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BPH

The prostate gland lies below the bladder and enlarges in most men as they age due to benign prostatic hyperplasia (BPH). By age 60, half of men and by age 70-80, 80% of men experience BPH symptoms like frequent and difficult urination. While the cause is not fully known, testosterone and other hormones are thought to play a role in prostate growth. BPH involves non-cancerous growth and hyperplasia of prostate cells that obstruct the urethra. Treatment options include watchful waiting, drug therapies like alpha blockers, 5-alpha reductase inhibitors or combinations thereof, and surgical procedures like transurethral resection of the prostate.

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226 views

BPH

The prostate gland lies below the bladder and enlarges in most men as they age due to benign prostatic hyperplasia (BPH). By age 60, half of men and by age 70-80, 80% of men experience BPH symptoms like frequent and difficult urination. While the cause is not fully known, testosterone and other hormones are thought to play a role in prostate growth. BPH involves non-cancerous growth and hyperplasia of prostate cells that obstruct the urethra. Treatment options include watchful waiting, drug therapies like alpha blockers, 5-alpha reductase inhibitors or combinations thereof, and surgical procedures like transurethral resection of the prostate.

Uploaded by

surya mertayasa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Benign

Prostatic Hyperplasia
(BPH)
what is the prostate gland
n Prostate gland : is a fbromuscular and glandular

organ lying Just inferior to the bladder .

n According to Mcneal , the prostate has a peripheral

zone , central zone and transitional zone.

n According to Lowsley , the prostate has posterior

,two lateral , anterior and middle lobes


Benign prostatic hyperplasia (BPH)

n Half of all men over the age of 60 will


develop an enlarged prostate
n By the time men reach their 70s and 80s,
80% will experience urinary symptoms
Etiology : is not completely understood , but it seems
to be multifactorial and endocrine controlled .
Hormones :
androgen deprivation in older man reduces
prostate size , additional investigation have
demonstrated a positive correlation between level of
free testesterone and estrogen and the volume of the
BPH .
Stromal - epithelial interaction theory. This caused
by various growth factors.
Pathology :

BPH develops in the transitional zone . It is


truly hyperplasia process resulting from
increase in cell number .
Microscopically reveal a nodular growth
pattern that it is composed of varying amount
of stromal and epithelial tissue, stromal tissue
composed from collagen and smooth
muscle
Pathophysiology
n obstructive component
of BPH .
Mechanical obstruction .
Dynamic obstruction .

n Irritative voiding
complaints
n Clinical Feachers:

Symptoms:
Irritative symptoms
Obstructive symptoms
Signs:
Neurological examination .
Digital rectal examination ,it shows size of
the prostate (not compatible with severity
of the symptoms)
In BPH ,it reveals smooth,firm,elastic
enlargement of the prostate .
n Lab. Findings:

Urinalysis
Renal function
There is 10% renal insufficiency observed in BPH.
PSA (prostatic specific antigen)
Imaging :
IVP and ultrasound are indicated in concomitant
urinary tract disease or complicated BPH
Cystoscopic examination
Additional testes : cystometrogram and urodynamic
prophile for patient with
Neurological disease .
Failed prostatic surgery .
Complications of BPH:
Bladder stones
UTI
Hematuria
Bladder decompensation
Renal failure
Acute and chronic urine retention
Treatment :
1. Watchful waiting
2. Medical treatment
a- alpha blockers :
-Phenoxybenzamine , it is non selective
blocker (Dose 10mg ).
-prazosin it is short acting selective 1
blocker .
-terazosin (5mg,10mg ),doxazosin (4mg,
8mg) ,these are long acting 1
blockers .
-tamsulosin (0.4mg,0.8mg),silodosin
(8mg) 1a selective blocker. This is
the most potent blockers.
Side effects :
-orthostatic hypotension
-dizziness
-tiredness
-retrograde ejaculation
-rhinitis
-headack
b- 5-reductase inhibitors :

Side effects :
-decreased libido
-decreased ejaculatory volume
-impotence
c-Combination therapy :

d-Phyto therapy
3-conventional surgical therapy :

(a)Taransurethral resection
of the prostate (TURP)
90% of simple prostatectomy
can be done endoscopically
,symptoms and flow rate
improvement is superior to
that of any minimally invasive
therapy .
Complications:

Impotence
Incontinence
Bleeding
May require blood
transfusion
Retrograde ejaculation.
TUR syndrome :
TUR syndrome :

It is a clinical manifestation of nausea


,vomiting, confusion ,hypertension
bradycardia and visual disturbance .

Treatment:
1-Diuresis
2-Hypertonic saline in severe case .
b-Transurethral incision of the
prostate (TUIP)
C- open
prostatectomy
Indications:
prostate gland over 100 gm .
BPH with bladder diverticule .
BPH with vesical stone .
if dorsal lithiotomy position is not
possible .
Minimally invasive therapy :
(1) Laser therapy

Advantages:
-minimal blood loss .
-rare instance of TUR syndrome .
-ability to treat patient with anti coagulant
therapy .
-ability to done in out patient procedure.
Disadvantages :
--longer postoperative catheterization
time
-more irritative voiding complaints.
-high cost of laser fibers and generators.
2- Transurethral evaporization of
the prostate
3-hyperthermia

Micro wave thermal therapy


(4) High Intensity Focused Ultrasound
(HIFU):
(5) Intra urethral stents
Transurethral balloon dilation of the
prostate
Thank You

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