This document discusses benign prostate hyperplasia (BPH), including its etiology, pathology, clinical features, diagnosis, and treatment. BPH is a non-cancerous enlargement of the prostate that occurs in older men due to an imbalance of hormones. It causes obstruction of the urethra and symptoms like frequent urination, weak urine stream, and retention. Diagnosis involves exams, urine and blood tests, and imaging of the prostate, kidneys, and bladder. Treatment depends on symptoms and complications but may include catheterization, surgery to remove part of the prostate like TURP, or other procedures to relieve blockage.

1. en love da Homoeopathy
BENIGN
PROSTATE
HYPERPLASIA

2. BENIGN
PROSTATE
HYPERPLASIA

3. BENIGNPROSTATE
HYPERPLASIA(BPH)
AETIOLOGY
• It is benign enlargement of
prostate which occurs after
50 years, usually between60
and 70 years.
• BPHaffects both glandular
epitheliumand connective
tissue stroma.
• It is involuntary hyperplasia
due to disturbance of the
ratio and quantity of
circulating androgens and
estrogens.

4. • Hypothalamus → pulsatile
release of LHRH → release
of luteinising hormone (LH)
fromanterior pituitary →
stimulates Leydig cells of
testes → releases
testosterone (TS) → reaches
prostate → releases 5α
reductase type II of prostate
→ converts TS to DHT
(dihydrotestosterone) for its
effects.
AETIOLOGY
• DHTis five times more
potent than TS
↓
90%TS is fromtestes.
Remaining ,10%TS is from
adrenal cortex.
↓
Withage TS level drops slowly.
↓
But fall of oestrogen level is not
equal

5. ↓
So prostate enlarges through
intermediate peptide growth
factor.
• BPH is a benign neoplasm,
also called as
fibromyoadenoma.
↓
BPHarises fromsubmucosal
glands of periurethral
transitional zone
↓
with stromal proliferation and
adenosis.
↓
It eventually compresses the
peripheral zone and enlarges as
lateral lobe.
↓
BPH arising fromsubcervical
glands of central zone enlarges
as middle lobe projecting up
into the bladder

6. PATHOLOGY
BPH usually involves median
and lateral lobes or one of
them.
↓
It involves adenomatous zone of
prostate, i.e. submucosal
glands.
↓
Medianlobe enlarges into the
bladder.
↓
Lateral lobes narrowthe
urethra causing obstruction.
↓
Urethra above the
verumontanumgets
elongatedand narrowed.
↓
Bladder initially takes the
pressure burden causing
trabeculations, sacculations
and later diverticula
formation.
↓
Enlargedprostate compresses
↓
the prostaticvenous plexus

7. ↓
causing congestion, called as
vesical piles leading to
haematuria
↓
Incriminationof BPH as the
source of haematuria before
excluding other causes is
termed as “Decoyprostate”.
↓
Kidneyand ureter:
Backpressure causes
hydroureter and
hydronephrosis.
↓
Secondaryascending infection
can cause acute or chronic
pyelonephritis.
↓
Oftensevere obstruction can
lead to obstructive uropathy with
renal failure.
↓
BPH causes impotence.

8. CLINICALFEATURES
• Frequency occurs due to
introversionof sensitive
urethral mucosaintothe
bladder or due to cystitis
and urethritis.
• Urgency, hesitancy, nocturia.
• Overflow and terminal
dribbling.
• Difficulty in micturition with
weak streamand dribble.
• Painin suprapubicregion
and in loin due to cystitis
and hydronephrosis
• Acute retention of urine
• Chronicretentionalso can
occur in BPH.
• Retention with overflow.
• High pressure chronic
retentionwith functional
obstruction.
• Impairedbladder emptying
with its problems like
cystitis, urethritis, stone
formation and residual
urine.
• Haematuria.
• Renal failure

9. • Prostatism is a
combination of symptoms
likefrequency bothat day
and night, poor stream,
delayin starting and
difficulty in micturition
• Tenderness in suprapubic
region, with palpable
enlargedbladder due to
chronic retention.
• Hydronephrotic kidney
may be palpable.
• Per rectal examination
shows enlarged prostate. It
should be done when
bladder is empty.
• Features of urinary
infectionlike fever, chills,
burning micturition.
• International prostate
symptomscore is available
now

10. DIFFERENTIAL DIAGNOSIS
• Stricture urethra.
• Bladder tumour
• carcinoma prostate
• Neurological causes of
retentionof urine like
diabetes, tabes, disseminated
sclerosis, Parkinson’s
disease.
• Idiopathic detrusor activity.
• Bladder neck stenosis
• bladder neckhypertrophy
INVESTIGATION
• Urine for microscopy and
C/S.
• Blood urea and serum
creatinine.
• Ultrasoundabdomen—
look for presence of residual
urine
• Cystoscopy.
• Transrectal US (TRUS) is
useful to find out
nodules/possibility of
carcinoma prostate.
• It is not done routinely.

11. • Urodynamics.
• Urine flow rate >15
ml/sec is normal.
• 10–15 ml is equivocal
• <10 ml is low.
• Voiding pressure <60
cm of water is normal
• 60–80 is equivocal
• >80 is high.
• Acid phosphatase.
• Prostate specific antigen
(PSA).
• IVU—tosee kidney
function.
• Serumelectrolytes.
TREATMENT
• Patient withacute retention
of urine requires urethral
catheterisation.
• If urethral catheterisation
fails, thensuprapubic
cystostomy (SPC) is done.

12. • If patient presents with
uraemia, then urethral
catheterisationis a
must.
• That allows the kidney
to functionadequately
and further obstructive
damage is prevented.
• Serumelectrolytes
should be corrected
properlyin these
patients
INDICATIONS OF SURGERY
• Prostatism (frequency,
dysuria, urgency)
• Acute retention of urine.
• Chronicretentionof urine
with residual urine more
than 200 ml.
• Complications like
• Hydroureter
• Hydronephrosis
• stone formation
• recurrent infection,
• bladder changes.
• Haematuria.

13. Surgeries
1. Transurethral resectionof
prostate
Postoperative complications are:
• ™
Water intoxication with
congestive cardiacfailure
• TURP syndrome ™
• Hyponatraemia ™
• Haemorrhage™
• Infection
• Incontinence ™
• Perforationof the bladder
• impotence ™
• Recurrence
2. Freyer’s suprapubic
transvesical prostatectomy.
3. Millin’s retropubic
prostatectomy.
.
4. Young’s perineal
prostatectomy throughperineal
approach.
5. Microwave hyperthermia
treatmentwithtempe ra ture of
45–50 degree
• prostaticcapsule ™
• Stricture urethra ™
• Retrograde ejaculation

14. 6. Laser treatment is becoming
popular, using holmiumlaser.
7. Highenergy electromagnetic
treatment
8. Placement of intraurethral
stents at prostaticurethra.
9. Placementof extrauretheral
stents whichare inert.
10. Transurethral balloon
dilatation of the prostate.
11. If patient presents with acute
retentionof urine, initial
urethral catheterizationis done.
• If not possible then
suprapubic trocal
cystostomy ideallyor formal
openSPCis done.
• Once patient’s obstructive
uropathyis under control,
• TURP is done after7–14
days afterevaluation

15. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

16. A
Special Thanks
To A Very
Special Doctor