Article 118: Symptoms and Stages of Benign Prostatic Hyperplasia

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What are the symptoms?

Symptoms typically appear after age 50. The severity of symptoms depends on the degree of obstruction, the speed of disease progression, and whether there is concurrent infection or stones, rather than the degree of prostate enlargement itself. If enlargement does not cause obstruction or causes only mild obstruction, there may be no symptoms at all, and it has no impact on health.

1. Early symptoms of benign prostatic hyperplasia (BPH):

(1) Frequent urination: The most obvious is the increase in the number of times you urinate at night.

(2) Incomplete urination: After urination, there is dull pain in the urethra, dribbling after urination, residual urine dripping out, or lower abdominal discomfort.

(3) Thin urine stream: The ability to urinate is weakened and the urine stream becomes thinner.

(4) Difficulty urinating: urethral obstruction increases resistance to urine excretion.

(5) Changes in urine: hematuria and pyuria may be observed.

(6) Discomfort in the posterior urethra and pressure in the perineum.

2. Symptoms of mid-stage benign prostatic hyperplasia:

(1) Increased urinary frequency.

(2) Significant difficulty in urinating.

(3) Prolonged urination time, thin urine stream, and interruption of urine stream.

(4) Residual urine appears, 50-100 ml.

(5) Hematuria is likely to occur at the end of urination, and there is a lot of residual urine which makes it easy to get infected. The symptoms of painful urination are obvious, but the general condition is still good.

3. Symptoms of late-stage benign prostatic hyperplasia:

(1) The frequency of urination is more severe, with an increase in the number of urinations, especially at night.

(2) The difficulty in urinating is progressively worsening.

(3) The urination time is significantly prolonged, the urine stream is not continuous, the urine stream is very short, and sometimes the clothes are wet.

(4) Bladder function has decompensated, residual urine is more than 150 ml, up to 400-500 ml, or chronic urinary retention.

4. Complications of benign prostatic hyperplasia (BPH): Because urine cannot be properly expelled from the bladder, the following symptoms may occur on the basis of BPH:

(1) Infection: It can lead to complications such as prostatitis, cystitis, urethritis, epididymitis and pyelonephritis, and related symptoms.

(2) Uremia: Due to lower urinary tract obstruction, bilateral hydronephrosis and renal insufficiency may occur, and clinical symptoms such as loss of appetite, nausea, vomiting, and anemia may appear.

(3) Abdominal mass: When obstruction causes significant hydronephrosis of the kidney and ureter, an enlarged kidney can be felt; when the bladder is full, a cystic mass can be felt in the middle of the lower abdomen.

(4) Other: Due to difficulty in urinating, abdominal pressure needs to be increased for a long time to urinate, which may lead to symptoms such as rectal prolapse, hematochezia, hernia, and varicose veins in the lower extremities.

Staging of Benign Prostatic Hyperplasia

Phase 1: Also known as the symptom stimulation phase, the main symptoms include frequent urination at night, discomfort in the posterior urethra and perineum, prolonged urination time, and a thin urine stream. During this phase, the residual urine volume is less than 50 ml, and the uroflowmetry may show a normal curve.

Phase II: Also known as the residual urine stage, the above symptoms worsen, and the patient needs to strain to urinate. The residual urine volume is between 50 and 150 ml, accompanied by a feeling of residual urine. Sudden acute urinary retention or infection may occur, and the uroflowmetry shows a multi-waveform curve.

Stage 3: Also known as the decompensated stage or the bladder dilatation and urinary retention stage, the residual urine volume is greater than 150 ml, and urinary retention or overflow incontinence, renal insufficiency, etc. occur. The uroflowmetry shows a flat curve.

Staging of benign prostatic hyperplasia (BPH) is significant in determining the treatment plan. Generally, conservative treatment is suitable for stage I BPH; early-stage stage II patients can also try conservative treatment; stage II patients whose condition does not respond well to conservative treatment or whose condition has progressed, as well as stage III BPH patients, should consider surgical treatment.

What tests should be done?

1. Blood tests: Serum urea nitrogen and creatinine levels may be elevated.

2. Urine examination: When complicated by urinary tract infection, red blood cells, white blood cells, and pus cells may be present.

3. Measurement of residual urine volume: After urination, a urinary catheter is inserted, and the urine volume is measured. This is the residual urine in the bladder. Normally, it should not exceed 50 ml. When it exceeds 60 ml, it indicates that the bladder has lost its compensatory function.

4. B-mode ultrasound examination: can measure the size, weight, and residual urine volume of the prostate.

5. Cystoscopy: This can reveal the extent of hyperplasia in the median and lateral lobes, and help determine if there are any complications such as stones, diverticula, or tumors.

6. Urodynamic examination: In the early stages of benign prostatic hyperplasia, changes in urination function may occur, such as decreased maximum and average urinary flow rates, prolonged urination time, and increased urethral resistance.

7. X-ray examination: Plain abdominal X-ray can be used to observe bladder stones; excretory urography can be used to determine urinary tract obstruction and renal function; cystography can be used to observe the compression of the bladder neck or base; urography can show stenosis of the prostatic urethral segment, etc.

8. Other examinations: Long-term urinary retention can affect kidney function. Therefore, tests such as phenol red excretion and creatinine clearance, as well as measurements of blood non-protein nitrogen, blood urea nitrogen, creatinine, and carbon dioxide combining power are all essential examinations.