The prostate is a gland in the male reproductive system that adds fluid to semen. Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate that occurs in older men. It can cause lower urinary tract symptoms like frequent urination, weak urine stream, and difficulty emptying the bladder fully. Assessment of BPH includes a digital rectal exam, urine flow rate test, and ultrasound or cystoscopy. Treatment options include medications to relax the prostate or reduce its size, as well as surgery to remove part of the enlarged prostate.

1. Dr Soumar Dutta Guwahati Refinery Hospital

2. The prostate is an accessory gland of the male reproductive system. The secretions of this gland add bulk to the seminal fluid. Shape: Inverted cone Apex, base & 4 surfaces Size: 4cm X 3cm X 2cm Weight: 8 Gm Consistency: Firm Lobes: 5 Histological 3 zones outer /peripheral middle/transitional inner/central

4. Changes in the urethra : enlargement of the prostatic urethra exaggeration of the normal posterior curvature of the prostatic urethra urethra compressed laterally reducing it to an A-P slit Changes in the urinary Bladder: Compensatory hypertrophy of the vesical detrussor Trabeculation of bladder wall. Hypertrophy of the trigone. Formation of diverticula Formation of pool of residual urine- cystitis,calculus[triple PO4] Changes in ureters and kidney: Hydroureter and Hydronephrosis Vesicoureteric reflux- Ac. & Chr. Pyelonephritis

8. Cystoscopy: Indications: Haematuria Urethral stricture or H/O urethritis. Prior TURP / Open Prostatectomy IVP: Determines f(x) of kidneys Hydronephrosis / Hydroureter Diverticula of Bladder

10. Alpha- blockers : Relaxes smooth muscles -> decrease urethral resistance . Non selective : phenoxybenzamine Selective alpha 1 : Prazosine, Terazocin, Doxazocin. Selective alpha 1a : Tamsulosin and Alfuzosin Androgen suppression : Involution of Epithelial Component, decreasing Volm. Anti-androgens : Flutamide 5 Alpha Reductase Inhibitors : Finestride; Dutasteride Estrogen suppression : Atamastane

11. Surgery: Procedure: Prostatectomy Approach: Transurethral- TURP Retropubic Transvesical Perineal Complications: Haemorrhage Perforation of UB and prostatic capsule. Incontinence Urethral strictures Retrograde ejaculation and impotency Bladder neck Contractures Urethral strictures Reoperation TUR Syndrome: water intoxication --> dilution hyponatraemia.

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