World Kidney Day | Lower urinary tract symptoms and kidney disease caused by prostatic hyperplasia

Editor's Note: March 14, 2024 is the 19th World Kidney Day. This year's theme is "Kidney Health for All: Advancing equitable access to care and optimal medication practice", which aims to arouse attention to kidney health and promote the prevention and treatment of kidney diseases. In order to build a health science popularization platform for medical workers and improve the public's understanding of kidney diseases, this magazine has launched an essay solicitation activity on the occasion of World Kidney Day and selected excellent articles for readers.

Prostatic hyperplasia is the most common disease causing lower urinary tract symptoms (LUTS) in middle-aged and elderly men. The clinical manifestations of LUTS include storage phase, voiding phase and post-micturition symptoms: storage phase symptoms include urinary urgency, frequent urination, urge incontinence and nocturia; voiding phase symptoms include thinning of urine stream, bifurcated urine stream, intermittent urine stream and hesitant urination; post-micturition symptoms include dripping after urination and incomplete urination.

LUTS caused by prostatic hyperplasia is related to multiple factors of renal impairment, including the age, medical history, prostate volume, residual urine, prostate-specific antigen, etc. of patients with prostatic hyperplasia, which should be detected early and clinically valued. Most patients often come to the hospital for symptoms such as lower limb edema, at which time renal function tests are crucial, and renal impairment is also one of the indications for surgical intervention of LUTS.

Mild LUTS has little impact on the quality of life. Since there is no widespread LUTS education for the general public in China, some patients lack the awareness of seeking medical treatment. Studies have found that patients with lower urinary tract problems are often unwilling to actively seek treatment due to embarrassment and other emotions. Some patients also have insufficient understanding of the disease and believe that LUTS is an inevitable part of aging.

LUTS often precedes renal impairment by a long time and can be regarded as a "barometer" of kidney disease. As the degree of prostatic hyperplasia continues to worsen, patients will experience acute urinary retention, resulting in more and more residual urine, which increases the intra-bladder pressure and is transmitted along the bilateral ureters to the bilateral renal calyces and renal pelvis, leading to chronic renal impairment and even renal insufficiency. Therefore, it is recommended that patients go to the hospital for examination and treatment in time when they have LUTS caused by prostatic hyperplasia to avoid delaying the disease.

(Author: Li Weiliang, Department of Urology, Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University)