"How Can Prostate Enlargement with Cysts Be Effectively Treated?"

Update Date: 2024-09-19 Source: Network

Treatment for Enlarged Prostate with Cysts

The prostate is a vital gland in men's bodies, but it is also prone to pathological changes, especially in middle-aged and elderly individuals who may develop benign prostatic hyperplasia (BPH), characterized by symptoms such as frequent urination, urgency, and incontinence, significantly impacting health and quality of life. Some patients not only suffer from BPH but also have cysts, and in such cases, the primary concern is often the treatment method. Let's explore how to treat an enlarged prostate accompanied by cysts.

I. Treatment for Enlarged Prostate with Cysts

1. Small cysts without clinical symptoms may not require treatment.

2. Cyst puncture and injection therapy involves puncturing the cyst under ultrasound guidance through the perineum or rectum, aspirating the cyst fluid, and injecting a sclerosing agent. However, this method is prone to recurrence.

3. Surgical treatment is necessary if the cyst protrudes into the urethra or bladder. Transurethral resection of the cyst wall is performed for adequate drainage. For larger cysts, resection can be done through a suprapubic or perineal approach, but this method often results in incomplete removal and easy recurrence.

II. Treatment for Enlarged Prostate

The harmfulness of BPH lies in the pathophysiological changes caused by lower urinary tract obstruction. The pathological individual differences are significant, and not all cases progress continuously. Some lesions stop progressing at a certain point, so even mild obstructive symptoms do not always require surgery.

1. Observation and Wait: For mild symptoms with an IPSS score below 7, observation without treatment is recommended.

2. Pharmacological Treatment:

(1) 5α-Reductase Inhibitors are suitable for BPH patients with enlarged prostate volume accompanied by moderate to severe lower urinary tract symptoms. 5α-Reductase is a crucial enzyme in the conversion of testosterone to dihydrotestosterone, which plays a role in BPH. Therefore, 5α-Reductase inhibitors can inhibit hyperplasia.

(2) α1-Blockers are suitable for BPH patients with moderate to severe lower urinary tract symptoms. These drugs are believed to improve dynamic urinary obstruction, reduce resistance, and alleviate symptoms. Commonly used drugs include terazosin, with side effects such as dizziness, headache, fatigue, drowsiness, orthostatic hypotension, and abnormal ejaculation.

(3) Other options include M-receptor antagonists, plant preparations, and traditional Chinese medicine. M-receptor antagonists block bladder M-receptors, alleviate overactive detrusor contractions, reduce bladder sensitivity, and improve storage symptoms in BPH patients. Plant preparations like Prostat are suitable for treating BPH and related lower urinary tract symptoms.

Comprehensive assessment of the condition before pharmacological treatment is crucial, considering drug side effects and the possibility of long-term medication. Long-term follow-up and regular urodynamic examinations are necessary to observe the therapeutic effects and avoid delaying surgical intervention.

3. Surgical Treatment: Surgery remains an essential treatment for BPH, suitable for patients with moderate to severe lower urinary tract symptoms (LUTS) significantly affecting their quality of life. Classical surgical methods include transurethral resection of the prostate (TURP), transurethral incision of the prostate, and open prostatectomy. Currently, TURP is still the "gold standard" for BPH treatment. Surgical indications include:

Lower urinary tract obstruction symptoms with significant changes in urodynamic examination or residual urine exceeding 60ml.
Severe unstable bladder symptoms.
Upper urinary tract obstruction and renal function impairment.
Repeated episodes of acute urinary retention, urinary tract infections, or gross hematuria.
Concurrent bladder stones.
Combined with inguinal hernia, severe hemorrhoids, or rectal prolapse, where the clinical judgment indicates that the treatment effect cannot be achieved without relieving lower urinary tract obstruction.

For patients with long-term urinary obstruction, significantly impaired renal function, severe urinary tract infections, or acute urinary retention, a urethral catheter should be inserted first to relieve the obstruction. Surgery should be performed after infection is controlled and renal function recovers. If urethral catheterization is difficult or causes urethritis due to prolonged catheterization