How to distinguish the severity of benign prostatic hyperplasia from a medical perspective

From a medical point of view, the grading of prostate hyperplasia can only explain the extent of prostate enlargement, and cannot explain the extent of obstruction of the prostate gland to the urethra or the severity of the disease.

According to anatomical orientation, the prostate is divided into five lobes: anterior, posterior, left, right, and middle. The proximal end is the inner gland (hereinafter referred to as the inner gland) surrounding the urethra, and the outer end is the outer gland (hereinafter referred to as the outer gland). In a normal prostate gland, the outer gland occupies the majority of the prostate gland, while the inner gland is located in a very small part of the center.

However, when the current columnar gland hyperplasia occurs, the situation is different. "If hyperplasia mainly occurs in the inner layer of the prostate, which tightly surrounds the urethra, even if it is slightly enlarged, it can easily flatten the urethra, causing difficulty in urinating.".

This is because it is still difficult to detect prostate hypertrophy even through digital anal examination. "The external glands may mainly grow laterally, sometimes growing very large, even to the third degree, but they do not oppress the urethra, so there may be no symptoms of urethral obstruction, or symptoms may be mild.". Obviously, the grading of BPH can only indicate the size of the prostate gland, but not the severity of the lesion.

In order to indicate the severity of the disease in patients with BPH, doctors clinically divide BPH into three stages:

In the first stage, the patient has difficulty urinating, frequent urination, increased nocturia, weakness in urination, and trabeculae in the bladder wall due to laborious urination, but there is no residual urine;

The second stage refers to the beginning of decompensation of the urinary muscles in the bladder wall, which leads to residual urine due to the inability to completely exclude urine, often accompanied by chronic bacterial cystitis;

The third stage refers to the decline of bladder emptying function, urinary retention and renal insufficiency caused by long-term urination.

If judged based on the results of urine flow rate measurement, there are several situations:

The maximum and average urinary flow rates of patients in the first stage did not decrease significantly, and the urinary flow patterns were mostly within the normal range;

The maximum and average urinary flow rates of patients in the second stage were significantly decreased, the urination time was significantly prolonged, and the urine flow pattern presented a multi wave curve;

The maximum urinary flow rate of patients in the third or advanced stage is further reduced, and the urination time is longer. The urinary flow pattern is mostly low and flat.

The staging of BPH has certain significance in determining treatment options. It is generally believed that conservative treatment is suitable for patients with stage 1 prostate hyperplasia, and it may also be suitable for patients with early stage 2 prostate hyperplasia. Patients with stage 2 prostate hyperplasia who have poor or progressive effects of conservative treatment, as well as patients with stage 3 prostate hyperplasia, should consider surgical treatment.

In summary, when seeking medical attention, patients with BPH should not only be satisfied with the size of the prostate measured by a doctor through a digital rectal examination, but should combine the severity of their own dysuria symptoms and the results of urine flow rate tests to determine the clinical stage of the disease. If necessary, B-ultrasound, renogram, and blood urea nitrogen tests should also be supplemented. In particular, patients with only once enlarged or even small but symptomatic prostate cancer undergoing digital rectal examination should not be taken lightly because they are not seriously ill, in order to avoid delaying the favorable opportunity for treatment.