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Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is common in aging men. BPH causes lower urinary tract symptoms (LUTS) such as frequent urination, weak urine stream, and incomplete bladder emptying due to compression of the urethra by the enlarged prostate. Diagnosis involves assessing LUTS, digital rectal exam, prostate-specific antigen levels, and urodynamic tests. Treatment options include medications, minimally invasive procedures, and transurethral resection of the prostate (TURP), which is the gold standard surgical treatment but carries risks of complications like bleeding and incontinence.

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DR-Somalaraju Sateesh Kumar Raju
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95 views

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is common in aging men. BPH causes lower urinary tract symptoms (LUTS) such as frequent urination, weak urine stream, and incomplete bladder emptying due to compression of the urethra by the enlarged prostate. Diagnosis involves assessing LUTS, digital rectal exam, prostate-specific antigen levels, and urodynamic tests. Treatment options include medications, minimally invasive procedures, and transurethral resection of the prostate (TURP), which is the gold standard surgical treatment but carries risks of complications like bleeding and incontinence.

Uploaded by

DR-Somalaraju Sateesh Kumar Raju
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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BENIGN PROSTATIC

HYPERPLASIA
(BPH)
THE PROSTATE GLAND
• MALE SEX GLAND
• PEAR-SHAPE,WT 7-16GM
• SIZE OF A WALNUT
• HELPS CONTROL URINE
FLOW
Clip • PRODUCES FLUID
COMPONENT OF SEMEN
• PRODUCES PROSTATE
SPECIFIC ANTIGEN (PSA)
FOUR AREAS OF THE PROSTATE

• TRANSITION ZONE • ANTERIOR ZONE


• PERIPHERAL ZONE • CENTRAL ZONE
Sagittal View of the Prostate
Plexus of Anterior Middle
lobe lobe Posterior lobe
Santorini

Seminal vesicle

Base of
prostate Rectum
Pubic bone
Puboprostatic
ligament
Apex of prostate Denonvillier's fascia
Penis and
Urethra

Deep transverse
perineal muscle
What is Benign Prostatic Hyperplasia?

• Benign enlargement of prostrate.

Peripheral zone
Transition zone
Urethra
Peripheral zone

Transition zone

Urethra
WHAT CAUSES BPH?

n BPH IS PART OF THE NATURAL AGING


PROCESS (INCREASE IN ANDROGEN
RECEPTOR)

n DIHYDROTESTOSTERONE (DHT) MAY


PLAY A ROLE

n BPH CANNOT BE PREVENTED

n
BPH CAN BE TREATED
WHAT’S LUTS? (LOWER URINARY TRACT
SYMPTOMS )
VOIDING (OBSTRUCTIVE) STORAGE (IRRITATIVE OR
SYMPTOMS FILLING) SYMPTOMS
• HESITANCY • URGENCY
• WEAK STREAM • FREQUENCY
• STRAINING TO PASS URINE • NOCTURIA
• PROLONGED MICTURITION • URGE INCONTINENCE
• FEELING OF INCOMPLETE
BLADDER EMPTYING
• URINARY RETENTION

LUTS is not specific to BPH – not everyone with


LUTS has BPH and not everyone with BPH has LUTS
COMMON SYMPTOMS

nHESITANCY
n DECREASE IN THE
URINARY STREAM nPAINOR BURNING
DURING URINATION
DRIBBLING OR LEAKING
n

AFTER URINATION nFEELINGTHAT THE


BLADDER NEVER
nINTERMITTENCY
COMPLETELY EMPTIES
WHAT CAUSES THESE SYMPTOMS?

n Prostate grows with age


n Pressure on the urethra restricts urine flow
DIAGNOSIS OF BPH
• Symptom assessment
– the International Prostate Symptom Score (IPSS) is recommended as it is
used worldwide
– IPSS is based on a survey and questionnaire developed by the American
Urological Association (AUA). It contains:
• Feeling of incomplete bladder emptying
• Frequency
• Intermittency
• Urgency
• Weak stream
• Straining
• Nocturia.
• Each with 5 , total score 0–7 (mild), 8–19 (moderate), 20–35 (severe)
• eighth standalone question on Quality of life- 1-6score
• Digital rectal examination(DRE)
– Very imp: to differentiate between BPH &
Ca Prostrate.
– FINDINGS IN BPH:
– Enlarged, firm, rubbery, lobulated,
homogeneous, non tender.
– Rectal mucosa moves freely over the gland.
– Lateral lobes felt as a bulge into rectum,
median sulcus well defined.
– FINDINGS IN CA PROSTRATE:
– Gland is hard, modular, irregular,
heterogenous consistency.
– Median sulcus obliterated.
– Rectal mucosa tethered in the gland.
A. IMAGING

 USG Abd & pelvis


 TRUS
 IVP- Intravenous pyelogram
 Cystoscope.

B. LABORATORY INVESTIGATIONS

 Urine- CUE, C/S


 RFT
 Prostrate Specific Antigen (PSA)
 Acid Phosphatase
 Urodynamics (Urine flow rate, Voiding
Pressure.
PROSTRATE SPECIFIC ANTIGEN-

 Androgen regulated serine protease produced from the Prostratic


epithelium- secreted in semen.
 Normal value - < 4 ng/ml of plasma.
 Elevated in Carcinoma, BPH, Prostetitis.
 >10 ng/ml S/O carcinoma, <35 ng/ml is diagnostic.

ACID PHOSPHATASE-

 Enzyme that splits organic PHOSPHATASE. It gets activated


in acid PH.
 Found in many human tissues but more concentrated in
Prostrate.
 Secreted by prostrate, drains into the urethra through
prostratic ducts- blood levels remains very low.
 Normal range: 0-5 King Armstrong units per 100ml of
serum.
 Doesn’t raise in BPH.
 Raised significantly in Ca prostrate with metastasis
URODYNAMICS

Urine flow rate Inference


(For a voided volume of > 200ml)
>15ml/sec Normal
10-15ml/sec Equivocal
<10ml/sec Low

Voiding pressure Inference


<60 cm of H2O Normal
60-80 cm of H2O Equivocal
>80 cm of H2O High
MANAGEMENT

 Acute retention of urine - Urethral/Supra pubic catheterisation.

 If Uraemia, correct electrolytes.


CONSERVATIVE
 Low fat, red meat diet, High protein and vegetables.

 Medications for Mild to Moderate symptoms:-

5 –alpha reductase inhibitors:–


• Inhibits conversion of TS to DHT, shrinks prostrate.
• FENESTERIDE 5mg PO QID.
• Side effects- Erectile dysfunction, Decreased Libido, Breast enlargement,
Retrograde ejaculation.

Alpha Blockers:
• Relaxes bladder neck muscles and muscle fibres in the prostrate making urination
easier.
• TAMSULOSIN 0.4mg-0.8mg PO OD.
• SIDE EFFECTS- Head ache, Retrograde ejaculation, Orthostatic hypertension,
Dizziness.

COMBINATION THERAPY
• DUTASTERIDE (0.5mg) + TAMSULOSIN (0.4mg).
SURGICAL PROCEDURES

• TRANS URETHRAL RESCTION OF PROSTRATE - TURP


• TRANSURETHRAL ELECTRO-VAPORISATION
• TRANSURETHRAL INCISION OF PROSTRATE - TUIP
• TRANSURETHRAL LASER TECHNIQUE (HOLMIUM,KTP)
• BALLOON DILATATION
• PROSTATE STENTS
• PROSTATECTOMY:- SUPRAPUBIC, RETROPUBIC, PERINEAL.
• LAPROSCOPIC
INDICATIONS

• INCREASED FREQUENCY, DYSURIA, INCREASED URGENCY, UNABLE TO


URINATE, NOCTURIA, ACUTE RETENTION OF URINE WITH RESIDUAL
URINE >200ML.
• COMPLICATIONS LIKE HYDRONEPHROSIS, RECURRENT INFECTIONS.
TURP
(transurethral resection of the prostate)

n “Gold Standard” of care for BPH


n Uses an electrical “knife” to surgically cut
and remove excess prostate tissue
n Effective in relieving symptoms and
restoring urine flow
SURGICAL PROCEDURE
• Operation is
performed through a
modified cystoscope
• Prostatic tissue is
resected using an
electrically energized
wire loop.
• the Prostatic capsule
is usually preserved.
• Continuous irrigation
is necessary to distend
the bladder and to wash
away blood and
dissected prostatic
tissue.
IRRIGATION FLUID

Ideally the irrigation


solution should be:
• Isotonic
• electrically inert
• Nontoxic
• Transparent
• inexpensive
• NONHEMOLYTIC
• NONMETABOLIZED
COMPLICATIONS

•TURP can be associated


with a number of
complications:
•TURP Syndrome (2%)
•Hemorrhage
•Bladder perforation
(1%)
•Hypothermia
•Septicemia (6%)
•DIC
•The main challenges are
blood loss and TURP
Syndrome due to
excessive absorption of
irrigant fluid
THE “GOLD STANDARD”- TURP

BENEFITS DISADVANTAGES
n GREATER RISK OF SIDE
n WIDELY AVAILABLE EFFECTS AND
COMPLICATIONS
n EFFECTIVE n 1-4 DAYS HOSPITAL STAY
n 1-3 DAYS CATHETER
n LONG LASTING
n 4-6 WEEK RECOVERY
POSSIBLE SIDE EFFECTS OF TURP
n IMPOTENCE

n INCONTINENCE

n BLEEDING

n ELECTROLYTE IMBALANCE (TURP


SYNDROME).

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