This document discusses benign hypertrophy of the prostate (BHP). It defines BHP as a non-malignant growth of the prostate that is common in men over 40. Symptoms include frequent and urgent urination. Diagnosis involves physical exam, urine tests, and imaging. Treatment options discussed include medications, surgery, and homeopathic medicines.

1. BENIGN HYPERTROPHY OF
PROSTRATE
DR. ANJALI MIGLANI
CHIEF MEDICAL OFFICER ( H )
DTE. OF AYUSH

2. WHAT IS BENIGN HYPERTROPHY OF
PROSTRATE
• BENIGN PROSTATIC HYPERPLASIA IS NON MALIGNANT GROWTH OF PROSTATE.
• AGE-RELATED PHENOMENON IN NEARLY ALL MEN, STARTING AFTER 40 YEARS OF
AGE.
• HISTOLOGICALLY 50-60% MEN IN 60S AND 80-90% IN THEIR 70S AND 80S
SUFFER FROM BHP.
• PROSTATE GLAND SIZE INCREASES UP TO 45GMS. (THE NORMAL WEIGHT IS
APPROX. 10 GMS)

3. ETIOPATHOLOGY
• ETIOLOGY IS POORLY UNDERSTOOD DESPITE DECADES OF INTENSE
RESEARCH. IT IS THOUGHT TO BE STIMULATED BY DIHYDROTESTOSTERONE
(DHT)
• RISK FACTORS ARE: CHANGES TO BLADDER ANATOMY AND FUNCTION,
URINARY TRACT INFECTION, FORMATION OF BLADDER STONES AND RENAL
FAILURE
• ADDITIONAL RISK FACTORS: POSITIVE FAMILY HISTORY OF BHP

4. SYMPTOMS/ SIGNS
• HESITANCY, FREQUENCY, URGENCY, STRAINING, WEAK FLOW, PROLONGED
VOIDING, PARTIAL OR COMPLETE URINARY RETENTION, SMALL VOIDED
VOLUMES, NOCTURIA, PAINFUL URINATION.
• IF PEAK URINARY FLOW RATE <10 ML/S, THEN SUB VESICAL OBSTRUCTION IS
SEEN IN 90% PATIENTS OF BHP
• SOMETIMES OTHER DISEASES E.G. PROSTATE CANCER, BLADDER OUTLET
OBSTRUCTION LIKE URETHRAL STRICTURE AND STONES ALSO HAVE SIMILAR
LOWER URINARY TRACT SYMPTOMS AND SHOULD BE RULED OUT

5. DIAGNOSIS
• CAREFUL HISTORY AND PHYSICAL EXAMINATION INCLUDING RECTAL
EXAMINATION (DRE)
• DRE IS HOWEVER UNRELIABLE IN ASSESSING SIZE AND MAY UNDERESTIMATE
SIZE OF PROSTATE.
• URINE ANALYSIS, SERUM CR. PROSTRATE SPECIFIC ANTIGEN.
• UROFLOWMETRY-URINARY FLOW RATE <10 ML/S HIGHLY SUGGESTIVE OF
OUTLET OBSTRUCTION
• TRANSABDOMINAL ULTRASOUND - FOR POSTVOID RESIDUAL URINE
MEASUREMENT

6. MANAGMENT
• AVOID FLUIDS PRIOR TO BEDTIME OR GOING OUT
• REDUCE CAFFEINE AND ALCOHOL ESPECIALLY TOWARDS EVENING
• SCHEDULED URINATION AT LEAST ONCE EVERY 3 HOURS
• IN CASE OF URGENCY OF URINE, PASS URINE AS SOON AS POSSIBLE. IF THE
URGE IS NEGLECTED FOR A CONSIDERABLE TIME , IT MAY LEAD TO ACUTE
URINARY RETENTION.
• LEAD A HEALTHY LIFE STYLE

7. ALLOPATHIC TREATMENT
• ALPHA-1-ADRENERGIC ANTAGONISTS
• IT RELAXS SMOOTH MUSCLE IN THE BLADDER NECK, PROSTATE CAPSULE, AND
PROSTATIC URETHRA
• 5-ALPHA-REDUCTASE INHIBITORS
• IT REDUCES THE SIZE OF THE PROSTATE GLAND
• ANTICHOLINERGICS
• FOR PATIENTS WITH PREDOMINATELY IRRITATED SYMPTOMS RELATED TO
OVERACTIVE BLADDER

8. SURGICAL OPTIONS
• IN CASE ORAL MEDICATIONS DO NOT HELP, SURGERY CAN BE THOUGHT OF.
• IT CAN BE OPEN PROSTATECTOMY, OR ENDOSCOPICALLY WHEN TRANSURETHRAL
INCISION OF THE PROSTATE (TURP) IS DONE
• OTHER SURGICAL INTERVENTIONS ARE:
• TRANSURETHRAL NEEDLE ABLATION (TUNA)
• TRANSURETHRAL MICROWAVE THERAPY (TUMT)
• TRANSURETHRAL ELECTRO EVAPORATION OF THE PROSTATE (TUVP)

9. HOMOEOPATHIC MEDICINES
• BENZOIC ACID- DRIBBLING OF URINE IN OLD MEN. URINE IN CLOTHES SCENTS THE WHOLE ROOM.
URINE DARK BROWN IN COLOR AND VERY OFFENSIVE.
• STAPHISAGRIA- OLD MEN WITH FREQUENT URINATION AND DRIBBLING OF URINE AFTER WARDS.
BACKACHE WORSE AT NIGHT IN BED AND IN THE MORNING BEFORE RISING.
• CONIUM MACULATUM- URINE FLOWS, STOPS AND FLOWS AGAIN INTERMITTENTLY, ESP IN OLD
BACHELORS. DRIBBLING OF URINE IN OLD MEN. SWEATING DAY OR NIGHT, AS SOON AS ONE
SLEEPS OR EVEN WHEN CLOSING THE EYES.
• THUJA- ANTI SYCOTIC REMEDY. PROLIFERATIONS, PROSTRATIC AFFECTIONS AND PATHOLOGICAL
VEGETATIONS ESP AFTER SUPPRESSED GONORRHOEA. PAIN AND BURNING FELT NEAR NECK OF
BLADDER WITH FREQUENT , URGENT DESIRE TO URINATE

10. HOMOEOPATHIC MEDICINES
• CARBOLICUM ACIDUM- IRRITABLE BLADDER IN OLD MEN WITH FREQUENT
URINATION AT NIGHT. URINE ALMOST BLACK. BHP WITH DIABETES
• SABAL SERRULATA- CYSTITIS WITH BHP. DISCHARGE OF PROSTATIC FLUID
WITH WASTING OF TESTIS AND LOSS OF SEXUAL POWER. IRITIS WITH
PROSTATIC TROUBLES.
• FERRUM PICRICUM- FREQUENT URINATION AT NIGHT, FEELING OF FULLNESS
AND PRESSURE IN RECTUM. SMARTING AT NECK OF BLADDER AND PENIS.
RETENTION OF URINE.