Benign prostatic hyperplasia - symptomes and treatment

1. BENIGN PROSTATIC
HYPERPLASIA
(BPH)

2. WHAT IS BPH?
It is an enlarged prostate gland.
The prostate gland surrounds the urethra. As the
prostate gets bigger, it may squeeze or partly block
the urethra, which causes problems with urinating.
It is also known as benign prostatic hypertrophy.

3. ANATOMY
The prostate: is a gland that forms
part of the male reproductive system.
It is a conduit between the bladder
and the urethra.
It is composed of several zones.
(Peripheral, central, anterior
fibromuscular stroma, and transition
zones).
BPH originates in the transition zone,
which surrounds the urethra.

4. BPH
oThe main function of the prostate
gland is to secrete an alkaline fluid
that comprises 70% of the seminal
volume.
oThe secretions produce:
 lubrication and nutrition for the
sperm.
liquefaction of the seminal plug.
neutralize the acidic vaginal
environment.

5. CAUSES OF BPH
• BPH is probably a normal part of the aging process
in men.
• Changes in hormone balance.
• Changes in cell-growth factors.
• Genetics (may also play a role).

6. PATHOPHYSIOLOGY
oProstatic enlargement depends on the potent
androgen dihydrotestosterone (DHT). In the prostate
gland, type II 5-alpha-reductase metabolizes circulating
testosterone into DHT, which works locally, not
systemically.
oDHT binds to androgen receptors in the cell nuclei,
potentially resulting in BPH.

7. PATHOPHYSIOLOGY
vitro studies have shown that large numbers of alpha-1-
adrenergic receptors are located in the smooth muscle of
the stroma and capsule of the prostate. Stimulation of
these receptors causes an increase in smooth-muscle tone,
which can worsen LUTS.
Microscopically, BPH is characterized as a hyperplastic
process. The hyperplasia results in enlargement of the
prostate that may restrict the flow of urine from the
bladder, resulting in clinical manifestations of BPH.
The prostate enlarges with age in a hormonally
dependent manner.
Notably, castrated males (e.g: who are unable to make
testosterone) do not develop BPH.

8. SIGN AND SYMPTOMS
• Many men with BPH have no symptoms.
When symptoms (lower urinary tract symptoms) occur, they
may range from mild to serious and disruptive.
• The amount of Prostate enlargement is not always related to
the severity of the symptoms.
• Your symptoms may become worse during cold weather or
as a result of physical or emotional stress.

9. SIGNS AND SYMPTOMS
The symptoms of BPH may involve problems
emptying the bladder or problems
with bladder storage, they include:
• Urinary frequency
• Urinary urgency
• Incomplete bladder emptying
• Decreased force of stream
• Difficulty initiating the urinary stream;
interrupted, weak stream
• Straining - The need strain or push to initiate
and maintain urination in order to more fully
evacuate the bladder
• Dribbling - The loss of small amounts of
urine due to a poor urinary stream

10. PROGNISIS
Chronic BOO secondary to BPH may lead to:
 Urinary retention
 Renal insufficiency
 Recurrent UTI
 Gross hematuria
 Bladder calculi

11. IS BPH A TYPE OF CANCER?
No!
BPH is completely benign. It is not a precursor
to prostate cancer.
But prostate cancer may cause symptoms similar to
those of BPH.

12. DIAGNOSIS
OF BPH

13. TESTS THAT ARE OFTEN DONE :
Digital rectal exam. The doctor inserts a finger into
the rectum to check your prostate for enlargement.
Urine test and urine culture. Analyzing a sample of
your urine can help identifying an infection or
other conditions that can cause similar symptoms.

14. TESTS THAT ARE OFTEN DONE :
A prostate-specific antigen (PSA) test helps check
for prostate cancer, which can cause the same
symptoms as BPH.

15. TESTS THAT ARE USED AS NEEDED
A blood creatinine test checks how well
your kidneys are working.
Post-void residual urine test (PVR) measures the
amount of urine left in the bladder after urination
using ultrasound or a small tube (catheter) put
into the bladder through the urethra.

16. TESTS THAT ARE USED AS NEEDED
Pressure flow studies measure pressure in the bladder
while urinating .
Cystometrogram measures the bladder's pressure,
compliance, and capacity during urinary storage. Like
a uroflowmetry test, which measures how fast the
urine flows out of the bladder.

17. NON
PHARMACOLOGICAL
TREATMENT OF BPH

18. NON PHARMACOLOGICAL
TREATMENT
Limiting the amount of fluids you drink in
situations where needing to go to the toilet may
be inconvenient.
Avoiding drinks that are diuretics because they
increase the amount of urine released by the
body.

19. NON PHARMACOLOGICAL
TREATMENT
Using double-voiding technique when you urinate :
after urinating, you wait a moment and try again to
see if more urine comes out.
Doing exercises to train your bladder to hold
more urine.

20. PHARMACOLOGICA
L TREATMENT

21. DRUGS USED FOR BPH
 α1-adrenoceptor-blocking agents
 5α-reductase inhibitors

22. Α1-ADRENERGIC ANTAGONIST
Terazosin, Doxazosin, Tamsulosin, Alfuzosin, &
Silodosin
Mechanism of Action
They block the α1(A) and α1(B) receptors in
the prostate, causing prostatic smooth muscle
relaxation, which leads to improved urine
flow.

23. Doxazosin, Terazosin,& Alfuzosin block α1(A)
and α1(B) receptors, which decrease
peripheral vascular resistance and lower
arterial BP by causing relaxation of both
arterial and venous smooth muscle.
Tamsulosin & silodosin, are more selective for
the α1(A) receptors and have less effect on BP.

24. ADVERSE EFFECTS
oDizziness, a lack of energy, nasal congestion,
headache, drowsiness and orthostatic
hypotentsion.
oTachycardia, vertigo, and sexual dysfunction.
oInhibition of ejaculation and retrograde
ejaculation.
oTamsulosin has a caution about “floppy iris
syndrome”, a condition in which the iris billows in
response to intraoperative surgery.

25. DOXAZOSIN
(CARDURA®, CARDURA XL®, CADEX®)
S/E: (dizziness, headache, diarrhea,
low blood pressure …).
Preparations: TAB. (1,2,4&8 mg)
TAB. SR (4&8 mg).

26. TAMSULOSIN (FLOMAX®)
S/E: (anemia, nausea & vomiting, weakness,
headache … ).
Preparations: 0.4mg Cap.
Dosing:
The dose may be increased after 2-4 weeks if the
response is not adequate.

27. 5-Α REDUCTASE INHIBITORS
Finasteride & Dutasteride
Mechanism of Action
They inhibit the enzyme 5-α rductase, which is
responsible for converting testosterone to the more
active dihydrotestosterone (DHT). DHT is an androgen
that stimulates prostate growth. By reducing it, the
prostate shrinks and urine flow improves.

28. ADVERSE EFFECTS
o Sexual side effects ..( decreased ejaculate,
decreased libido, ED, gynecomastia, &
oligospermia).
o They have teratogenic potential.. (Causing birth
defects involving genitalia in a male fetus).

29. FENASTERIDE (PROSCAR®)
S/E: ( impotence, decreased libido, confusion, …).
Preparations: 1,5 mg TAB. .
Dosing:
For 6-12 months
to notice a benefit.

30. DUTASTERIDE (AVODART®)
S/E: (impotence, ejaculation disorder ..).
Preparation: 0.5mg liquid-filled capsule.

31. DRUGS FOR BPH
TRADE NAME ACTIVE
INGREDIENT
COMPANY DISTRIBUTER
XATRAL ALFUZOSIN SANOFI MSS
ALFU-KAL XL ALFUZOSIN PERRIGO BD&M
CADEX DOXAZOSIN DEXCEL ‫الرام‬ ‫مستودع‬
TAMSULOSIN
teva
TAMSULOSIN TEVA ‫نابلس‬ ‫مستودع‬
OMNIC TAMSULOSIN ASTELLAS ‫ش‬.‫لألدوية‬ ‫صيام‬
AVODART DUTASTERIDE GSK

32. REFERENCES
• Pharmacology text book/ Lippincott illustrated reviews.
• http://emedicine.medscape.com/
• http://www.webmd.com/
• https://www.andrologyaustralia.org

33. THANK YOU
DONE BY:
ALA’ ABU TAIR
BAYAN ABU SBEIH
RINAD BAKRI