Source: Medical Channel Asia
Transcript:
题目是关于前列腺增生，属于良性的一个疾病。
我们首先要了解的就是关于前列腺这个器官，它是主要是男性的生殖器官，属于在我们这个膀胱的下部，重要的是它会环绕着我们的这个尿道，所以有时候就会造成某一些尿道的病状，如果它有出现什么问题的话。
01:01 另外还有就是，精管也是会栓入前列腺的中央，（如果前列腺出现问题的话）有一些症状和前列腺有关的（问题）话也会出现在射精的过程中。
01:28 然后，要了解就是我们前列腺的主要的功能是什么？它是和生殖器官有关系，主要就是会分泌精液，然后这个精液就很重要，主要是产生刺痒和运输精子，还有就是激发精子的活力。前列腺也会分泌血清前列腺特异抗原（PSA），医生通常会做PSA检测，目的是检测癌症的可能性及风险。所以，这也是前列腺的其中一项功能。
02:44 另外呢,前列腺主要会出现这三种相关疾病。前列腺炎、前列腺癌还有前列腺增生。前列腺炎几乎会同时发生在年轻人及老年人身上，很多时候它的症状和尿道发炎有相似之处。而前列生增生和前列腺癌症主要发病期是在老年人身上。这些疾病都会有相关的发病特征，同一个时候会出现两个发病特征，所以医生需要做一些检验来判断病人主要患上哪一种疾病（确认病情）。
04:20 今天主要探讨的前列腺增生是一种良性的增生，而不是癌症。所以很多時候，我们发现这个前列腺增生大都发生在前列腺的中央，接近在尿道的周围，前列腺会慢慢肿胀，导致它压住尿道，使尿道变得狭窄，造成排尿的过程困难。有些增生发生在膀胱的下半部， 增生导致压力的增加，尿道阻塞，也会导致小便变得困难。
5.36 所以这样的情况下，我们的膀胱就需要更加用力的把尿排出去。前列腺进而变得肥大，会造成某一些的症状，所以它的反应会促使膀胱的墙越來越厚， 越來越有更高的壓力。比如一些症狀，等一下我會跟大家分享。如果前列腺增生不及早医治的话，它将会带来更多的并发症。
06:46 我这里有列出几种并发症，主要都是和这个尿储存有关系。有时候病人完全不能够排尿，突然间面临排尿困难、想排尿却不能够排的话，就会很痛很不舒服。
07:14 另外，就是有时候这个尿储存是慢性的，如果慢性的话呢，很多时候病人都会感觉上厕所会很密很频繁； 也因为尿储存的关系，会发生来不及上厕所漏尿等问题。前列腺增生因为尿储存的关系还会引发尿道发炎、膀胱结石。一旦结石问题发生，很多时候可能也会造成出血，尿里面会发现有血或者比较浑浊。
08:10 如果前列腺增生还不及时治疗的话，膀胱功能会慢慢衰退，并且丧失功能，功能完全的喪失以后，就不能夠排尿，到时候再治疗的话，病人也不一定能完全康复之前的状况，也可能不能够完全排尿。前列腺增生有时候也可能会导致肾衰竭，如果膀胱里的那个压力很高的话它会直接造成肾也会受影响。
09:10 为什么我们需要多一些了解良性前列腺增生的问题呢？ 主要是因為跟著我們的年龄，前列腺增生是越來越普遍。50岁以上的男性接近50%都有这个情况，
09:39 随后更年长的年龄好像60岁70岁，发病几率是一直在增加的。 年纪越大的话，越可能会有这种病症，就会需要治疗或者需要去检验，不然的话很可能会发生越来越多的症狀,然後就并发症也会随着出现。
10:17 我想跟大家分享一下关于这个病症有哪些症状：前列腺如果肿大会导致尿道阻塞，然后会造成储存的问题，比如很急尿，一个小时里面可能会一直频密地上厕所。出门的时候一直要寻找厕所，很多病人在这样的压力下就会导致不敢出门的情况发生。
11:14 另外晚上也是，因为尿频，病人很多时候都起来两三次或者更多的次数，间接会造成睡眠也是受影响。所以发现这个症状时，病人就会来看医生。另外呢，尿急也是其中一个症状。
11:44 尿急有时候造成病人就不够时间去厕所，来不及的时候还可能会尿失禁。尿失禁的话就很糟糕，这些症状导致诸多不便，并且影响我们的日常生活。
12:24 另外呢，尿道发炎会不舒服，病人也会发现排尿的时候要等一下才能够排得出。 尿流的速度也会很慢。很多时候要等一些时间，才会发现尿才会排完。病人也会经常有这个感觉说尿好像一直排不完，像刚刚上完厕所却还是感觉有尿储存在膀胱里,不久又想要上厕所。
13:28 所以这些也是它的病状。 如果发现有这种病状的话, 这很可能和前列腺增生有关系。
13:43 前列腺增生会造成尿液储存越来越多，这样的话就很容易细菌感染，就会造成尿道发炎。比如好像排尿的时候会感觉很痛
14:11 那個尿道裡感覺到刺痛或者很辣（灼热）的感觉外，还有在我们臀骨上一点或者下腹的位置会感到疼痛，另外会感觉到尿很急，一直想要上廁所的感觉，在尿里（尿血）或精液（血精）中发现有血的情况。
14:41 这些都和尿道发炎、前列腺炎有关系。前列腺增生的时候往往会导致前列腺炎在同一个时期一并发生。当病人来看医生时，我们需要做一些检测，以临床的诊断为先。让你所看到的，前列腺属于在我们男性盆腔比较尾端的部分，
15:41 很多时候从体外是检查不到的。所以我们是需要用个手指进入这个直肠，才能够摸得到前列腺。由于经常操作，从这个检查中泌尿科医生就会知道并且感觉得到这个前列腺是否出现增生的情况。
16:10 某一些前列生增生出现比较硬的感觉，就不排除有癌症的可能性。所以从这个检测，配合尿液的检验，比如说要培养看有没有病菌的存在，
16:40 就会从中知道道有發炎的情況。另外， 我们也会进行前列腺特异抗原的测量（PSA）以确保它的水平是否升高。一般正常指数是在<4以下。
17:10 如果指数超过>4，我们就会担心病人是否有潜在的癌症风险，如果确认风险比较高，我们就会再做进一步的检测。
17:39 不过今天所我们所讨论的前列腺增生，很多时候病人前来的时候都比较担心是癌症， 先把癌症风险排除的话，病人就会比较安心的进项下一步治疗。
18:04 PSA有时候会升高，不过不是每一次的升高或超过指数4就代表病人患上癌症。因为前列腺增生也会导致PSA升高，另外尿道发炎也会导致PSA出现升高的情况。所以很多时候对我们医生来说，就是要把癌症这个情况排除。如果到最后还是有察觉癌症风险的话，当然就要进一步的检查。
19:02 所以磁共振 MRI 或者需要从前列腺当中抽取一些样本化验，才能够断判到底有没有癌症。所以这一部分很多时候是需要分析清楚，才能够进一步的治疗。
19:30 如果经过检查以后发现前列腺有增生的话，进一步要了解这个前列腺的话，我们需要做超声波检验。通常有两种方法能进行这个超声波：第一个是从下腹，超声波经过膀胱，也能清楚看见前列腺；以测量他它的肿大和形状；第二种比较准确的方法是经过直肠， 进入直肠以后，放入超声波仪器，从这部位检查会比较准确。
20:29 这个检测主要是要了解前列腺的状况还有它的肿大，这样我们就能够观探病人的情况，制定一套适合病人的治疗方案。
21:04 另外呢，通过尿流计算测验这个排尿的过程以及排尿的速度快或者慢，一般上正常的话呢，那个排尿的时间大概是在差不多30秒就应该能够排完；
21:34 正常的排尿速度会蛮快的，一般是超过15毫升。每一秒钟要超过15ml就属于没有阻塞的情况；如果低过15ml，像在这里给大家看到的这个图。这个病人他的那个尿的速度很慢，
22:04 曲线是平的，所以从这里我们就能观察到， 病人出现阻塞尿道的情况。所以从这个测量 们就大概了解到这个病人 可能因为前列腺增生导致尿道比较狭窄，所以他的尿排出来的速度就比较慢。
22:32 病人排尿过后，我们会用超声波再来测量膀胱里面是否还有储存住尿液，如 果尿液还是蛮多的话，就代表 病人的膀胱也不能够一次排完尿，还有尿液储存在里面，也就代表说,它的这个前列腺增生的情况比较严重，需要进一步治疗。
23:01 然后看能够用药或者用手术方面来治疗。治疗过后，持续性的检测还是需要的，因为我们也需要了解治疗效果是否见效。今天分享就到这里，谢谢。
Benign Prostatic Hyperplasia (BPH)
We will first understand the prostate, which is a male reproductive organ located below the bladder. Importantly, it surrounds the urethra, so problems with the prostate can cause urinary symptoms.
01:01 Additionally, the ejaculatory ducts also enter the central part of the prostate. Therefore, some symptoms related to prostate problems can also occur during ejaculation.
01:28 Next, we need to understand the main functions of the prostate. It is related to the reproductive system and mainly secretes semen. This semen is important for nourishing and transporting sperm, and for activating sperm motility. The prostate also secretes prostate-specific antigen (PSA), which doctors often test to assess the possibility and risk of cancer. Therefore, this is also one of the prostate’s functions.
02:44 The prostate is mainly associated with three diseases: prostatitis, prostate cancer, and benign prostatic hyperplasia (BPH). Prostatitis can occur in both young and elderly men, and its symptoms often resemble those of urethral inflammation. BPH and prostate cancer mainly occur in elderly men. These diseases have related characteristics, and sometimes two characteristics can occur simultaneously, so doctors need to perform tests to determine the patient’s primary condition.
04:20 Today, we will mainly discuss BPH, which is a benign enlargement, not cancer. Often, BPH occurs in the central part of the prostate, near the urethra. The prostate gradually swells, compressing the urethra and making it narrow, causing difficulty in urination. Some hyperplasia occurs in the lower part of the bladder, increasing pressure and causing urinary obstruction, also leading to difficult urination.
5:36 In such cases, the bladder needs to work harder to expel urine. The enlarged prostate causes certain symptoms, and this reaction causes the bladder wall to thicken and increase pressure. Some symptoms will be shared later. If BPH is not treated early, it will lead to more complications.
06:46 Here are some complications, mainly related to urine storage. Sometimes, patients cannot urinate at all, suddenly facing difficulty urinating, and experiencing pain and discomfort when they want to urinate but cannot.
07:14 Also, sometimes urine storage is chronic. In chronic cases, patients often feel the need to urinate frequently. Due to urine storage, problems such as urinary leakage due to rushing to the toilet can occur. BPH can also cause urethral inflammation and bladder stones due to urine storage. Once stones occur, they can often cause bleeding, with blood or cloudy urine.
08:10 If BPH is not treated promptly, bladder function will gradually decline and become dysfunctional. After complete loss of function and inability to urinate, treatment may not fully restore the patient’s previous condition, and they may not be able to urinate completely. BPH can sometimes lead to kidney failure if the pressure in the bladder is high, directly affecting the kidneys.
09:10 Why do we need to know more about BPH? Mainly because with age, BPH becomes more common. Nearly 50% of men over 50 have this condition.
09:39 Subsequently, the incidence continues to increase in older age groups, such as 60 and 70. The older you are, the more likely you are to have this condition, requiring treatment or testing, otherwise more symptoms and complications may occur.
10:17 I would like to share some symptoms of this condition: prostate enlargement can cause urethral obstruction and storage problems, such as urinary urgency, frequent urination within an hour. Patients often look for toilets when going out, and many patients are afraid to go out under this pressure.
11:14 Also, at night, due to frequent urination, patients often wake up two or three times or more, indirectly affecting sleep. Therefore, patients seek medical attention when they notice these symptoms. Urinary urgency is also a symptom.
11:44 Urinary urgency sometimes causes patients to not have enough time to reach the toilet, and they may experience urinary incontinence. Urinary incontinence causes many inconveniences and affects daily life.
12:24 Additionally, urethral inflammation is uncomfortable, and patients may find it difficult to start urinating. The urine flow rate is also slow. Often, patients have to wait for some time for the urine to finish. Patients also often feel that the urine is not completely emptied, feeling like they still have urine stored in the bladder after urinating, and soon wanting to urinate again.
13:28 These are also symptoms. If you notice these symptoms, they are likely related to BPH.
13:43 BPH can cause more and more urine storage, which easily leads to bacterial infections and urethral inflammation. For example, pain during urination.
14:11 In addition to stinging or burning sensations in the urethra, there may be pain in the upper or lower pelvis, a feeling of urinary urgency, and blood in the urine (hematuria) or semen (hematospermia).
14:41 These are related to urethral inflammation and prostatitis. BPH often leads to prostatitis occurring simultaneously. When patients see a doctor, we need to perform tests, starting with clinical diagnosis. As you can see, the prostate is located in the posterior part of the male pelvis.
15:41 Often, it cannot be examined externally. Therefore, we need to insert a finger into the rectum to feel the prostate. Through frequent examinations, urologists can know and feel whether the prostate is enlarged.
16:10 Some BPH cases have a harder feel, which raises the possibility of cancer. Therefore, from this examination, combined with urine tests, such as culture to see if there are bacteria,
16:40 we can know if there is inflammation. Additionally, we will measure prostate-specific antigen (PSA) to ensure its level is elevated. The normal index is generally below 4.
17:10 If the index exceeds 4, we will worry about the patient’s potential cancer risk. If the risk is confirmed to be high, we will do further tests.
17:39 However, regarding the BPH we are discussing today, patients are often more worried about cancer when they come, and eliminating the cancer risk first will make patients more comfortable with further treatment.
18:04 PSA sometimes rises, but not every rise or exceeding the index of 4 means the patient has cancer. BPH can also cause PSA to rise, and urethral inflammation can also cause PSA to rise. Therefore, for us doctors, the most important thing is to rule out cancer. If cancer risk is still detected in the end, further examination is necessary.
19:02 Therefore, MRI or taking samples from the prostate for testing is necessary to determine if there is cancer. Therefore, this part often needs to be analyzed clearly before further treatment.
19:30 If, after examination, hyperplasia of the prostate is found, to further understand the prostate, we need to do ultrasound examination. There are usually two ways to do this ultrasound: one is from the lower abdomen, where the ultrasound goes through the bladder and can clearly see the prostate, to measure its enlargement and shape; the second more accurate method is through the rectum, where the ultrasound instrument is inserted into the rectum, and examination from this part is more accurate.
20:29 This examination is mainly to understand the prostate’s condition and its enlargement, so that we can observe the patient’s condition and develop a treatment plan suitable for the patient.
21:04 Additionally, through uroflowmetry, we can measure the urination process and the speed of urination, which is normally completed in about 30 seconds;
21:34 normal urination speed is quite fast, generally exceeding 15 ml. If it exceeds 15 ml per second, it means there is no obstruction; if it is lower than 15 ml, as shown in the picture here, the patient’s urine speed is very slow,
22:04 the curve is flat, so from here we can observe that the patient has urethral obstruction. Therefore, from this measurement, we can roughly understand that the patient’s urethra may be narrow due to BPH, so the speed of urine discharge is slower.
22:32 After the patient urinates, we will use ultrasound to measure whether there is still urine stored in the bladder. If there is still a lot of urine, it means that the patient’s bladder cannot empty urine at once, and there is still urine stored inside, which means that the BPH condition is more serious and needs further treatment.
23:01 Then we will consider medication or surgery for treatment. After treatment, continuous monitoring is still needed, because we also need to understand whether the treatment is effective.
That’s all for today’s sharing, thank you.