Patient's question:
Detailed medical condition and consultation purpose: Benign Prostatic HyperplasiaDuration of current illness and persistence: 2 months
Current general condition: Frequent urination 3-4 times. Same as before
History of previous diagnosis and treatment, as well as effectiveness: Taking Proscar and Santal. Occasional sensation of irritation.
Doctor's answer:
Hello: Some treatment methods for benign prostatic hyperplasia (BPH) are as follows:(1) Medication Therapy: Based on the three pathological changes related to BPH symptoms (see Question 126), current medications for BPH are also divided into three categories:
① Cholinesterase inhibitors
Urological (Fluvoxamine hydrochloride), oral, 0.2–0.4 grams per time, three times daily.
② α1 receptor blockers
First-generation α1 receptor blockers (also known as non-selective α1 receptor blockers), such as phenoxybenzamine (), oral, 5–10 milligrams per time, once daily. Adverse reactions mainly include dry mouth, nasal congestion, dizziness, fatigue, and orthostatic hypotension, which disappear after discontinuation. Second-generation α1 receptor blockers (also known as selective α1 receptor blockers), such as prazosin, oral, 2 milligrams per time, twice daily; Sata (alfuzosin), oral, 2.5 milligrams per time, three times daily; Goutling (terazosin), oral, once daily before bedtime, 2 milligrams per time. Adverse reactions are less severe than those of the first generation. Third-generation α1 receptor blockers (also known as ultra-selective α1 receptor blockers), such as Harle, oral, 0.2 milligrams per time, once daily. Performance is better than the previous two.
③ Drugs to Reduce Prostate Volume
Prostate is a pollen preparation containing various bioactive enzymes, trace elements, and amino acids. It reduces prostate volume and improves related symptoms by regulating sex hormone metabolism. Oral, 6 tablets per time, three times daily. Mepar (Urorec) can inhibit the absorption of hormones in the liver-intestine cycle, improving symptoms by reducing hormone levels. Oral, one tablet per time, three times daily. Proscar (Pros) is a 5α-reductase inhibitor. Oral, 5 milligrams per time, once daily. Sanctum (Pristine) is an extract of naked oat pollen, which inhibits the binding of dihydrotestosterone to its receptors. Oral, 375 milligrams per time, twice daily. Berberis, which can simultaneously inhibit 5α-reductase and phospholipase A2, reduces prostate volume, fights inflammation, and alleviates edema. Oral, 160 milligrams per time, twice daily. TURP (Urological) is an extract of African chestnut, a fibroblast and growth factor inhibitor. Oral, 50 milligrams per time, twice daily.
(2) Surgical Treatment
For patients with BPH with residual urine exceeding 60 milliliters or frequent urinary retention and infections, surgical treatment remains an important and effective method. Currently, the main surgical methods include the following:
① Suprapubic transvesical prostatectomy, the most commonly used surgical method, suitable for patients with bladder complications.
② Posterior pelvic prostatectomy, suitable for patients with simple BPH and larger prostate gland volume.
③ Posterior pelvic extravesical prostatectomy (Madigan procedure), which can better preserve urethral integrity.
④ Transurethral resection of the prostate (TURP), suitable for patients with prostate weight below 60 grams, unwilling to undergo open surgery, or with severe complications that cannot tolerate open surgery.
⑤ Perineal prostatectomy, suitable for patients with severe cardiopulmonary diseases, but currently used less frequently.
For patients who cannot tolerate open surgery, simple bladder catheterization can be performed.
(3) Microwave Hyperthermia
Applying a fixed microwave heat source to the prostate causes cells within a 2-centimeter radius to degenerate and die, blood vessels to atrophy, and the urethral segment of the prostate to widen, thereby improving symptoms while maintaining urethral wall integrity. Microwaves are high-frequency electromagnetic waves whose energy interacts with tissue fields, causing ion oscillation or local temperature rise due to changes in molecular magnetic field direction. The temperature for microwave treatment of BPH is 45°C–47°C, which can also damage normal tissues. Therefore, microwave treatment devices are equipped with temperature-measuring devices and computerized automatic monitoring, along with a water cooling circulation system to protect normal tissues such as the urethral mucosa. Treatment methods include transurethral, transrectal, and extracorporeal approaches, but repeated treatments are required for significant efficacy, and long-term outcomes are not ideal.
(4) Radiofrequency Hyperthermia
Radiofrequency has a longer wavelength than microwaves, stronger penetration, and dual heating and sensing functions, resulting in deeper heat therapy. Single treatments often yield effective results in about 1 hour, without the need for a water cooling system.
(5) Laser Therapy
Laser treatment for BPH primarily utilizes its photothermal and photoacoustic effects. Currently, continuous-wave laser surgery is commonly used, mainly in three forms:
① Non-contact, where the laser reaches the tissue through air or liquid.
② Contact-based transurethral laser prostatectomy, which directly vaporizes prostate tissue, immediately widening the urethral segment.
③ Interstitial laser coagulation of the prostate (ILCP), where low-energy YAG laser is inserted into the enlarged prostate tissue via perineal puncture through an optical fiber.
(6) Urethral Stents
Memory alloy stents, primarily titanium-nickel alloy, can be shaped arbitrarily below 40°C and rapidly restore their original form at 37°C. These spiral stents are generally placed and fixed under cystoscopy in the prostate segment of the urethra. Placement location is critical. Initial reactions may include incontinence, which typically resolves within about two months.
(7) Prostate Dilators
Inserting the prostate dilator (auto-positioning) into the bladder and rotating the simple operation plate can quickly position the dilator accurately at the bladder neck and urethral segment, fully splitting the prostate without damaging the external sphincter. However, it is not suitable for patients with mid-lobe prolapse into the bladder.
Active self-care for BPH patients is of great importance for coordinating treatment and disease outcomes.
(1) Diet should be light and easily digestible, with plenty of vegetables and fruits, while avoiding spicy and irritating foods, alcohol, and reducing the chance of prostate congestion.
(2) Regarding sexual activity, neither overindulgence nor abstinence is recommended; it should be adjusted based on age and health status. Patients with a history of urinary retention should be cautious and avoid sexual activity if possible.
(3) as little as possible, as the bicycle seat can compress the upper prostate area, worsening the condition.
(4) Avoid holding urine for long periods to prevent damage to the detrusor muscle and exacerbation of symptoms.
(5) Maintain a calm mood, avoid excessive worry and anger, and avoid overexertion.
(6) Treat urinary and genital infections promptly and actively prevent urinary retention.
(7) Engage in moderate physical activity to enhance the body's resistance and improve local blood circulation in the prostate.
(8) Before going to bed each night, massage acupoints (Yongquan, Huanyin, Guanyuan, Zhongji, etc.) and repeatedly perform kegel exercises.