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良性前列腺增生的临床表现和诊断性评估

Authors
Glenn R Cunningham, MD
Dov Kadmon, MD
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Lee Park, MD, MPH
Translators
刘荣福, 主任医师，教授

引言

良性前列腺增生(benign prostatic hyperplasia, BPH)是一种常见疾病，其发生率在50岁以上男性中随着年龄增长而逐渐增加(图 1)。疑似BPH患者的临床表现和诊断方法总结在此。BPH的流行病学、发病机制和治疗，男性下泌尿道症状(lower urinary tract symptom, LUTS)，以及急性尿潴留(acute urinary retention, AUR)将单独讨论。 (参见“良性前列腺增生的流行病学与发病机制”和“良性前列腺增生的药物治疗”和“经尿道手术治疗良性前列腺增生”和“男性下尿路症状”和“急性尿潴留”)

临床表现

BPH的临床表现是LUTS，包括尿频、夜尿、排尿踌躇、尿急和尿流无力。这些症状通常在数年内缓慢出现并逐步进展。然而，这些并非BPH的特异性症状。此外，这些症状与通过直肠检查或经直肠超声评估前列腺大小所发现的前列腺增大的相关性较差。这种差异很可能归因于随年龄增长而出现的膀胱功能改变[1]和前列腺移行区增大(直肠检查中并非总是明显)。

BPH患者也可能会有血尿。然而，临床医生不能因为存在BPH而不对患者的血尿实施进一步评估，尤其是因为年龄较大的男性更可能有严重的疾病，如前列腺癌或膀胱癌。 (参见“成人血尿的病因和评估”)

自然病程

BPH的自然病程越来越被人们所熟知[2]。人群研究显示，中至重度LUTS及最大尿流率降低的患病率随年龄的增大而上升；LUTS、最大尿流率和前列腺体积之间有较小的相关性。纵向研究已表明，美国泌尿协会(American Urologic Association, AUA)症状指数评分仅轻度增加。这些BPH的替代指标说明了疾病的严重程度处于某一范围，且并不具有阈值效应。

对于少部分男性，未经治疗的BPH可导致AUR、复发性泌尿道感染、肾积水，甚至肾衰竭。据估计，一名有中至重度症状的60岁男性在未来10年发生AUR的可能性为13.7%。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-28.
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