Differential diagnosis of prostatic hyperplasia

Prostate hyperplasia is believed to be a problem that troubles many men. After the problem of prostate hyperplasia occurs, the patient not only has to face great pain, but will also be greatly affected in daily life. Therefore, after the problem of prostate hyperplasia occurs, it must be treated in time. Of course, differential diagnosis must be made before treatment. Next, I will introduce to you the differential diagnosis methods of prostate hyperplasia!

1. Bladder neck contracture

The patient has symptoms of lower urinary tract obstruction, and rectal examination did not reveal obvious enlargement of the prostate. In addition to the possibility that the enlarged glandular lobe protrudes into the bladder, the possibility of bladder neck contracture should also be considered. It is generally believed that bladder neck contracture is secondary to inflammatory lesions. The smooth muscle of the bladder neck is replaced by connective tissue and may be accompanied by inflammation. Patients with bladder neck contracture have a long history of lower urinary tract obstruction. During cystoscopy, the bladder neck is elevated, and the posterior urethra and bladder trigone are contracted and shortened. Cystoscopy showed that the prostatic urethra was not squeezed or deformed, and the internal urethral opening was reduced. When the lobes of simple prostatic hyperplasia protrude toward the bladder neck, they are covered by soft mucosa, the bladder trigone sinks, and the posterior urethra is extended.

Bladder neck contracture may be accompanied by prostatic hyperplasia. Due to the unclear boundary between the hyperplastic gland and the surgical capsule, removal is often difficult, and the gland is significantly smaller than predicted by rectal examination or B-ultrasound. If the contracted bladder neck is not treated at the same time after the gland is removed, lower urinary tract obstruction will be difficult to relieve.

Treatment may include alpha-blockers. If the symptoms are severe, urinary tract infections recur, or urodynamic examinations are abnormal, transurethral resection, suprapubic bladder neck wedge resection, or bladder neck YVplasty may be considered.

2. Prostate cancer

Prostate cancer, especially the ductal type, may present with lower urinary tract obstruction as the first symptom. Some patients have prostate cancer along with prostate hyperplasia, and their serum PSA (prostate-specific antigen) is elevated, usually >10.0ng/ml. Rectal examination revealed that the surface of the prostate was not smooth and felt like rock. Transrectal biopsy is better guided by B-ultrasound, and the diagnosis can be confirmed by pathological examination.

3. Neurogenic bladder, detrusor sphincter dyssynergia

It often manifests as abnormal urination in the lower urinary tract and urinary incontinence. It is necessary to inquire in detail about the history of trauma and check for the presence of levator ani reflex. Urodynamic examinations should be used to rule it out, such as filling cystometry, urethral pressure diagram, and simultaneous pressure/flow rate testing.

4. Weak bladder (aging of bladder wall)

It manifests as urinary retention, abnormal urination in the lower urinary tract, and a large amount of residual urine. It should be differentiated from prostatic hyperplasia, and factors such as injury, inflammation, and diabetes should be ruled out, mainly through urodynamic examination. Special urethral pressure diagram and pressure/flow rate simultaneous detection are used for identification. The cystometrogram showed low bladder pressure, no contraction pressure waveform, etc.