Article 121: Drug Treatment and Cautions for Benign Prostatic Hyperplasia

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Treatment and recuperation of common diseases

Medications for treating benign prostatic hyperplasia

1. Anti-androgen drugs: The most widely used drugs in this category are progesterone-based drugs. After a period of use, anti-androgen drugs can improve symptoms and urinary flow rate, reduce residual urine, and shrink the prostate.

(1) Diethylstilbestrol: 2-3 mg orally daily for 4 weeks as one course of treatment. Long-term use will increase cardiovascular complications, and side effects include nausea and vomiting, gynecomastia in men, and impotence.

(2) Medroxyprogesterone acetate: 40 mg each time, 3 times a day. It inhibits 5-α reductase activity and can reduce plasma testosterone levels.

(3) Flunitroxamide: 250 mg each time, 3 times a day, for 3 months as one course of treatment. It can reduce the size of the prostate and the amount of residual urine. Side effects include gynecomastia, nausea and vomiting, and abnormal liver function.

2. Alpha-blockers: Alpha-blockers can relieve symptoms of urinary tract obstruction and facilitate early catheter removal in patients with acute urinary retention. Commonly used drugs in this class include the following:

(1) Phenoxybenzamine: 10 mg each time, 2-3 times a day, for 2 weeks. Side effects often include dizziness, visual disturbances and orthostatic hypotension.

(2) Phentolamine: 10 mg intravenously by slow infusion each time. It is a drug in the same class as phenoxybenzamine, but because this drug has a faster onset of action and a shorter duration of action, it is generally used for acute urinary retention. Side effects are the same as phenoxybenzamine.

(3) Prazosin: Initial dose 0.5 mg, if no response, reduce to 1 mg, 3 times daily. May cause orthostatic hypotension, but has no effect on sexual function.

(4) Gotrazine: Initial dose 1 mg, followed by 2 mg, taken once before bedtime. It is a selective alpha receptor inhibitor, mainly used to relieve bladder neck obstruction and improve urination. This product has few side effects and generally does not cause dizziness or orthostatic hypotension.

3. 5-α reductase inhibitor: This product inhibits 5-α reductase, blocking the conversion of testosterone to dihydrotestosterone, thereby preventing further prostatic hyperplasia. Clinical observation has confirmed its efficacy. The commonly used drug is Proscar, 5 mg once daily, for at least 6 months. This product has virtually no side effects, but a small number of patients may experience sexual dysfunction.

Medications that should be used with caution by patients with benign prostatic hyperplasia

1. Antipsychotic drugs: such as chlorpromazine (chlorpromazine), perphenazine, haloperidol (haloperidol), etc., which can cause difficulty in urination.

2. Antidepressants: such as imipramine, doxepin, amitriptyline, clomipramine, etc., these drugs can also induce urinary retention.

3. Bronchodilators: such as aminophylline, theophylline, ephedrine, and isoproterenol (osinaline), can all cause difficulty in urination.

4. Cardiovascular and cerebrovascular disease medications: such as propranolol, nifedipine, and verapamil, can all cause urinary retention by inhibiting bladder muscles.

5. Gastrointestinal analgesics: such as belladonna, atropine, scopolamine, anisodamine (654-2), septicemia medication, camphor alkaloid, oxfen bromide, propantheline bromide, etc., can all relax the bladder detrusor muscle and cause urinary retention.

6. Potent diuretics, such as furosemide and ethacrynic acid, can cause electrolyte imbalance, leading to urinary retention. Therefore, patients with benign prostatic hyperplasia should switch to medium-potency diuretics, such as hydrochlorothiazide or benzfluthiazide, or low-potency diuretics, such as spironolactone or acetazolamide.

7. Antihistamines: such as phenergan, phenthiazide, dimenhydrinate, chlorpheniramine, antihistamines, azathadine, mequinatazine, etc., can all increase difficulty in urination. Astemizole can be used instead.

8. Others: such as hydroxychloroquine, isoniazid, mecainide, vinpocetine, and the traditional Chinese medicine immature bitter orange, can also cause urinary retention.

Laser treatment for benign prostatic hyperplasia

1. Preoperative preparation: Prepare according to the procedure for cystoscopy. Disinfect the cystoscope 12 hours before the procedure (using 10% formalin solution). At the same time, check the patient's kidney, heart, liver, and lung function, as well as perform routine blood and urine tests.

2. Anesthesia: Analgesic and lubricating gel irrigation anesthesia is commonly used for cystoscopic laser surgery for benign prostatic hyperplasia. Due to the short operation time, most patients do not require other anesthesia. Sacral plexus anesthesia may be chosen for special patients.

3. Surgical Procedure: Clean and disinfect the vulva. Drape with a sterile drape. Inject analgesic lubricant through the urethral orifice. Gently pinch the glans penis with the thumb and forefinger of the left hand, and squeeze the penis backward with the fingers of the right hand to expel the medication into the bladder. After about 3-5 minutes, remove the sterilized cystoscope, rinse with saline, and disinfect with formaldehyde. Insert the inner endoscope and insert the cystoscope. When a feeling of obstruction is felt in the posterior urethra, remove the inner endoscope and replace it with a fiberoptic endoscope, carefully observing the obstruction within the urethra. At this point, a protrusion within the urethra may be visible. Insert the laser fiber through the biopsy port. Before insertion, remove approximately 4 mm of the outer protective layer from the fiber tip. The commonly used power is 40 watts. Adjust the light output according to the degree of obstruction. If the urethral obstruction is visible under endoscopy, place the laser tip firmly against the obstruction site, and apply appropriate pressure to the tip of the cystoscope close to the proliferative lesion. Remember, the fiber optic tip must protrude approximately 1 cm from the front of the cystoscope. This means the fiber optic cable and the lesion must be clearly visible under the cystoscope before triggering the laser for cutting. For unilateral prolapse, treat that side first; for bilateral prolapse, cut simultaneously. For severe prolapse, use the laser scalpel for contact cutting or vaporization. The prolapsed prostate tissue does not need to be immediately detached after laser resection; it will begin to detach locally and gradually repair itself from the inside out 3 days post-surgery. After the procedure, withdraw the laser scalpel. Then observe the urethra. If the obstructive prostate enlargement is not relieved, reinsert the laser scalpel for further removal.

4. Postoperative management: Local exudation may occur in some patients after endoscopic laser surgery. Acute hematuria generally does not occur. The bleeding is due to the shedding of local resected tissue during urination. Initially, the first urine contains blood mixed with urine, but soon after, it becomes pure urine. To prevent bleeding and promote early wound healing, hemostatic agents are given postoperatively, which can be administered orally, intravenously, or intramuscularly. In addition, high doses of vitamin C, vitamin B1, vitamin B2, and vitamin E are given orally. Appropriate use of antibiotics can prevent infection. Patients with cardiac, pulmonary, or renal complications should be treated promptly.