This document provides an overview of benign prostatic hyperplasia (BPH), including relevant anatomy, etiology, pathophysiology, symptoms, complications, diagnosis, and treatment options. It discusses the prostate gland anatomy and development. Etiology sections cover the roles of androgens, estrogen, growth factors, and other signaling pathways. Pathophysiology involves increased urethral resistance and compensatory bladder changes. Symptoms include both voiding and storage issues. Complications include urinary retention, incontinence, and infection. Diagnosis involves history, exam, testing such as DRE, ultrasound and PSA. Treatment ranges from medications to minimally invasive procedures like TUNA and TUMT to surgeries
BPH is a common noncancerous enlargement of the prostate gland that increases in frequency with age in men over 50. By age 60, 50% of men will show microscopic signs of BPH, increasing to 90% by age 85. BPH causes lower urinary tract symptoms like frequent urination, weak urine stream, and incomplete emptying due to static obstruction from an enlarged prostate and dynamic obstruction from prostate smooth muscle contraction. Diagnosis involves evaluating symptoms, digital rectal exam to assess prostate size and consistency, urinalysis to rule out infection, and tests like uroflowmetry and post-void residual urine measurement to assess bladder function.
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
Benign prostatic hyperplasia (BPH) is a common benign tumor in older men that results from proliferation of cells in the prostate. It affects the transition zone of the prostate and causes obstruction of urine flow. Common symptoms include hesitancy, weak stream, urgency and frequency. Diagnosis is based on history, physical exam and symptom scoring. Treatment options range from watchful waiting for mild cases to medications, minimally invasive procedures or surgery for more severe cases. Alpha blockers and 5-alpha reductase inhibitors are first line medical therapies that work by relaxing prostate smooth muscle tone.
Benign prostate hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland caused by aging. It results in obstruction of urine flow and irritative urinary symptoms. Diagnosis involves digital rectal exam, urinalysis, prostate-specific antigen levels, and urodynamic tests. Treatment includes medications to relax the prostate or reduce its size, minimally invasive procedures such as transurethral resection of the prostate, and open prostatectomy if medications fail. Nursing care focuses on restoring urinary drainage, preventing infections, and addressing patient anxiety.
This document provides an overview of benign prostatic hyperplasia (BPH) including its etiology, pathology, clinical findings, and investigation. It notes that BPH begins as microscopic nodules in the transitional zone of the prostate that can grow and compress surrounding tissue. Common symptoms include urinary frequency, urgency, and nocturia. Evaluation involves assessment of lower urinary tract symptoms, digital rectal exam, urinalysis, post-void residual measurement, and in some cases urodynamic testing. BPH is a common condition among older men that results from changes in hormone levels and growth factors.
Urethral strictures can be caused by injury or infection leading to scar tissue formation in the urethra. Common causes include trauma, instrumentation, surgery, and STDs. Presentation includes obstructive voiding symptoms. Diagnosis involves history, exam, and imaging tests. Treatment depends on location and severity but may include dilation, incision, stents, reconstruction, or tissue grafts. Complications can include recurrence, infection, and incontinence if not properly managed.
Benign prostatic hyperplasia (BPH) is a common condition in aging men that involves enlargement of the prostate gland. It often causes bothersome lower urinary tract symptoms (LUTS) such as frequent urination and weak urine flow. BPH-LUTS refers to these urinary symptoms linked to an enlarged prostate. Treatment involves medications like alpha-blockers and 5-alpha-reductase inhibitors to shrink the prostate and relieve symptoms. For men with larger prostates or those where medications fail, surgery such as transurethral resection of the prostate (TURP) may be considered, though it carries risks like incontinence or sexual side effects.
BPH is a common noncancerous enlargement of the prostate gland that increases in frequency with age in men over 50. By age 60, 50% of men will show microscopic signs of BPH, increasing to 90% by age 85. BPH causes lower urinary tract symptoms like frequent urination, weak urine stream, and incomplete emptying due to static obstruction from an enlarged prostate and dynamic obstruction from prostate smooth muscle contraction. Diagnosis involves evaluating symptoms, digital rectal exam to assess prostate size and consistency, urinalysis to rule out infection, and tests like uroflowmetry and post-void residual urine measurement to assess bladder function.
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
Benign prostatic hyperplasia (BPH) is a common benign tumor in older men that results from proliferation of cells in the prostate. It affects the transition zone of the prostate and causes obstruction of urine flow. Common symptoms include hesitancy, weak stream, urgency and frequency. Diagnosis is based on history, physical exam and symptom scoring. Treatment options range from watchful waiting for mild cases to medications, minimally invasive procedures or surgery for more severe cases. Alpha blockers and 5-alpha reductase inhibitors are first line medical therapies that work by relaxing prostate smooth muscle tone.
Benign prostate hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland caused by aging. It results in obstruction of urine flow and irritative urinary symptoms. Diagnosis involves digital rectal exam, urinalysis, prostate-specific antigen levels, and urodynamic tests. Treatment includes medications to relax the prostate or reduce its size, minimally invasive procedures such as transurethral resection of the prostate, and open prostatectomy if medications fail. Nursing care focuses on restoring urinary drainage, preventing infections, and addressing patient anxiety.
This document provides an overview of benign prostatic hyperplasia (BPH) including its etiology, pathology, clinical findings, and investigation. It notes that BPH begins as microscopic nodules in the transitional zone of the prostate that can grow and compress surrounding tissue. Common symptoms include urinary frequency, urgency, and nocturia. Evaluation involves assessment of lower urinary tract symptoms, digital rectal exam, urinalysis, post-void residual measurement, and in some cases urodynamic testing. BPH is a common condition among older men that results from changes in hormone levels and growth factors.
Urethral strictures can be caused by injury or infection leading to scar tissue formation in the urethra. Common causes include trauma, instrumentation, surgery, and STDs. Presentation includes obstructive voiding symptoms. Diagnosis involves history, exam, and imaging tests. Treatment depends on location and severity but may include dilation, incision, stents, reconstruction, or tissue grafts. Complications can include recurrence, infection, and incontinence if not properly managed.
Benign prostatic hyperplasia (BPH) is a common condition in aging men that involves enlargement of the prostate gland. It often causes bothersome lower urinary tract symptoms (LUTS) such as frequent urination and weak urine flow. BPH-LUTS refers to these urinary symptoms linked to an enlarged prostate. Treatment involves medications like alpha-blockers and 5-alpha-reductase inhibitors to shrink the prostate and relieve symptoms. For men with larger prostates or those where medications fail, surgery such as transurethral resection of the prostate (TURP) may be considered, though it carries risks like incontinence or sexual side effects.
This document provides information about benign prostatic hyperplasia (BPH) from the Department of Urology at Government Royapettah Hospital and Kilpauk Medical College in Chennai, India. It discusses the pathology, pathophysiology, symptoms, examinations, investigations, symptom scores, and treatment options for BPH, including watchful waiting, medical therapy using various drugs, and surgical procedures like transurethral resection of the prostate. It provides details on specific drugs, procedures, risks, and indications for different treatment approaches. The moderators and their specialties are listed at the beginning.
BPH is a common condition among elderly males that results from abnormal proliferation of the prostate's three histological elements. It causes bothersome lower urinary tract symptoms that negatively impact quality of life. Diagnosis involves evaluating an older man's symptoms and conducting a digital rectal exam and imaging tests. Most cases are treated initially with medications, while surgical intervention with TURP is recommended for severe, refractory, or complicated cases.
This document discusses hematuria (blood in the urine). It defines hematuria and notes that not all red urine is necessarily hematuria, as there can be other causes of red or discolored urine unrelated to blood. The document then discusses potential causes of hematuria originating from the kidneys, ureters, bladder, prostate, urethra, and from general systemic factors. It provides details on evaluating a patient with hematuria, including relevant history, examination findings, and potential diagnostic tests.
This document provides an overview of the anatomy and surgical procedures related to the prostate gland. It begins with the surgical anatomy of the prostate, including its relations to surrounding structures, coverings, lobes, blood supply, lymphatic drainage and innervation. It then discusses various prostate surgeries like TURP, open and laparoscopic prostatectomy. It concludes with potential complications of prostate surgery, such as injuries, urinary incontinence, and issues with erection, ejaculation and fertility. Videos are also embedded to demonstrate different prostate procedures.
This document provides information about urinalysis and urologic investigations including laboratory tests, radiological imaging, and endoscopy. It discusses the procedures and significant findings for urinalysis including macroscopic examination, chemical analysis using urine dipsticks, and microscopic examination. It also summarizes different radiological investigations like KUB, ultrasonography, intravenous urography, cystography, retrograde pyelography and CT scans and what types of urinary tract abnormalities each can identify. Endoscopic procedures like cystoscopy, urethroscopy and nephroscopy are also briefly mentioned.
This document provides an overview of obstructive uropathy. It begins by defining obstructive uropathy as the functional or anatomic obstruction of urine flow at any level of the urinary tract. It then discusses the prevalence of obstructive uropathy and how it can be classified based on factors like duration and site of obstruction. Potential causes of obstructive uropathy are then reviewed for different parts of the urinary tract. The pathophysiology and hemodynamic changes that occur with obstruction are explained. Cellular and molecular changes that can lead to fibrosis and tubular cell death are described. Management of patients is discussed including diagnostic imaging, issues in patient care like hypertension and pain management, and considerations for surgical intervention.
1) Genitourinary tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 4% of the total TB disease burden. It commonly involves the kidneys, fallopian tubes, epididymis, and prostate.
2) Clinical presentations are non-specific and include recurrent urinary tract infections, irritative voiding symptoms, renal or epididymal masses, and infertility.
3) Diagnosis involves identifying the characteristic granulomatous lesions and caseous necrosis on biopsy of the involved organs, along with identifying the tuberculosis bacilli through microscopy or culture.
The document summarizes information about the prostate gland and benign prostatic hyperplasia (BPH). It discusses the anatomy and function of the prostate gland. It describes how the size of the prostate increases with age due to BPH in many men. Common symptoms of BPH include frequent urination and weak urine stream. Treatment options for BPH include watchful waiting, medications, and surgery. The risk of prostate cancer also increases with age and it is a major health concern for older men.
The document provides an overview of benign and malignant prostate diseases, including benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. It discusses the incidence, etiology, pathogenesis, signs, symptoms, and treatment options for each condition. Treatment options discussed include medications like alpha-blockers and 5-alpha-reductase inhibitors, as well as surgical procedures for BPH such as transurethral resection of the prostate (TURP) and newer minimally invasive therapies.
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
This document discusses Priapism, which is a prolonged and sometimes painful erection that lasts over 4 hours and is unrelated to sexual stimulation. It defines two types, ischemic (low blood flow) and non-ischemic (high blood flow). The case presented is of a 64-year old man who developed an erection after injecting his penis with medications for erectile dysfunction. His priapism was determined to be ischemic based on history and blood gas analysis. He underwent drainage of blood from his penis, injection of the drug phenylephrine, and follow up with urology.
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, terminology, evaluation, medical and surgical treatment options, and pathophysiology. Some key points include:
- BPH is a histological diagnosis defined as nonmalignant hyperplasia of the prostate gland. It often presents clinically as bothersome lower urinary tract symptoms and an enlarged prostate.
- Evaluation involves medical history, physical exam including DRE, urinalysis, and symptom assessment. Additional tests like flow rate and residual urine may be used if symptoms are moderate to severe.
- Medical therapy options are alpha-blockers which target the dynamic component of obstruction, and 5-alpha-re
Renal Hypoplasia FINAL OUTPUT by Nica ValenciaNica Valencia
Renal hypoplasia is an underdevelopment of one or both kidneys that occurs during embryonic development. It can be unilateral, affecting one kidney, or bilateral, affecting both kidneys. Unilateral hypoplasia may cause hypertension in childhood while bilateral hypoplasia can lead to chronic renal failure in the first decade of life. Diagnosis is typically made through ultrasound, CT scan, or x-ray by detecting abnormally small kidneys. Treatment focuses on fluid and electrolyte management to prevent dehydration and correct acidosis.
This document discusses acute bacterial prostatitis, an infection of the prostate gland caused by ascending urethral infection or intraprostatic reflux. Patients present with obstructive and irritative urinary symptoms as well as pelvic, rectal, or perineal pain. Physical examination may reveal abdominal tenderness or costovertebral angle tenderness. Diagnosis is made through history, physical exam, urinalysis, and urine culture. Treatment involves antibiotics, with imaging only needed if symptoms do not improve. Complications include prostatic abscesses or recurrence of infection.
This document discusses the etiology and pathophysiology of benign prostatic hyperplasia (BPH). It states that while androgens are required for normal prostate development, the precise causes of BPH are uncertain. Several factors may be involved, including androgens, estrogens, growth factors, inflammation and genetic factors. BPH causes prostate enlargement which obstructs the urethra. This obstruction induces changes in bladder function over time, leading to lower urinary tract symptoms. A variety of treatment options exist to relieve bladder outlet obstruction and manage symptoms.
This document discusses a horseshoe kidney and percutaneous nephrolithotomy (PCNL) for treating kidney stones in a horseshoe kidney. It begins by defining a horseshoe kidney as two distinct kidney masses connected by an isthmus of tissue across the midline. It then discusses the embryology, incidence, variations, associated anomalies, symptoms, diagnosis and treatment of stones in a horseshoe kidney. Key points are that PCNL is the treatment of choice for large stones (>1.5-2 cm) in a horseshoe kidney due to the anatomy making percutaneous access easier compared to a normal kidney. Access is typically through an upper pole calyx for the best access. Flexible instruments may help reach more
This document discusses the pathogenesis of benign prostatic hyperplasia (BPH). It covers several key points:
1) BPH results from an increase in epithelial and stromal cells in the prostate transition zone due to proliferation and impaired programmed cell death. While androgens are important for normal prostate development, they are not direct mitogens for BPH growth.
2) Other contributing factors include stem cell dysfunction, growth factors, inflammation, and genetic/familial components. The prostate and bladder both adapt in response to outflow obstruction through changes like smooth muscle hypertrophy, increased extracellular matrix, and altered neural control.
3) While BPH causes lower urinary tract symptoms, the symptoms are
This document discusses urethral stricture, including its anatomy, causes such as trauma or inflammation, pathology involving fibrosis and scarring of the urethral lumen, clinical features like poor urinary stream, and potential complications. Investigations may include urine tests, urosonology, and urethrogram. Treatment options involve dilation, urethrotomy, stents, and for strictures over 2cm, urethroplasty using grafts or flaps.
The document describes a case of a 62-year-old man presenting with lower urinary tract symptoms due to bladder outflow obstruction. Investigations including ultrasound, CT scan and cystoscopy revealed a heterogeneous mass arising behind the bladder, which was diagnosed as a neoplastic mucocele of the appendix causing extrinsic compression of the bladder neck.
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland caused by changes in hormone levels as men age. It involves the proliferation of cells within the prostate and commonly causes urinary symptoms like frequent urination, weak urine stream, and incomplete emptying of the bladder. Diagnosis involves a digital rectal exam, urinalysis, and tests to evaluate urine flow and residual urine in the bladder. While not cancerous, BPH can lead to complications like urinary tract infections if left untreated.
Benign prostatic hyperplasia - symptomes and treatmentAreej Abu Hanieh
BPH, or benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate gland caused by changes in hormone balance and cell growth as men age. It occurs when the prostate blocks part of the urethra, causing problems with urination. Symptoms range from mild to serious and include frequent, urgent, and interrupted urination. Diagnosis involves exams, tests to check urine and rule out infection or cancer. Treatment options include lifestyle changes, medications like alpha-blockers to relax the prostate or 5-alpha-reductase inhibitors to shrink the prostate, and surgery for severe cases. While not cancer, left untreated BPH can damage the kidneys.
This document provides information about benign prostatic hyperplasia (BPH) from the Department of Urology at Government Royapettah Hospital and Kilpauk Medical College in Chennai, India. It discusses the pathology, pathophysiology, symptoms, examinations, investigations, symptom scores, and treatment options for BPH, including watchful waiting, medical therapy using various drugs, and surgical procedures like transurethral resection of the prostate. It provides details on specific drugs, procedures, risks, and indications for different treatment approaches. The moderators and their specialties are listed at the beginning.
BPH is a common condition among elderly males that results from abnormal proliferation of the prostate's three histological elements. It causes bothersome lower urinary tract symptoms that negatively impact quality of life. Diagnosis involves evaluating an older man's symptoms and conducting a digital rectal exam and imaging tests. Most cases are treated initially with medications, while surgical intervention with TURP is recommended for severe, refractory, or complicated cases.
This document discusses hematuria (blood in the urine). It defines hematuria and notes that not all red urine is necessarily hematuria, as there can be other causes of red or discolored urine unrelated to blood. The document then discusses potential causes of hematuria originating from the kidneys, ureters, bladder, prostate, urethra, and from general systemic factors. It provides details on evaluating a patient with hematuria, including relevant history, examination findings, and potential diagnostic tests.
This document provides an overview of the anatomy and surgical procedures related to the prostate gland. It begins with the surgical anatomy of the prostate, including its relations to surrounding structures, coverings, lobes, blood supply, lymphatic drainage and innervation. It then discusses various prostate surgeries like TURP, open and laparoscopic prostatectomy. It concludes with potential complications of prostate surgery, such as injuries, urinary incontinence, and issues with erection, ejaculation and fertility. Videos are also embedded to demonstrate different prostate procedures.
This document provides information about urinalysis and urologic investigations including laboratory tests, radiological imaging, and endoscopy. It discusses the procedures and significant findings for urinalysis including macroscopic examination, chemical analysis using urine dipsticks, and microscopic examination. It also summarizes different radiological investigations like KUB, ultrasonography, intravenous urography, cystography, retrograde pyelography and CT scans and what types of urinary tract abnormalities each can identify. Endoscopic procedures like cystoscopy, urethroscopy and nephroscopy are also briefly mentioned.
This document provides an overview of obstructive uropathy. It begins by defining obstructive uropathy as the functional or anatomic obstruction of urine flow at any level of the urinary tract. It then discusses the prevalence of obstructive uropathy and how it can be classified based on factors like duration and site of obstruction. Potential causes of obstructive uropathy are then reviewed for different parts of the urinary tract. The pathophysiology and hemodynamic changes that occur with obstruction are explained. Cellular and molecular changes that can lead to fibrosis and tubular cell death are described. Management of patients is discussed including diagnostic imaging, issues in patient care like hypertension and pain management, and considerations for surgical intervention.
1) Genitourinary tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 4% of the total TB disease burden. It commonly involves the kidneys, fallopian tubes, epididymis, and prostate.
2) Clinical presentations are non-specific and include recurrent urinary tract infections, irritative voiding symptoms, renal or epididymal masses, and infertility.
3) Diagnosis involves identifying the characteristic granulomatous lesions and caseous necrosis on biopsy of the involved organs, along with identifying the tuberculosis bacilli through microscopy or culture.
The document summarizes information about the prostate gland and benign prostatic hyperplasia (BPH). It discusses the anatomy and function of the prostate gland. It describes how the size of the prostate increases with age due to BPH in many men. Common symptoms of BPH include frequent urination and weak urine stream. Treatment options for BPH include watchful waiting, medications, and surgery. The risk of prostate cancer also increases with age and it is a major health concern for older men.
The document provides an overview of benign and malignant prostate diseases, including benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. It discusses the incidence, etiology, pathogenesis, signs, symptoms, and treatment options for each condition. Treatment options discussed include medications like alpha-blockers and 5-alpha-reductase inhibitors, as well as surgical procedures for BPH such as transurethral resection of the prostate (TURP) and newer minimally invasive therapies.
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
This document discusses Priapism, which is a prolonged and sometimes painful erection that lasts over 4 hours and is unrelated to sexual stimulation. It defines two types, ischemic (low blood flow) and non-ischemic (high blood flow). The case presented is of a 64-year old man who developed an erection after injecting his penis with medications for erectile dysfunction. His priapism was determined to be ischemic based on history and blood gas analysis. He underwent drainage of blood from his penis, injection of the drug phenylephrine, and follow up with urology.
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, terminology, evaluation, medical and surgical treatment options, and pathophysiology. Some key points include:
- BPH is a histological diagnosis defined as nonmalignant hyperplasia of the prostate gland. It often presents clinically as bothersome lower urinary tract symptoms and an enlarged prostate.
- Evaluation involves medical history, physical exam including DRE, urinalysis, and symptom assessment. Additional tests like flow rate and residual urine may be used if symptoms are moderate to severe.
- Medical therapy options are alpha-blockers which target the dynamic component of obstruction, and 5-alpha-re
Renal Hypoplasia FINAL OUTPUT by Nica ValenciaNica Valencia
Renal hypoplasia is an underdevelopment of one or both kidneys that occurs during embryonic development. It can be unilateral, affecting one kidney, or bilateral, affecting both kidneys. Unilateral hypoplasia may cause hypertension in childhood while bilateral hypoplasia can lead to chronic renal failure in the first decade of life. Diagnosis is typically made through ultrasound, CT scan, or x-ray by detecting abnormally small kidneys. Treatment focuses on fluid and electrolyte management to prevent dehydration and correct acidosis.
This document discusses acute bacterial prostatitis, an infection of the prostate gland caused by ascending urethral infection or intraprostatic reflux. Patients present with obstructive and irritative urinary symptoms as well as pelvic, rectal, or perineal pain. Physical examination may reveal abdominal tenderness or costovertebral angle tenderness. Diagnosis is made through history, physical exam, urinalysis, and urine culture. Treatment involves antibiotics, with imaging only needed if symptoms do not improve. Complications include prostatic abscesses or recurrence of infection.
This document discusses the etiology and pathophysiology of benign prostatic hyperplasia (BPH). It states that while androgens are required for normal prostate development, the precise causes of BPH are uncertain. Several factors may be involved, including androgens, estrogens, growth factors, inflammation and genetic factors. BPH causes prostate enlargement which obstructs the urethra. This obstruction induces changes in bladder function over time, leading to lower urinary tract symptoms. A variety of treatment options exist to relieve bladder outlet obstruction and manage symptoms.
This document discusses a horseshoe kidney and percutaneous nephrolithotomy (PCNL) for treating kidney stones in a horseshoe kidney. It begins by defining a horseshoe kidney as two distinct kidney masses connected by an isthmus of tissue across the midline. It then discusses the embryology, incidence, variations, associated anomalies, symptoms, diagnosis and treatment of stones in a horseshoe kidney. Key points are that PCNL is the treatment of choice for large stones (>1.5-2 cm) in a horseshoe kidney due to the anatomy making percutaneous access easier compared to a normal kidney. Access is typically through an upper pole calyx for the best access. Flexible instruments may help reach more
This document discusses the pathogenesis of benign prostatic hyperplasia (BPH). It covers several key points:
1) BPH results from an increase in epithelial and stromal cells in the prostate transition zone due to proliferation and impaired programmed cell death. While androgens are important for normal prostate development, they are not direct mitogens for BPH growth.
2) Other contributing factors include stem cell dysfunction, growth factors, inflammation, and genetic/familial components. The prostate and bladder both adapt in response to outflow obstruction through changes like smooth muscle hypertrophy, increased extracellular matrix, and altered neural control.
3) While BPH causes lower urinary tract symptoms, the symptoms are
This document discusses urethral stricture, including its anatomy, causes such as trauma or inflammation, pathology involving fibrosis and scarring of the urethral lumen, clinical features like poor urinary stream, and potential complications. Investigations may include urine tests, urosonology, and urethrogram. Treatment options involve dilation, urethrotomy, stents, and for strictures over 2cm, urethroplasty using grafts or flaps.
The document describes a case of a 62-year-old man presenting with lower urinary tract symptoms due to bladder outflow obstruction. Investigations including ultrasound, CT scan and cystoscopy revealed a heterogeneous mass arising behind the bladder, which was diagnosed as a neoplastic mucocele of the appendix causing extrinsic compression of the bladder neck.
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland caused by changes in hormone levels as men age. It involves the proliferation of cells within the prostate and commonly causes urinary symptoms like frequent urination, weak urine stream, and incomplete emptying of the bladder. Diagnosis involves a digital rectal exam, urinalysis, and tests to evaluate urine flow and residual urine in the bladder. While not cancerous, BPH can lead to complications like urinary tract infections if left untreated.
Benign prostatic hyperplasia - symptomes and treatmentAreej Abu Hanieh
BPH, or benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate gland caused by changes in hormone balance and cell growth as men age. It occurs when the prostate blocks part of the urethra, causing problems with urination. Symptoms range from mild to serious and include frequent, urgent, and interrupted urination. Diagnosis involves exams, tests to check urine and rule out infection or cancer. Treatment options include lifestyle changes, medications like alpha-blockers to relax the prostate or 5-alpha-reductase inhibitors to shrink the prostate, and surgery for severe cases. While not cancer, left untreated BPH can damage the kidneys.
This document provides information about benign prostatic hyperplasia (BPH), also known as an enlarged prostate. It discusses what the prostate is, what causes BPH, common symptoms, and treatment options. BPH is a common condition for men over 50 that occurs when the prostate gland enlarges but is not cancerous. Symptoms can include difficulty urinating, but it can often be treated successfully with medications or minimally invasive laser surgery, which provides faster recovery than traditional surgery.
Benign prostatic hyperplasia (BPH) is a common condition in aging men where the prostate gland enlarges. This can cause lower urinary tract symptoms like frequent urination, weak urine stream, and urgency. BPH is caused by changes in hormone levels as men age and cannot be prevented. Treatment options include medications to shrink the prostate or relax muscles, heat therapies, and surgery. Transurethral resection of the prostate (TURP) is a common surgical procedure that uses an electrified loop to cut away prostate tissue through the urethra. Potential complications include bleeding, infection, and a condition called TURP syndrome if too much irrigating fluid is absorbed during surgery. Careful fluid
This document summarizes benign prostatic hyperplasia (BPH). It finds that the incidence of BPH increases with age, affecting 20% of men aged 41-50 and over 90% of men over 80. Risk factors include genetics and race. BPH causes both obstructive symptoms like weak urinary stream and irritative symptoms like frequent urination. Treatment options range from watchful waiting for mild cases to drug therapies like alpha blockers and 5-alpha reductase inhibitors to surgical procedures like transurethral resection of the prostate. Minimally invasive procedures also exist like laser therapy, transurethral vaporization of the prostate, and transurethral needle ablation of the prostate.
Evaluation of the patient with benign Prostatic Hyperplasia(BPH)Labib Mortuza
This document provides an overview of how to evaluate a patient with benign prostatic hyperplasia (BPH). The evaluation involves taking a medical history, performing a physical exam including a digital rectal exam, and ordering relevant investigations. The medical history focuses on lower urinary tract symptoms and their severity is assessed using the International Prostate Symptom Score. The physical exam also includes neurologic tests to rule out other causes. Investigations include urine analysis, ultrasound of the kidneys/prostate/bladder, uroflowmetry, serum PSA, x-ray, and more. Based on the evaluation, BPH is staged and treatment is determined, which may include watchful waiting, medical therapy, or surgery.
Benign Prostatic Hyperplasia BPH [Dr. Edmond Wong]Edmond Wong
Here are the key points about the natural history and progression of BPH on watchful waiting:
- Most men with BPH will experience gradual worsening of symptoms over time if left untreated. However, the rate of progression varies between individuals.
- In the Ball et al study of 100 men on watchful waiting for 5 years, about 25% got better, 30% stayed the same, and 45% got worse.
- Other studies have found annual progression rates of symptoms and complications to be around 10-15% per year. However, many men have stable disease for many years as well.
- Risk factors for faster progression include larger prostate size, more bothersome initial symptoms, and older age at presentation
Dr. Ornouma Sriwanishvipat is an ENT specialist with over 15 years of experience treating ear disorders like tinnitus and ear infections. She offers both medical and surgical treatments. The ear is divided into the outer, middle, and inner ear. The outer ear collects sound waves, the middle ear amplifies sounds through tiny bones, and the inner ear converts sounds into nerve signals sent to the brain. Common ear diseases include otitis externa (swimmer's ear), which involves infection of the outer ear canal, and otitis media, a middle ear infection that can cause hearing loss if not treated with antibiotics or surgery like myringoplasty to repair the eardrum.
Voice change surgery-male to female or vice versa. Contact: yanhee_ent@yahoo.comDr. Ornouma-ENTdoctor
This document discusses voice feminization surgery for transgender individuals. It describes the surgery, called cricothyroid approximation (CTA), which raises vocal pitch by stimulating the cricothyroid muscle to contract and approximate the cricoid and thyroid cartilages. The surgery is performed under general anesthesia on an inpatient basis. It involves making an incision in the neck to access the vocal cords, removing part of the vocal cords to shorten them, and potentially elevating the voice box. The goal is to change the voice from a male pitch range of 100-150 Hz to a female pitch range of 200-300 Hz. Follow up includes hormone treatment and suture removal after one week. Before and after photos show the reduction
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malaysia and developing countries. The main causes of PPH are uterine atony, retained placenta, and genital tract injuries. Uterine atony occurs when the uterus fails to contract after delivery, allowing blood vessels at the placental site to remain open. Retained placenta is the partial or complete failure of the placenta to separate from the uterine wall. Genital tract injuries like lacerations can also cause excessive bleeding. Improving emergency obstetric care and access to blood transfusions in hospitals is key to reducing mortality from PPH.
Obstetric emergency which can kill instantly !! - PPH presenting to ED, so what is the role of Emergency Dept ? The most basic presentation of Obstetric emergency and how to tackle it? Being an emergency physician, obstetrics is always challenging! Keep yourself updated with Obstetric emergency.
Seminar on gestational trophoblastic disease (gtd) (f inal)Santosh Narayankar
The document discusses gestational trophoblastic disease, specifically hydatidiform mole and choriocarcinoma. It covers the types, causes, risk factors, signs and symptoms, diagnostic methods, treatment options and follow up protocols for these conditions. Hydatidiform mole is characterized by abnormal proliferation of chorionic villi and can be complete or partial. Choriocarcinoma is a highly malignant form that may metastasize and behaves like a carcinoma or sarcoma.
Acute urinary retention is a urologic emergency most common in older men due to benign prostatic hyperplasia. Common causes include BPH, medications, infections, and neurological disorders. Patients present with inability to pass urine and lower abdominal discomfort. Evaluation involves history, physical exam including bladder palpation, and rectal exam. Management is bladder decompression initially with Foley catheter, or emergency suprapubic puncture if catheterization fails. Patients require monitoring after decompression to watch for post-obstructive diuresis.
Urinary retention is the inability to empty the bladder completely. It can happen suddenly and be acute or last a short time, or it can be chronic. The main causes are obstruction of the urethra from conditions like enlarged prostate, strictures, or tumors, nerve problems from issues like diabetes or injury, certain medications, or weakened bladder muscles from aging. Men over 70 are most at risk. Evaluation involves history, exam, and bladder drainage initially via catheter. Long term treatment depends on the underlying cause but may involve surgery.
Gestational trophoblastic disease (GTD) is a heterogeneous group of lesions characterized by abnormal trophoblast proliferation. GTD includes complete and partial hydatidiform moles, which are abnormally formed placentas with genetic abnormalities, as well as choriocarcinoma and placental site trophoblastic tumor, which are true neoplasms of previllous and extravillous trophoblast, respectively. Complete moles have a diploid karyotype composed entirely of paternal chromosomes and produce marked uterine enlargement without a fetus. Partial moles have a triploid karyotype and may contain a malformed fetus. Choriocarcinoma is a malignant neoplasm composed of trophoblast without villi
Gestational Trophoblastic Disease (GTD) includes benign and malignant conditions that arise from abnormal trophoblastic cells in the placenta. Types include hydatidiform mole (complete or partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. Hydatidiform mole is the most common and can progress to invasive mole or choriocarcinoma in rare cases. Diagnosis is made through beta-hCG levels and ultrasound showing the "snowstorm" appearance. Treatment involves surgical evacuation and chemotherapy depending on risk factors. Follow up monitoring is important to watch for recurrence or progression.
Benign Prostate Hyperplasia: Aetiology, Pathology , Diagnosis and Medical therapy is a document that discusses benign prostate hyperplasia (BPH). It covers the etiology, pathology, diagnosis, and medical therapy of BPH. The document discusses risk factors for BPH like age, genetics, and hormones. It describes the pathological features of BPH including epithelial and stromal cell hyperplasia. Diagnosis involves history, exam, lab tests like PSA and ultrasound. Medical therapy options presented are watchful waiting, alpha blockers, 5-alpha-reductase inhibitors, and anticholinergics.
Benign disorders of the prostate include benign prostatic hyperplasia (BPH) and prostatitis. BPH involves hyperplastic growth of the prostate gland, leading to obstruction of urine flow. Common symptoms are urinary hesitancy, straining, and incomplete emptying. Evaluation involves history, exam, PSA, and imaging. Treatment options include medications like alpha blockers and 5-alpha reductase inhibitors as well as surgery. Prostatitis causes inflammation of the prostate and can be acute or chronic.
Prostate cancer is another common benign disorder, where malignant cells form in the prostate gland. Risk increases with age. Early detection relies on digital rectal exam and PSA screening. Staging involves biopsy
BENIGN PROSTATIC HYPERPLASIA: Epidemiology, Etiology, Pathophysiology, and ev...Gagan Adhikari
This document discusses the embryology, anatomy, etiology, and pathophysiology of benign prostatic hyperplasia (BPH). It notes that BPH originates from the transition zone of the prostate and results from an increase in epithelial and stromal cells. The precise causes are unknown but factors discussed include aging, genetics, androgens, estrogens, impaired programmed cell death, and interactions between stromal and epithelial cells. Androgens are required for normal prostate development and maintenance but do not directly cause BPH; their role may involve inhibiting cell death.
This document provides information about disorders of the male reproductive system. It begins with describing the anatomy and physiology of the male reproductive system. It then discusses common diagnostic tests used to evaluate disorders like prostate-specific antigen testing, ultrasound, and biopsy. Several common disorders are explained such as benign prostate hyperplasia, prostatitis, prostate cancer, disorders of the testes, scrotum, penis and urethra. The disorders are defined and their signs, symptoms, diagnostic workup and management are outlined.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
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Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
This document provides an overview of benign prostatic hyperplasia (BPH). It defines key terms related to BPH and lower urinary tract symptoms. It describes the histopathology and molecular etiology of BPH, risk factors such as aging and genetics, and the pathophysiology whereby BPH causes bladder outlet obstruction and changes in bladder function. It also discusses complications of BPH, correlations with severity measures, and a staging system for determining appropriate treatment.
This document discusses benign prostatic hyperplasia (BPH) and its management. It begins by defining BPH as a benign enlargement of the prostate gland that commonly occurs in aging men. It then covers the anatomy and histology of the prostate, causes of BPH, pathophysiology and effects of BPH, symptoms, diagnostic tests including DRE, PSA, uroflowmetry, and management options like watchful waiting, lifestyle changes, medications such as alpha blockers and 5-ARIs, and surgeries.
The prostate gland secretes fluid that nourishes and protects sperm. It normally enlarges with age due to a balance between cell growth and death being disrupted. The main cause of enlargement is benign prostatic hyperplasia (BPH), where cells multiply faster than they die. BPH symptoms include frequent urination and weak urine stream. Diagnosis involves exams and ruling out other causes. Mild cases are treated with lifestyle changes while moderate-severe cases may require medicines or surgery like transurethral resection of the prostate (TURP).
As a part of my M.Sc. Nursing course, I have prepared PPT on Bengin Prostate Hyperplasia, which is an important topic from clinical as well as exam point of view. I hope this material will be helpful to the prospect nursing student. However, refer books for the better understanding of the topic.
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This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy of the prostate gland and defines BPH as non-malignant prostate tissue growth due to aging. Risk factors for BPH include increasing age and family history. Clinical evaluation involves history, physical exam including digital rectal exam, and testing like PSA and ultrasound. Treatment options range from lifestyle changes and medications like alpha blockers and 5-alpha-reductase inhibitors for mild-moderate BPH to surgical interventions like TURP for severe cases. The document provides details on evaluation and management approaches for BPH.
This document provides information on benign prostatic hyperplasia (BPH):
- It describes the anatomy and zones of the prostate gland and discusses theories on the causes of BPH related to hormone levels and aging.
- The pathology, clinical features, investigations, management options including medications, minimally invasive procedures, and surgeries for BPH are summarized. Surgical options include transurethral resection of the prostate (TURP) and newer laser procedures.
- Complications of treatments like TURP are noted. Indications for medical versus surgical management are provided.
It is not for practicing, only general description of prostate cancer.......of my presentation . for explanation study authentic books also .....and webs.
Benign Prostate Hyperplasia (BPH) has an uncertain molecular etiology. Factors that may play a role include androgens, estrogens, stromal-epithelial interactions, growth factors, and neurotransmitters. The prostate maintains its ability to respond to androgens throughout life. Stromal cells play a central role in androgen-dependent prostate growth, and type 2 5-alpha reductase within stromal cells is key in amplifying androgenic effects. Programmed cell death is important in maintaining glandular homeostasis, and defects in apoptosis may contribute to BPH pathogenesis. Various growth factors, cytokines, and signaling pathways also influence prostate proliferation and growth. A familial
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This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy and development of the prostate gland. BPH is defined as a non-cancerous enlargement of the prostate that narrows the urethra. Risk factors include increasing age and family history. Symptoms include difficulty urinating and frequent urination. Medical management includes alpha blockers and 5-alpha reductase inhibitors to shrink the prostate. Minimally invasive options for BPH include transurethral microwave thermotherapy, transurethral needle ablation, laser therapies, and urethral stents. More invasive options are transurethral resection of the prostate and transurethral incision of the prostate.
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Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
3. Prostate Gland Anatomy
•
•
•
•
•
•
Male sex gland
Pear-shape,wt7-16gm
Size of a walnut
Helps control urine flow
Produces fluid component of semen
Produces Prostate Specific Antigen (PSA
4.
5.
6. Development
• The prostatic part of the urethra develops from the
urogenital sinus (endodermal origin).
• It grows into the surrounding mesenchyme
• The glandular epithelium of the prostate differentiates
from these endodermal cells
• Mesenchyme differentiates into the dense stroma and
the smooth muscle of the prostate
• The prostate glands arises by the 9th week of
embryonic life
• Condensation of mesenchyme, urethra and Wolffian
ducts gives rise to the adult prostate gland, a
composite organ made up of several glandular and
non-glandular components tightly fused.
7. Arterial supply
• From the anterior division of the internal iliac
artery
Inferior vesical artery,
Middle rectal artery
Internal pudendal artery originates (hypogastric)
artery.
• The capsular artery is the second main branch of
the prostate. Supply the glandular tissue.
8. Venous drainage
• Prostatic plexus of veins
• Valveless communication exists between the
prostatic and vertebral plexus through which
prostatic carcinoma spread to vertebral
column and to skull
9. • Innervations
from pelvic plexuses formed by the parasympathetic,
visceral, efferent, and preganglionic fibers that arise
from the sacral
• levels(S2-S4)
sympathetic fibers from the thoracolumbar levels (L1L2).
The pudendal nerve is the major nerve supply leading
to
• Somatic innervations of the striated sphincter and the
levator
• ani. The preprostatic sphincter and the vesicle neck or
internal sphincter is under alpha-adrenergic control.
10. Lymphatic drainage
• Obturator and the internal iliac lymphatic
channels.
• External iliac, presacral, and the para-aortic
lymph nodes.
11. ETIOLOGY
Role of Androgens
• Androgens do not cause BPH
• The development of BPH requires the
presence of testicular androgens
• Patients castrated before puberty or who are
affected by a variety of genetic diseases that
impair androgen action or production do not
develop BPH.
12. ETIOLOGY
Dihydrotestosterone and Steroid 5α-Reductase
• Intraprostatic DHT concentrations are
maintained but not elevated in BPH
• DHT is a more potent androgen than
testosterone because of its higher affinity for
the AR
• Moreover, the DHT-receptor complex may be
more stable than the testosterone receptor
complex.
13. • Two types of steroid 5α-reductase have been
discovered, each encoded by a separate
Type 1 5α-reductase, the predominant
enzyme in extraprostatic tissues, such as skin
and liver, is normally expressed in the 5αreductase deficiency syndrome
Type 2 5α-reductase is the predominant
prostatic 5α-reductase, although it is also
expressed in extraprostatic tissues
14. ETIOLOGY
Role of Estrogens
• There is animal model evidence to suggest that
estrogens play a role in the pathogenesis of BPH
• The role of estrogens in the development of
human BPH, however, is less clear
• There are at least two forms of ER
ER-α is expressed by prostate stromal cells
ER-β is expressed by prostate epithelial cells
15. ETIOLOGY
Regulation of Programmed Cell Death
• Programmed cell death (apoptosis) is a
physiologic mechanism crucial to the
maintenance of normal glandular homeostasis
• This is impaired in BPH
16. ETIOLOGY
Stromal-Epithelial Interaction
• Prostatic stromal and epithelial cells maintain
a sophisticated paracrine type of
communication
• Thus BPH may be due to a defect in a stromal
component that normally inhibits cell
proliferation, resulting in loss of a normal
“braking” mechanism for proliferation
17. ETIOLOGY
Growth Factors
• Interactions between growth factors and steroid
hormones may alter the balance of cell proliferation
versus cell death to produce BPH
• GF implicated in prostate growth.
bFGF (FGF-2)
acidic FGF (FGF-1)
Int-2 (FGF-3)
KGF, FGF-7)
β (TGF-β
EGF
• TGF-β (transforming ) is a potent inhibitor of
proliferation in normal epithelial cells in a variety of
tissues
18. ETIOLOGY
Other Signaling Pathways
• The early growth response gene-1 (EGR1)
• α2-macroglobulin
• IL-2, IL-4, IL-7, IL-17, interferon-γ (IFN-γ)
• Genetic and Familial Factors
19. PATHOPHYSIOLOGY
• The pathophysiology of BPH is complex
• BPH increases urethral resistance, resulting in
compensatory changes in bladder function
• Elevated detrusor pressure is required to
maintain urinary flow in the presence of
increased outflow resistance
20. LUTS
Voiding (obstructive)
symptoms
• Hesitancy
• Weak stream
• Straining to pass urine
• Prolonged micturition
• Feeling of incomplete
bladder emptying
• Urinary retention
Storage (irritative or
filling) symptoms
• Urgency
• Frequency
• Nocturia
• Urge incontinence
LUTS is not specific to BPH – not everyone with
LUTS has BPH and not everyone with BPH has LUTS
21. Common Symptoms
n
decrease in the urinary
stream
n Dribbling
or leaking
after urination
n Intermittency
n Hesitancy
n Pain
or burning
during urination
n Feeling
that the
bladder never
completely empties
22. Complications
Mortality
• 10 per 100,000
Bladder Stones
• bladder stone development is small
Urinary Tract Infections
• 0.1/100 patient-years
Bladder Decompensation
• progression from normal mucosa to advancing
trabeculation, diverticula and detrusor muscle
failure
23. Complications
Urinary Incontinence
• complications from surgical intervention for BPH
• secondary to overdistention of the bladder
(overflow incontinence)
• Due to detrusor instability (urge incontinence)
Acute Urinary Retention
• Long-term outcome resulting from BPH
24. Diagnosis of BPH
• History and Examination
• Digital rectal examination(DRE)
• inaccurate for size but can detect shape and consistency
• Ultrasonography
• Urodynamic analysis
• Measurement of prostate-specific antigen (PSA)
– high correlation between PSA and PV, specifically TZV
1
– men with larger prostates have higher PSA levels
– PSA is a predictor of disease progression and screening
tool for CaP
– as PSA values tend to increase with increasing PV and
increasing age, PSA may be used as a prognostic marker
for BPH
26. TREATMENT
BPH needs to be treated ONLY IF:
n
The symptoms are severe enough to
bother patient and affect the quality
of life
n
Renal insufficiency
n
Frequent urinary tract infections
28. TREATMENT
•First line of defense against bothersome urinary
symptoms
–Manage the condition - don’t fix it
•Two major types:
•(Alpha-1-blocker) - relax the prostate and
provide a larger urethral opening
(prazosin,terazosin)
•Shrink the prostate gland (5-alpha reductase
inhibitor) (finasteride)
29. TREATMENT
• Combination therapy with both an αadrenergic receptor blocker and a 5αreductase inhibitor has been demonstrated to
be the most effective
• Antimuscarinic agents are useful adjuncts for
patients with “storage” symptoms or ED
30. Minimally Invasive and Endoscopic
Temporary Stents
• Temporary stents are tubular devices that are
made of either a nonabsorbable or a
biodegradable material
• designed for short-term use, to relieve
bladder outlet obstruction (BOO)
31. Temporary Stents
• Spiral Stents- e.g Urospiral,stent should
remain in the prostatic urethra for longer than
12 months
• Polyurethane Stents
• Biodegradable Stents
32. Permanent Stents
• were introduced as a definitive treatment for
prostatic obstruction, particularly for patients
unfit for prostatic surgery
• Patients were able to void satisfactorily in
most cases, but complications were relatively
high
• UroLume endourethral prosthesis
33. TRANSURETHRAL NEEDLE ABLATION
OF THE PROSTATE (TUNA)
• Heat treatment inducing necrosis of prostatic
tissue
• The aim is to increase prostatic temperature
to in excess of 60° C
• Uses low-level radiofrequency (RF) energy
that produces localized necrotic lesions in the
hyperplastic tissue.
35. TRANSURETHRAL MICROWAVE
THERAPY
• These cover heat changes and differential
blood flow in the prostate
• Damages the sympathetic nerve endings
• Induction of apoptosis
37. LASERS
• “laser” stands for light amplification by the
stimulated emission of radiation
• There are four types of laser that can be used to
treat the prostate
1. Neodymium : Yttrium-Aluminum-Garnet Laser
2. Potassium-Titanyl-Phosphate Laser
3. Holmium : Yttrium-Aluminum-Garnet Laser
4. Diode Laser
38. LASERS
The energy from lasers can be delivered as follows:
• End firing
Bare tip
Sculptured tip
Sapphire tip
• Side firing
Metal or glass reflector
Prismatic internal reflector
39. TRANSURETHRAL RESECTION OF THE
PROSTATE (TURP)
• Gold Standard” of care for BPH
• Uses an electrical “knife” to surgically cut and
remove excess prostate tissue
• Effective in relieving symptoms and restoring
urine flow
40. TURP
Operation is performed through a modified
cystoscope
•
Prostatic tissue is resected using an electrically
energized wire loop
•
•
Prostatic capsule is usually preserved.
Continuous irrigation is necessary to distend
the bladder and to wash away blood and
dissected prostatic tissue.
•
43. COMPLICATIONS
•TURP can be
associated with a number of
complications:
•TURP Syndrome (2%)
•Hemorrhage
•Bladder perforation (1%)
•Hypothermia
•Septicemia (6%)
•DIC
•The main challenges are blood loss and TURP
Syndrome due to excessive absorption of irrigant
fluid
44. TURP SYNDROME
•
•
TURP syndrome: constellation of signs and
symptoms caused by the absorption of large
volumes of isotonic irrigating fluids through
prostatic veins or breaches in the prostatic
capsule.
The syndrome is characterized by
• hypervolemia,
• hyponatremia
• hypo-osmolarity
45. TURP SYNDROME:
RISK FACTORS
TURP syndrome is more likely
to occur:
1. The hydrostatic pressure of the
irrigation solution is high.
2. An excessively distended
bladder
3. Prostatic gland is large.
4. The Prostatic Capsule is
violated during surgery.
5. Duration of surgery (>60mins)
46. Retropubic Prostatectomy
• Proper Positioning of the Patient
• Once anesthesia has been induced the patient
is positioned on the operating table in a
supine position
• Trendelenburg position without extension
47. Retropubic prostatectomy. The space of Retzius has
been opened and the periprostatic adipose tissue has
been dissected free from the superficial branch of the
dorsal vein complex. The endopelvic fascia is incised
bilaterally
48. A 2-0 chromic suture on a 58-inch circle-tapered needle is passed in the avascular plane between
the urethra and the dorsal vein complex at the apex of the prostate. A tie is grasped and tied
around the dorsal vein complex. B, With 2-0 chromic suture material on a CTX needle, a figure-ofeight suture is placed through the prostatovesicular junction just above the level of the seminal
vesicles to control the main arterial blood supply to the prostate gland. When placing this suture,
care must be taken to avoid entrapment of the neurovascular bundles located posteriorly and
slightly laterally
49. Retropubic prostatectomy. A, With the superficial branch of the
dorsal vein complex secured proximally and distally, a No. 15
blade on a long handle is used to make the transverse
capsulotomy. B, Metzenbaum scissors are used to develop the
plane anteriorly between the prostatic adenoma and the
prostatic capsule.
50. Retropubic prostatectomy. A, With blunt dissection with the index finger, the
prostatic adenoma is dissected free laterally and posteriorly. B, Metzenbaum
scissors are used to divide the anterior commissure to visualize the posterior
urethra and verumontanum. C, The index finger is then used to fracture the
urethral mucosa at the level of the verumontanum. With this last maneuver,
extreme care is taken not to injure the external sphincteric mechanism
51. Retropubic prostatectomy. A, After removal of the left lateral lobe of the
prostate, the right lateral lobe is excised with the aid of a tenaculum and
Metzenbaum scissors. B, Lastly, the median lobe is removed under direct
vision
52. Retropubic prostatectomy. A, View of the prostatic fossa and posterior urethra after enucleation
of all the prostatic adenoma. Note that the verumontanum and a strip of posterior urethra
remain intact. B, After placement of a urethral catheter and, if needed, a Malecot suprapubic
tube, the transverse capsulotomy is closed with two running 2-0 chromic sutures. The two
sutures are tied first to themselves and then to each other across the midline to create a
watertight closure of the prostatic capsule.
53. Suprapubic Prostatectomy
• Proper Positioning of the Patient
• After anesthesia has been induced, the patient is
positioned on the operating table in a supine
position.
• The table is placed in a mild Trendelenburg
position without extension
• 22-Fr catheter is inserted into the bladder. After
residual urine is drained, 250 mL of saline is
instilled into the bladder and the catheter is
clamped.
54. Suprapubic prostatectomy. A, A lower midline incision is made
from the umbilicus to the pubic symphysis. B, After developing
the prevesical space, a small, longitudinal cystotomy is made
with an electrocautery
55. With adequate exposure of the bladder neck, a circular incision
in the bladder mucosa is made distal to the trigone, using an
electrocautery
56. Starting at the bladder neck posteriorly, Metzenbaum scissors
are used to develop the plane between the prostatic adenoma
and the prostatic capsule (lateral view). B, Anterior view of the
same maneuver
57. Using the index finger, the prostatic adenoma is enucleated from
the prostatic fossa (lateral view). B, Anterior view of the same
maneuver. With extreme large prostate glands, the left, right,
and median lobes should be removed separately
58. After enucleation of the entire prostatic adenoma, a 0-chromic suture is used
to place two figure-of-eight sutures to advance bladder mucosa into the
prostatic fossa at the 5- and 7-o’clock positions at the prostatovesicular
junction to ensure control of the main arterial blood supply to the prostate.
59. suprapubic tube, the cystotomy is closed in two layers using a
running 2-0 Vicryl suture, enforced by tying of multiple
interrupted 3-0 Vicryl stay sutures. A closed Davol suction drain
is placed on one side of the bladder and exits via a separate stab
incision
60. REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms
in older men. J Urol 2009;181(4):1779–87.
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia
with age. J Urol 1984;132(3):474–9.
Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the
community. Lancet 199124;338(8765):469–71.
Hutchison A, Farmer R, Verhamme K, et al. The efficacy of drugs for the treatment of LUTS/BPH, a
study in 6 European countries. Eur Urol 2007;51(1):207–15; discussion 215–206.
Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute
urinary retention. J Urol 1997;158(2):481–7.
Kohler T, McVary K. The relationship between erectile dysfunction and lower urinary tract
symptoms and the role of phosphodiesterase type 5 inhibitors. Eur Urol 2009;55(1):38–48.
Madersbacher S, Alivizatos G, Nordling J, et al. EAU 2004 guidelines on assessment, therapy and
follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction
(BPH guidelines). Eur Urol 2004;46(5):547–54.
McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride,
and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med
2003;349(25):2387–98.
McNeill SA, Hargreave TB, Roehrborn CG. Alfuzosin 10 mg once daily in the management of acute
urinary retention: results of a double-blind placebo-controlled study. Urology 2005;65(1):83–9;
discussion 89–90.