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4, surface gravis

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By , March 5, 2012 3:48 pm
                               
                

                 To see a thorough treatment of hyperthyroidism symptoms of myasthenia gravis is no longer a problem

| hyperthyroidism hospital | | Graves disease

Believe that many people treated for hyperthyroidism is no stranger to the disease myasthenia gravis, but many patients in early disease is difficult to fully understand what the symptoms of myasthenia gravis with hyperthyroidism! Only with a clear understanding of the symptoms of myasthenia gravis with hyperthyroidism, the disease can be detected early, treatment of hyperthyroidism in the best treatment of myasthenia gravis!

Beijing China Chinese Medicine Hospital economic treatment of hyperthyroidism center experts said that in the clinical symptoms of myasthenia gravis with hyperthyroidism have a lot of Ji in the following areas:

1, dysphagia: no gastrointestinal disease, appetite good, but want to eat a good meal of good food, but swallow, swallow even water can not enter. Water into the trachea when not choking cough that flow out from the nostrils. Some patients with myasthenia gravis because of severe dysphagia and must rely on feeding tube to eat.

2, double vision: Early symptoms of myasthenia gravis with hyperthyroidism that visual ghosting. Together with two eyes to see, a thing as two; if cover one eye, then see is a. Very young children could not be described as complex, often compensatory head tilt, torticollis, so clearly seen the disappearance of diplopia, severe cases can be manifested as strabismus.

3, general weakness: Early symptoms of myasthenia gravis with hyperthyroidism good skin from the outside it seems a good meat, and no muscle atrophy, if not the same disease; but severe muscle Patients often feel powerless severe generalized weakness, the shoulder can not lift, not to mention hands, squatted stand up, even face and hair have to rely on others for help.

Symptoms of myasthenia gravis patients with hyperthyroidism significantly improved rest for a while, and do a little living will significantly increase, seems to be fitted out like. Most of these patients accompanied by ptosis, diplopia and other symptoms.

4, surface gravis: Since the whole facial expression weakness, the patient is not touched upon during sleep is often closed. And has the early symptoms of myasthenia gravis patients with hyperthyroidism usually indifferent, laughed very natural, like crying, like, also known as laughing and crying face. This makes face look very hard to accept, the patient has pain Ku.

5, eyelid drooping, lift the humble skin: According to the analysis of MG patients found to eyelid drooping as the first symptom up to 73% can occur at any age , particularly among children is more common. Early symptoms of hyperthyroidism, weakness on one side, mostly, mostly on both sides of late, there are many eyes stare up the side of the patient, the other side of the eyelids and droop, drooping eyelid that appeared around the turn of the phenomenon.

6, unable to chew: teeth properly, but the bite boring, even bite bread feel effortless. You can also head Ji mouth can not move more bite more bite. This is one of the early symptoms of myasthenia gravis with hyperthyroidism.

What are the symptoms of hyperthyroidism gravis? These are some of the more common clinical symptoms of hyperthyroidism, myasthenia gravis, and only a clear understanding that in order for Zhao clear understanding of their physical condition the incidence of hyperthyroidism weakness! Finally, the Beijing Chinese Medicine Hospital hyperthyroid state economy treatment centers, experts also pointed out that once found himself suffering from hyperthyroidism, myasthenia gravis, it is best to accept a reasonable regular hospital treatment for hyperthyroidism!

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urodynamic Pok check (urodynamics) (optional)

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By , March 5, 2012 1:38 pm

first basics

One, Definition

Benign prostatic hyperplasia (benign prostatic hyperplasia, BPH) is caused by the reasons for voiding dysfunction in older men the most common form of benign disease [1] . Mainly on the organization curb prostate stromal and glandular components of the proliferation of prostate anatomy Pok increase (benign prostatic enlargement, BPE), lower urinary tract symptoms (lower urinary tract symptoms, LUTS) and clinical symptoms mainly urodynamic bladder outlet obstruction on the curb (bladder outlet obstruction, BOO). People’s Liberation Army No. 309 Hospital Transplant Center Lie

Two, epidemic Pok

Organization Pok on the incidence of BPH increases with age, usually occurs in the first 40 years of age [2] , to 60 years of age greater than 50%, 80 years old up to 83% [3] . Pok performance with similar organizations, with age, dysuria and other symptoms also increased. Approximately 50% of the tissue diagnosis of BPH in men Pok moderate to severe lower urinary tract symptoms [1] . Research has shown that Asians seem more prone than Americans – severe BPH-related symptoms [4] .

Three, cause Pok

BPH occurrence must have age and have two important features of testicular conditions. Who investigated the domestic Pok 26 elderly eunuch the Qing Dynasty, has been found in 21 of the prostate can not touch, or a dramatic drop in [5] . However, the occurrence of BPH specific mechanism is not clear, may be due to epithelial and mesenchymal cell proliferation and apoptosis caused by damage to the balance. Relevant factors are: male hormones and their interaction with estrogen, a prostate epithelial cell mesenchymal interactions, growth factors, inflammatory cells, neurotransmitter, and genetic factors [1] .

Four, Pathology

McNeal divided the prostate peripheral zone, central zone, transitional zone and periurethral glands area. All BPH nodules occurred in the transitional zone and periurethral glands District [1] . Glands around the urethra area of ​​early nodules completely stroma; and early transition zone nodules is mainly for the proliferation of glandular tissue, and reduced the number of interstitial. Interstitial tissue in the prostate smooth muscle also constitute an important component of these smooth muscle surrounding the urethra, and prostate tissue by adrenergic, cholinergic innervation of neurotransmitters or other enzymes, which play a major role in adrenergic nerve. Prostate and bladder neck in the G-rich receptors, especially α l receptor [6-7] , activate the adrenergic receptors can significantly improve the prostatic urethral resistance.

Prostate capsule and the anatomy is closely related to lower urinary tract symptoms, due to the presence of the capsule, hyperplasia of the gland to the urethra and bladder pressure and swelling thus increasing the urinary tract obstruction. After prostatic hyperplasia, nodular hyperplasia of the gland to form the rest of oppression Hyperplasia after surgical removal of part, the left compression glands, so after digital rectal examination and imaging examination can still explore Pok and prostate gland.

Five, pathophysiological changes

Prostatic hyperplasia lead to posterior urethral extension, compression distortion, stenosis and urethral resistance increased, causing the bladder pressure and the emergence of related voiding symptoms. With the increase in bladder pressure, bladder detrusor compensatory hypertrophy, detrusor instability and cause symptoms related to the urine storage phase. If not to lift the long-term obstruction, detrusor compensatory ability is lost. Secondary to BPH in the upper urinary tract changes, such as hydronephrosis and renal dysfunction is mainly due to urinary retention and bladder pressure due to vesicoureteral reflux.

Six, clinical manifestations, diagnosis and treatment

BPH in the major clinical manifestations of bladder irritation symptoms, obstructive symptoms and related complications. Or may have been a variety of symptoms throughout the course of sexual development. The diagnosis needs based on symptoms, physical examination, especially digital rectal examination, imaging Pok examination, urine examination and endoscopy power divider comprehensive judgments. The treatment of BPH include watchful waiting, drug therapy, minimally invasive treatment and surgery four categories. Therapeutic purposes is to improve the quality of life while protecting the patient’s renal function. Specific treatment options should be based on the severity of symptoms, combined with the laboratory examinations, local health conditions and patient compliance, etc. into account.

second BPH treatment guidelines developed by the background, purpose, meaning and methods

BPH is caused by middle-aged male urinary disorders, its incidence increases with age. BPH has become the world clinical urology clinic in one of the most common diseases, while its large patient populations, and high medical costs have become a social problem. With the continuous development of China’s national economy level, and the arrival of an aging society, BPH clinical treatment in the coming decades will likely become the urology clinical work and medical and health development of important issues.
one, BPH treatment guidelines for progress
early 1980s, international Pok Pok urological community who develop BPH treatment guidelines proposed bund will be started to develop their own BPH treatment guidelines. U.S. Department of Health and Urology Pok Health Committee will be co-sponsored in 1994 the first edition of BPH treatment guidelines, the main steps for BPH treatment a certain specification. 1996 American Urological further proposed to curb the symptoms of the new scoring system for the center of BPH treatment guidelines. European Urology Urology Pok Pok and Japan will be, respectively, in 1998 and 1999 made their BPH treatment guidelines. , The U.S. Department of Urology and European Urology Pok Pok will be respectively in 2003 and 2004 for their BPH treatment guidelines have been updated. As the social and cultural development of different countries will develop BPH Pok urology clinic focus of the Guide are also different. The United States and Europe will curb Urology BPH treatment guidelines developed by the result of attention to subjective factors, such as the use of international prostate symptom score (International Prostate Symptom Score, I-PSS) and quality of life index (quality of life, QOL) score results patients to judge the severity of interference. Japanese Urological Pok BPH treatment guidelines will be made with the subjective symptoms and objective factors, the results, such as the I-PSS and QOL score, prostate volume, maximum flow rate, residual urine volume of the results of the patient’s condition to determine the extent of the comprehensive .
Second, the need for the development of BPH treatment guidelines and objectives
BPH clinical manifestations in different in the form of lower urinary tract symptoms. The treatment of BPH in many different ways, including waiting for observation, medical therapy, minimally invasive treatment and surgery. However, in the course of clinical treatment of BPH, the patient to determine the degree of severity, the comparison of various treatment and different treatment options so there is no clear criteria to guide our country, it is necessary to conduct the clinical treatment of BPH the standardization work. The purpose of BPH treatment guidelines for different medical conditions urologists choose the right treatment for BPH diagnosis and provide appropriate clinical guidance.
three, BPH treatment guidelines of the significance of
BPH is the medical treatment guidelines to develop the field of clinical diagnosis and treatment Pok specification (clinical practice guideline) part, BPH treatment guidelines to complete the work on standardization of clinical promotion has a positive meaning. Journal of Medical Urology Pok Pok will be China’s most authoritative Urology Pok Pok surgery industry organizations, have the responsibility to provide a standardized medical social services model. One of the Clinical Practice Guidelines for the development and promotion of representative significance. The significance of the development of BPH treatment guidelines are mainly: 1) in favor of BPH diagnosis and treatment options and unity; 2) in favor of the continuous progress of BPHI clinical observation; 3) in favor of BPH to determine the effect of different treatment modalities; 4) BPH treatment benefit of all regional comparison of the results; 5) help to improve diagnosis and treatment of BPH, further safeguarding the interests of patients.
four, BPH treatment guidelines for the development of methods
generally believed that the evidence-based health clinic Pok guide the development of (evidence based guideline development) in a clear sense of this issue under the premise of a process requires the following Ji: 1) the choice of objects disease; 2) the establishment of organizational form; 3) the evaluation of clinical research papers; 4) Practice Guidelines specific development; 5) treatment guidelines for promotion and continuous improvement.
1 . Object conditions are selected
as the development of treatment guidelines will need to curb and community participation, so in the specific priority setting process there developed over the issue. Generally believed that more than the number of patients, health care costs high, high mortality, in the clinical treatment process are quite different development of the disease should have the right of priority. Japan will start Pok Urology BPH treatment guidelines to complete the formulation of a clinical survey showed that BPH, urolithiasis, and urinary incontinence among the top three. According to the Beijing Institute of Urology, a large clinical outpatient Pok statistical largest number of BPH patients, accounting for 20%. Therefore, the first to carry out the formulation of guidelines for BPH treatment has clinical value.
2 . Organization formed to establish
in the process of developing treatment guidelines should try to hire the Pok Pok and related subjects, including subjects by various experts Pok. The aim is to develop treatment guidelines not only have clinical utility and should have clinical and social promotion of. China’s development of BPH treatment guidelines by the Chinese Medical Branch at Pok Pok will be responsible for Urology, hired the nation’s major regions, including major hospitals, including nine experts and professors as a guide to clinical diagnosis and treatment in China BPHI formulation. Nine experts and professors from Beijing Institute of Urology, large bund (2), the Ministry of Health Beijing Hospital (1), Beijing Union Medical College Hospital (1), Shanghai Renji Hospital (1), Shanghai Changhai Hospital ( 1), Guangdong Provincial People’s Hospital (1), four  large Pok West China Hospital (1), Wuhan General Hospital of Guangzhou Military Region (1).
3 . Evaluation of clinical research papers
treatment guidelines in the formulation, the first reference to the international community has formally recommended Pok urology clinic guide content. BPH treatment guidelines in the development of our country, the will of the American Urological bund, Europe and Japan Urology Urology Pok Pok will be the development of BPH treatment guidelines had repeated discussions, which have common elements that can be used in our BPH treatment Guide. Of course, we discussed the following issues: 1) BPH treatment during the race difference is very small; 2) regardless of treatment should be consistent with national health insurance Yan policy; 3) China’s BPH treatment guidelines should have an international versatility.
Because the development of clinical practice guidelines is a rigorous scientific curb work, at home and abroad need to refer to the past 10 years related diseases reported in the literature, so need to judge the level of reference can refer to its value.
in our literature evaluation process, according to the following criteria to judge the credibility of specific literature:
I large-scale randomized clinical study results clearly Zhao
II small-scale random results of Zhao clear
Ⅲ non-randomized clinical studies have earlier clinical studies of Zhao
Ⅳ non-randomized, pre-clinical studies of Zhao of Zhao
V without clinical retrospective study
In the specific literature search process, the use of pub-med Medical Pok search network, the Chinese Medical Journal nets Pok 1996 to 2005, treatment of BPH-related papers were searched. According to the evaluation of the credibility of papers, the final total of 95 papers in our collection of BPH treatment guidelines, including those from China’s Pok Pok in the domestic or international technical journals published a total of 13 papers. In Table 1.

4 . Develop specific treatment guidelines
world according to China’s national conditions and development of urological conditions, we believe that the Chinese version BPH treatment guidelines should be of international interoperability, on behalf of domestic and foreign BPH treatment guidelines the highest level. Therefore, the Chinese version of the BPH treatment guidelines include the following seven parts:
① basic knowledge of benign prostatic hyperplasia benign prostatic hyperplasia articles
② treatment guidelines developed by the background, purpose, meaning and methods
③ benign prostatic hyperplasia The clinical progression of benign prostatic hyperplasia treatment
④ Guide – articles
⑤ diagnosis of benign prostatic hyperplasia treatment guidelines – treatment of benign prostatic hyperplasia articles
⑥ treatment guidelines – follow-up articles
⑦ benign prostatic hyperplasia treatment guidelines – were articles (booklet issued)
articles in the diagnosis and treatment of BPH patients in the initial evaluation tools and a variety of treatment recommendations is defined as:
; recommendation has been clinically proven and widely accepted content
; option in some patients are not clinically proven
not recommended has been clinically proven

five, BPH treatment guidelines for promotion and continuous improvement
develop BPH treatment guidelines aim is to specification of our medical work, so the most critical element is how the country promoting and implementing the guidelines. If necessary, we also need to curb the world community about the Chinese version of Urology BPH treatment guidelines.
in the application of BPH treatment guidelines, clinical diagnosis and treatment of BPH can not be completely modular, different conditions and needs of our patients with different needs for different treatment. While most developed countries have completed the development of the Clinical Practice Guidelines and has been repeatedly revised, for the Chinese community in terms of Urology Pok, benign prostatic hyperplasia treatment guidelines for the development of the first attempt, so inevitably there are some different of man’s place. For example, the evaluation of patient outcomes is still no uniform international standards-making process in our hope for effective treatment, no improvement or failure to develop clear clinical indications to determine, but due to lack of evidence-based health Pok The data support failed to complete. Hope in the next Ji years a large number of high-quality papers related to our professional journals in order to facilitate future of BPH treatment guidelines updated. Popularization and application of future clinical course of the treatment guidelines, but also concerned about the cost of various treatment methods and comparative study of the efficacy of such content, to further improve the BPH treatment guidelines.

third of BPH clinical progression of

As a number of studies confirm that the slow progress of BPH benign prostate disease [1-3] , the symptoms increase with age in patients with progressive increase, and a corresponding of complications.
one, BPH clinical progression of the definition of
different studies, the clinical progress of a different definition. Some researchers to a single target such as prostate volume increased, decreased urine flow rate, symptom score increased, serum prostate-specific antigen (prostate-specific antigen, PSA) to increase the incidence of acute urinary retention and progression such as the definition of < SUP> [4-5] . Other researchers have defined places composite index [6] . Despite the different definitions of clinical progress, the current show is more recognized clinical progression of BPH occur include: a result of lower urinary tract symptoms in patients with reduced quality of life, maximum flow rate decreased, acute urinary retention, recurrent hematuria , recurrent urinary tract infections and kidney damage [7-8] , BPH patients receiving surgical treatment is the ultimate manifestation of disease progression.
Second, the clinical progress of the evaluation index
1 . LUTS symptoms mainly through the IPSS score methods to evaluate
study [9-11] : BPH patients with I-PSS score increased year by year, the annual average increase ranging from 0.29 to 2 minutes.
2 . The maximum flow rate decreased
flow rate of clinical progression of BPH is judged one of the indicators of the objective, but its diagnosis of bladder outlet obstruction in the neck lack of specificity. In the Olmsted county study, patients were followed for 6 years, 40 years of age decreased maximum flow rate of 1.3% per year; 70 years old age annual rate of value reached 6.5% [13] ; all age groups the patient’s maximum flow rate continued to decline, the average annual rate of 2%.
3. BPH related complications
acute urinary retention, recurrent hematuria, recurrent urinary Road, infection, stones, and renal dysfunction and other produce for the performance of BPH progression, including acute urinary retention and renal dysfunction as the main indicator.
MTOPS experimental results suggest [1] : BPH result in serious complications, including renal insufficiency, recurrent urinary tract infections, urinary stones and urinary incontinence, the incidence of acute urinary retention the highest. The incidence of acute urinary retention is bladder decompensation mainly for BPH progression is an important event. A number of studies show that cumulative incidence of acute urinary retention wind Yan to 6.8 ‰ / was -12.3 ‰ / year.
BPH clinical progression of chronic renal insufficiency with a certain relationship exists between. A study of BPH patients with chronic renal insufficiency was 9% [14] .
4 . BPH surgery Ji rate increase
surgical treatment of the increased wind Yan, Ji surgery increased rate of clinical progression of BPH is a sign.
PLESS research showed [12,15] : follow-up of 4 years in the placebo group, 7% of patients with acute urinary retention, 10% of patients need to undergo surgery. Surgical treatment of acute urinary retention is the primary reason.

Three, BPH clinical progression of risk factors Yan
currently supports clinical progression of BPH with the most powerful research is Olmsted County < SUP> [1] , PLESS [2] and the MTOPS study [3] . Research data show that many of the age, serum PSA, prostate volume (prostate volume), maximum urinary flow rate (maximum flow rate, Qmax), residual urine volume (postvoid residual urine) and I-PSS score and other factors and the clinical progression of BPH related [1-7] .
1 . Age: BPH clinical progression of age is a risk factor. Studies have shown that: BPH patients with AUR and the need for surgery, the incidence increases with age, increasing [1,3,6,8] . Olmsted County study found that 70-79 age group the incidence of AUR 40-49 age group higher than 7.9 times [6] ,> 70 years of age are in need of transurethral resection of the prostate to 10.9/1000 person-years, while the 40-49 age group is only 0.3/1000 person-years [1] . MTOPS study: placebo group, age> 62 years of clinical progression of BPH patients are more likely to [3] .
2 . Serum PSA: Serum PSA is BPHI wind Yan clinical predictors of progression, one study found that domestic and predictable increase in prostate volume [9-11] , the maximum flow rate of change [12] and the risk of acute urinary retention occurred in Xian and the possibility of requiring surgery [4,13-16] . PV patients with high serum PSA increased faster [9-11] ; PLESS study: the incidence of acute urinary retention and surgical needs with wind Yan serum PSA increased with increasing cumulative incidence after 4 years rate from the lowest PSA level (0.2-1.3ng/m1) rose 7.8% to the highest PSA levels (3.3-12.0ng/m1) of 19.9% ​​ [4] . MTOPS study: serum PSA ≥ 1.6ng/ml clinical progression of BPH patients are more likely to occur [3] .
3 . Prostate volume: clinical progression of prostate volume is BPHI another wind Yan predictor of prostate volume in patients with BPH can predict the risk of acute urinary retention and need for surgery Yan possibility [3,4,6 , 13,15] . PLESS study found the incidence of acute urinary retention in BPH patients and surgical needs with wind Yan prostate volume increased with the increase, four years later from a minimum cumulative incidence of prostate volume group (14-41m1) up to 8.9% in the largest group of prostate volume (58-150m1) of 22% [4] . Olmsted County study found that prostate volume ≥ 30ml of acute urinary retention BPH patients is the possibility of prostate volume <30ml 3 times [6] . MTOPS study confirmed prostate volume ≥ 3lml clinical progression of BPH patients are more likely to [3] .
4 . Maximum flow rate: The maximum flow rate can predict the occurrence of acute urinary retention BPH patients and clinical progress of the wind Yan possibility [3,6,17-18] . MTOPS study found that the maximum flow rate of <10.6ml / s clinical progression of BPH patients are more likely to [3] . Another study showed that: The maximum flow rate of ≤ 12ml / s in patients with acute urinary retention BPH wind Yan is the maximum flow rate> 12ml / s by four times [6] . Pok were also found domestic and non-surgical patients with BPH there are significant differences in maximum urinary flow rate [18] .
5 . Residual urine volume: residual urine volume can predict clinical progression of BPH [3,17-18] . MTOPS study found that residual urine volume ≥ 39ml clinical progression of BPH patients are more likely to [3] . Domestic Pok BPH patients have found the incidence of hydronephrosis with an increase in residual urine volume increased significantly [18] .
6 . Symptom score: BPHI symptom score in predicting clinical progression has some value [6,15,17] , I-PSS> 7 points in BPH patients with acute urinary retention is the wind Yan I-PSS <7 points were four times [6] . For no history of acute urinary retention in patients with BPH, urine storage period and the total symptom score, symptom scores were useful in predicting surgical treatment of BPH wind Yan [15] .
In addition, long-term high blood pressure (especially high diastolic blood pressure) [19] , transitional zone prostate volume and transition zone index [20-21] and BPH may also be clinical progression. Although studies have shown that there are several factors that can predict the clinical progression of BPH, but the majority of research has been supported by clinical progression of BPH forecast indicators are age, PSA and prostate volume and so on. With the risk of BPH clinical progression of increasingly sophisticated Yan factors, will filter out the wind Yan with clinical progression of BPH is possible to timely clinical intervention.

Part IV diagnosis of BPH

Chief complaint of the following treatment of urinary tract symptoms for more than 50 years old male patient, should first consider the possibility of BPH. To confirm the diagnosis, subject to the following clinical assessment.
an initial assessment
l , medical history (recommended)
(1) the characteristics of lower urinary tract symptoms, duration and associated symptoms
(2) surgical history, history of trauma, especially history of pelvic surgery or trauma
(3) past history and sexually transmitted diseases, diabetes, neurological diseases
(4) drug history can be understood whether current or recent patients taking drugs that affect the bladder outlet function
(5) the patient’s general condition
(6) international prostate symptom score ( LPSS)
I-PSS score is an internationally recognized standard to judge the severity of BPH symptoms in patients with the best means. I-PSS score is lower urinary tract symptoms of BPH severity of subjective reflection, with maximum flow rate, residual urine volume and prostate volume was no significant correlation [1-2] .
I-PSS score were as follows: (score 0-35 points)
mild symptoms 0-7 minutes
8-19 points
moderate symptoms and severe symptoms 20-35 minutes
(7) quality of life score (QOL)
QOL score (0-6 points) is to understand its current lower urinary tract symptoms in patients with the level of the subjective experience of their life, their main concern is affected by BPH patients with lower urinary tract the degree of symptom distress and is able to endure, it is also close troubled score (bother of score).
These two can not be completely summed score despite lower urinary tract symptoms on quality of life of BPH patients, but they provide communication between doctor and patient platform, enabling a good understanding of medical the patient’s disease state [3] .

2 , physical examination (recommended)
(1) < B> digital rectal examination (digital rectal examination, DRE)
lower urinary tract symptoms in patients with rectal examination is very important to be in the bladder after emptying.
can understand the existence of prostate cancer:
foreign Pok those clinical studies, abnormal digital rectal examination in patients suspected of having the final diagnosis of prostate cancer are 26 – 34% [4] . And the positive rate increased with age is rising.
can understand the prostate size, shape, texture, and tenderness with or without nodules, the central sulcus is shallow or disappear and the anus sphincter of the door. Digital rectal examination for prostate volume is not precise enough to determine the current abdominal ultrasound or transrectal ultrasound prostate can more accurately describe the shape and size [5].
(2) local neurological examination (including motor and sensory).
3 , urine (recommended)
urine to determine the lower urinary tract whether the patient has symptoms of hematuria, proteinuria, pyuria, and urine, etc.
4 , serum PSA (recommended)
prostate cancer, BPH, prostatitis can make serum elevated PSA. Therefore, serum PSA is not specific to prostate cancer. In addition, urinary tract infections, prostate, acute urinary retention, catheterization, digital rectal examination and prostate massage can also affect the serum PSA value.
serum PSA and age and race are closely related. Usually after the age of 40 will rise in serum PSA, PSA levels in different ethnic groups is not the same. Serum PSA and prostate volume-related, but the serum PSA and BPH correlation of 0.30ng/ml, and prostate cancer as 3.5ng/m1 [6] . Serum PSA can be used as the indication of prostate cancer biopsy. General clinical PSA ≥ 4ng/m1 as the cut-off point [7] . Serum PSA as a risk factor can be predicted Yan clinical progression of BPH, which guide the choice of treatment [8] .
5 , ultrasound examination (recommended)
prostate ultrasound examination can understand the shape, size, with or without abnormal echo, broke into the extent of the bladder and residual urine volume. Transrectal ultrasound (transrectal ultrasonography, TRUS) prostate volume can be accurately measured (calculated as about 0.52 × diameter × anteroposterior diameter × vertical diameter). In addition, abdominal ultrasonography can understand the urinary system (kidney, ureter) with or without water, expansion, stones or lesions [9] .
6 , flow rate check (recommended)
flow rate, there are two main indicators ( parameters): maximum flow rate (Qmax) and average flow rate (average flow rate, Qave), maximum flow rate which is more important. However, to reduce the maximum flow rate can not distinguish between obstruction and detrusor contractility reduced. Needed in combination with other checks, if necessary, urodynamic Pok check. The maximum flow rate there are great individual differences and capacity-dependent, so the urine in 150-200ml more accurate when checked [10] , if necessary, repeat the inspection.
Second, according to initial results of the assessment, some patients need further examination
1, voiding diary (optional)

as in the lower urinary tract symptoms mainly nocturnal voiding diary were of great value to record 24 hours voiding diary can help identify nocturnal polyuria and excessive drinking [1-2] .
2 , serum creatinine (optional)
As a result of BPH can cause bladder outlet obstruction impaired renal function, serum creatinine increased. But recent research data that MTOPS emptying under normal circumstances if you can not detect serum creatinine, because as BPH-induced renal dysfunction in up serum creatinine have been many other changes, such as hydronephrosis, ureter expansion reflux, etc., and these can be checked by ultrasound and intravenous pyelogram are clearly the result of
[11] . The disease has occurred only in suspected renal insufficiency is recommended you select this check.
3 , intravenous urography (intravenous urography, IVU) examination (optional)
if accompanied by lower urinary tract symptoms in patients with recurrent urinary tract infection, microscopic or gross hematuria, the expansion of suspected ureteral reflux or hydronephrosis, urinary stones should be intravenous pyelogram. It should be noted that when the contrast agent in patients with renal insufficiency or allergy against intravenous urography examination. When necessary, instead of using isotope renography intravenous urography examination of renal function and upper urinary tract drainage situation.
4 , urethrography (optional)
suspected urethral stricture, suggested that the inspection.
5 , urodynamic Pok check (urodynamics) (optional)
This check is done by pressure – flow rate functions curves and AG plans to analyze and determine the existence of detrusor bladder outlet obstruction. For reasons caused by bladder outlet obstruction have questions or need to evaluate bladder function when the proposed line of the check [12] , except in combination with other relevant checks to the nervous system caused by disease or diabetes, neurogenic bladder possible.
6 , urethral cystoscopy (urethrocystoscopy) check (optional)
suspected BPH patients with urinary tract narrow, space-occupying lesion within the bladder when the proposed line of the check.
cystoscopy through the urethra can be aware of the following:
(1) of the urethra due to enlarged prostate or bladder neck obstruction characteristics; (2)-induced elevation of bladder neck lip obstruction; (3) bladder formation of trabecular and crave room; (4), bladder stones; (5) residual urine volume determination; (6) of bladder tumor; (7) The location and extent of urethral stricture.
Third, check the items not recommended
computed tomography (computed tomography, CT) and magnetic resonance imaging (magnetic resonance imaging, MRI ) the high cost of the examination, under normal circumstances do not recommend such an examination.
four, BPH patients with an initial assessment Summary
1 , is recommended to check the project
① history and I-PSS, QOL score
② physical examination (digital rectal examination)
; ③ urine, serum PSA

④ ultrasound (including residual urine volume determination)
⑥ flow rate
2 , optional inspection items
① voiding diary
② urodynamic examination
③ Pok intravenous urography
④ urethrography
⑤ urethral cystoscopy
3 . Check the items not recommended
① computed tomography
② magnetic resonance imaging

the fifth chapter of BPH treatment

4. medicine and plant preparations
Chinese Medicine of China’s medical and health sector development and the health of the Chinese nation with indelible contribution. BPH is currently used in clinical treatment of many types of Chinese medicine, see Zhao Chinese medicine or Western medicine with Pok’s recommendation to carry out treatment.
botanicals, such as universal alleviate BPH in Thailand and other lower urinary tract symptoms associated to obtain a certain degree of clinical efficacy, at home and abroad to obtain a wider range of clinical applications.
Because Chinese medicine and the composition of complex plant preparations, the specific biological mechanisms are not yet clear Pok, actively carry out a variety of drugs, including traditional Chinese medicine, including basic research on traditional Chinese medicine and help to further consolidate the international status of plant preparations. Meanwhile, based on the principles of evidence-based health curb large-scale randomized clinical study of Zhao to further promote the traditional Chinese medicine and plant preparations in the treatment of clinical BPH has a positive meaning.

Two. Surgical treatment of BPH
1 .