Prostate diagnosis illustrates the question, differential diagnosis of prostatic hyperplasia

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1.Bladder neck contractures.

Patients with symptoms of lower urinary tract obstruction and no significant prostate enlargement on digital rectal examination should be considered in addition to possible protrusion of the glandular lobe towards the bladder. Bladder neck contractures are thought to be secondary to inflammatory lesions. The smooth muscles of the bladder neck are replaced by connective tissue, which can be accompanied by inflammation.

Patients with bladder neck contracture have a long history of lower urinary tract obstruction. On cystoscopy, the bladder neck is elevated and the posterior urethra and bladder triangle are shortened. Under cystoscopy, the prostatic urethra was not extruded and deformed, and the internal urethral opening was narrowed.

In contrast, when the lobes of the isolated prostatic hyperplasia glands protrude towards the neck of the bladder, they are covered by a soft mucosa, the triangular area of the bladder is sunken, and the posterior urethra is lengthened.

Bladder neck contracture can be accompanied by prostatic hyperplasia, which is often difficult to remove due to the unclear demarcation between the hyperplastic gland and the surgical capsule, and the gland is significantly smaller than that of digital rectal examination or ultrasound. If the contracture of the bladder neck is not treated at the same time after the gland is removed, the lower urinary tract obstruction is difficult to remove.

**Receptor blockers can be tried. If symptoms are severe, recurrent urinary tract infection, or urodynamic testing is abnormal, transurethral resection, suprapubic transbladder neck wedge resection, or bladder neck Y-V plasty may be considered.

2.Prostate cancer.

Prostate cancer, particularly ductal cancer, may present with urinary tract obstruction. In some patients, prostatic hyperplasia is accompanied by prostate cancer, and serum PSA (prostate-specific antigen) is elevated. Digital rectal examination of the prostate surface is not smooth and rocky.

Transrectal biopsy with B-ultrasound guidance is preferred, 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. A detailed history of trauma and a levator ani reflex should be examined for urodynamic testing, such as filling bladder manometry, urethral manometry, and simultaneous pressure flow rate measurements.

4.Weak bladder (aging of the bladder wall).

The manifestations are urinary retention, abnormal lower urinary tract urination, and a large amount of residual urine, which should be distinguished from prostatic hyperplasia, and factors such as injury, inflammation, and diabetes should be excluded, mainly by urodynamic testing. Special urethral pressure charts, pressure flow rate simultaneous testing to identify. Bladder pressure chart shows low bladder pressure, no systolic pressure waveform, etc.

The prostate is an important organ, and the enlarged prostate, also known as an enlarged prostate, can cause a blockage of the urinary tract, induce difficulty urinating, and frequent urination. In addition, there are several abnormalities in the body when the prostate gland is damaged.

What tests to do for the occurrence of prostatitis:

1. Prostatic fluid examination: the number of white blood cells in the prostatic fluid is more than 10 in the high-power field of the microscope, and the lecithin body is reduced, which can be diagnosed as prostatitis. If culture is done at the same time, a definitive diagnosis and classification of chronic prostatitis can be made.

If the bacterial culture of prostatitis fluid is positive, chronic bacterial prostatitis is diagnosed; Conversely, it is chronic non-bacterial prostatitis.

2. Digital rectal examination: the prostate is full, enlarged, soft and mildly tender. For a longer period of time, the prostate gland will become smaller, harder, uneven in texture, and have small indurations. At the same time, the prostate massage method is used to obtain prostatic fluid, and a routine examination is done.

3. B ultrasound examination: B ultrasound examination in some patients with chronic prostatitis, due to local exudation, fibrosis, adhesion and other capsular reflection is not smooth, and in severe cases, the capsular boundary is not clear; The glands are morphologically regular, symmetrical to the left and right, and localized reflexes are visible internally.

Generally, color ultrasound and prostate fluid tests can be done, and urine tests can be done.