoses, treatments, and outcomes: Currently taking Avodart ( terazosin hydrochloride tablets) and Propulsid (domperidone tablets). Same as before.
Ancillary tests: None
Other: None
Doctor's answer:
Hello, regarding the treatment of benign prostatic hyperplasia (BPH), there are generally the following methods:1. Observation and Waiting: Many BPH patients have symptoms that remain stable and mild over the long term and do not require immediate treatment. Observation and waiting can be considered, with annual repeat tests including urine flow rate, serum PSA, digital rectal examination, ultrasound, and the International Prostate Symptom Score.
2. Medication
(1) Adrenergic α-receptor blockers: These primarily address the tension of smooth muscles in the prostate and bladder neck to reduce urinary resistance. Common medications include:
1. Dual α1 and α2 adrenergic receptor blockers: Phenylephrine is a representative example, taken 10mg once or twice daily. Side effects include orthostatic hypotension and a 30% incidence of dizziness.
2. Adrenergic α1-receptor blockers: These can be divided into short-acting and long-acting types.
Short-acting: Prazosin 1mg twice or three times daily; Alfuzosin 2.5mg twice or three times daily.
Long-acting: Tamsulosin (Hypertension) is taken before bedtime each night. Start with 1mg per night for four days, then switch to 2mg per night if there is no significant dizziness.
Among long-acting α1 adrenergic receptor blockers, there is also the α1a-selective blocker Harlow (tamsulosin), which has fewer side effects and better efficacy, taken at 0.2mg per night.
(2) 5α-reductase inhibitors: The most widely used medication currently is finasteride (trade name: Proscar), which blocks the conversion of testosterone to dihydrotestosterone (DHT) in the prostate. This thereby reduces