Disease Description (Causes and Symptoms)
- Definition·pathophysiology: Benign cell proliferation occurs in the transition zone of the prostate, compressing the urethra and causing lower urinary tract obstruction. It is influenced by male hormones (testosterone → DHT), and age and genetic factors are known to be major associated factors. If obstruction persists for a long time, bladder wall thickening·detrusor muscle (bladder contractile force) weakening, hydronephrosis due to upper urinary tract reflux, and decreased kidney function may occur.
- Main symptoms: Delayed initiation of urination (hesitancy), weak urinary stream, intermittent urination, feeling of incomplete bladder emptying, frequent urination·nocturia·urgency (storage symptoms), difficulty urinating, hematuria, urinary tract infection, and acute urinary retention (a condition in which no urine comes out at all).
Treatment Methods and Precautions
- Treatment principles: Conservative treatment·medication·procedures·surgery are selected according to symptom severity (such as IPSS), presence or absence of complications (frequent urinary tract infections, bladder stones, acute urinary retention, decreased kidney function), prostate size, and the patient’s general condition.
- Conservative treatment·lifestyle management
- Adjust fluid intake (limit excessive intake in the evening), and limit caffeine·alcohol·irritating foods
- Timed voiding, double voiding (wait briefly after urinating and try again)
- Weight control and regular exercise
- Medication treatment
- Alpha-1 blockers (e.g., tamsulosin, alfuzosin, etc.): Improve urination by relaxing the smooth muscles of the prostate·bladder neck; act quickly (within days to weeks). Side effects: dizziness·orthostatic hypotension·fatigue.
- 5α-reductase inhibitors (e.g., finasteride, dutasteride): Reduce prostate size (requires at least 3–6 months of treatment), improve symptoms·urinary flow, and reduce the need for surgery. Side effects: decreased libido·erectile dysfunction·decreased semen volume. Care is needed when interpreting decreased PSA levels.
- Combination therapy: Alpha blockers + 5α-reductase inhibitors may be considered in moderate to severe cases, aiming to improve symptoms and reduce prostate size simultaneously.
- When storage symptoms are present: Antimuscarinic agents or beta-3 agonists (mirabegron) may be used, but caution is needed when there is a large amount of residual urine.
- PDE5 inhibitors (e.g., tadalafil): May help improve LUTS in some patients.
- Procedures·surgery
- Transurethral resection of the prostate (TURP): Standard surgery.
- Holmium laser enucleation of the prostate (HoLEP): Effective even for large prostates and associated with less bleeding.
- Open prostatectomy: Considered for very large prostates.
- Minimally invasive procedures (convective water vapor thermal therapy, stents, etc.): Selected when standard surgery cannot be performed because of poor general condition.
- Insertion of a urinary catheter or urethral stent is a means of securing urination temporarily·permanently.
- Common postoperative side effects: Retrograde ejaculation (semen flows back into the bladder), temporary·persistent urinary incontinence, and, rarely, erectile dysfunction.
- Emergencies and complications
- Acute urinary retention requires emergency treatment (catheter insertion).
- If left untreated for a long time, decreased bladder function, urinary tract infections, bladder stones, and decreased kidney function (hydronephrosis) may occur.
- Medication·interaction precautions
- Cold medicines (sympathomimetic decongestants)·anticholinergic agents may worsen difficulty urinating.
- When starting an alpha blocker, be cautious of hypotension·dizziness (especially in patients taking antihypertensive medication concomitantly).
- Whether anticoagulants are being taken must be confirmed before surgery.
Checkpoints Before an Outpatient Visit (Including Preparation Items and Sample Questions)
- Items to prepare (recommended to bring)
- A list of all medications·supplements currently being taken (including dosage·administration times)
- Previous test results: PSA, urinalysis, ultrasound (residual urine·prostate size), uroflowmetry (uroflow), etc.
- Recent symptom records: IPSS score (if available), number of nighttime urinations, number·frequency of urinations, and whether there is a history of acute urinary retention
- A voiding diary (24-hour urine volume·urination times)
- Underlying diseases (cardiovascular disease·diabetes·kidney disease, etc.) and whether anticoagulants are being taken
- Information to tell the doctor in advance during the outpatient visit
- Recent fever·burning symptoms (suspected urinary tract infection), hematuria, or inability to urinate acutely
- History of previous prostate surgery or catheter use
- Items the doctor may ask about during the consultation (it is helpful to prepare these in advance)
- When the symptoms began and how they have progressed, and whether they improve with medication
Examples of General Questions to Ask the Doctor
- What are the expected effects and estimated duration of this medication (or surgery)?
- What are the main side effects of the medication, and how should they be managed?
- Based on my current symptoms·test results, is surgery necessary? When would be the appropriate time?
- What impact will treatment or surgery have on sexual function (erection·ejaculation)?
- What are the intervals for regular monitoring (checkups) and the necessary tests (PSA, residual urine, ultrasound, etc.)?
- What should I do if acute urinary retention or a high fever·severe hematuria occurs?
Examples of Disease-Specific Questions
- Judging from my IPSS score (or residual urine volume, urinary flow), is medication treatment sufficient, or do you recommend surgery?
- If I take a 5α-reductase inhibitor (finasteride/dutasteride), how will the interpretation of the PSA test change? How should cancer screening be managed?
(Additional: Bringing the test results·medication list prepared before the visit will help with more accurate consultation and establishment of a treatment plan.)