6. BENIGN PROSTATE HYPERPLASIA
● Occure in men over 50 year of age,by age of 60 years,50%of men have
evidence of BPH
● Common cause of LUTS,most common cause of BOO in age >70 years
● ETIOLOGY
● HORMONES-LESS testosterone,increased oetrogenic effect
7. PATHOLOGY
● Typically affects submucous group of glands in transitional zone
● When BPH affects central zone,middle lobe projects into bladder within
internal sphincter
8. CONSEQUENCE OF BPH
● No symptoms no BOO
● No symptoms but urodynamic evidence of BOO
● LUTS,no evidence of BOO
● LUTS AND BOO
● Retention,hematuria,urinary infection,stone formation
9. ANATOMICAL EFFECTS
URETHRA-
● Prostatic urethra is lengthened,posterior curve may be exaggerated
● When only lateral lobe is enlarged,distortion of prostatic urethra occurs
BLADDER
● Bladder hypertrophy to overcome obstruction and appears trabeculated
● Increased blood flow at base of bladder are apt to cause hematuria.
10. LOWER URINARY TRACT SYMPTOMS
Idiopathic detrusor overactivity
Neuropathic bladder-
diabetes,stroke,Alzheimer disease,Parkinson disease
Can be described as-
Voiding hesitancy-if bladder is very full
Poor flow-unimproved by straining
11. Intermittent stream-stp and starts
Dribbling-after micturition
Sensation of poor bladder emptying
Episodes of near retention
20. LONG TERM EFFECT OF BOO
❖ Bladder may decompensate,detrusor becomes less efficient,residual urine
develops,leading to chronic retention
❖ Bladder may be more irritable,with decrease in functional capacity,caused by
detrusor overactivity,ageing or idiopathic.
21. COMPLICATIONS OF BOO
● Acute retention of urine
● Chronic retention
Residual volume >250ml,high pressure chronic retention,development of
bilateral hydronephrosis.
● Impaired bladder emptying-
Urinary infection and calculi are prone to develop.
● Hematuria
24. MANAGEMENT
Indications for prostatectomy-
● Acute retention in fit men with no other cause,drugs,constipation,recent
operation.
● Chronic retention and renal impairment-200ml
● Stone ,infection,diverticulum formation
● Haemorrhage
● Elective prostaectomy for severe symptoms
