Beware of prostate hyperplasia leading to uremia

Among middle-aged and elderly men, the prostate is the gland most susceptible to disease and a persistent source of discomfort. Prostatic hyperplasia poses significant health risks, requiring prolonged treatment. More critically, the progression of this condition often triggers secondary complications. Notably, prostatic hyperplasia can precipitate uremia in severe cases.

During the intermediate stage of prostatic hyperplasia, urethral obstruction intensifies, increasing urinary resistance beyond the bladder’s capacity. Patients experience frequent urination, urgency, and incomplete bladder emptying, leading to residual urine. Factors like fatigue, cold exposure, or alcohol consumption may exacerbate urethral mucosal edema, worsening obstruction and causing acute urinary retention. Timely catheterization and medication typically restore normal urination.

In advanced stages, severe urethral obstruction and diminished bladder compensation result in residual urine accumulation exceeding 200 ml. A palpable lower abdominal mass and dribbling urination emerge. Elevated intra-bladder pressure transmits to the kidneys, inducing bilateral hydronephrosis, renal dysfunction, and ultimately chronic uremia.

Though uremia is life-threatening, cases stemming from prostatic hyperplasia differ from nephritis-induced uremia. The former arises from reversible urethral obstruction rather than intrinsic kidney damage. Prompt relief of obstruction often restores renal function. Conversely, nephritis irreversibly damages kidney tissue, necessitating dialysis or transplantation.

Preventing uremia requires early catheterization to alleviate obstruction and preserve kidney function. Delayed treatment due to fear of catheterization exacerbates risks. For severe cases, prolonged catheterization risks infections; thus, cystostomy followed by prostatectomy (or permanent cystostomy for high-risk patients) offers a safer solution.