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Benign prostatic hyperplasia
This document discusses benign prostatic hyperplasia (BPH). It notes that BPH is the most prevalent benign tumor in men over 50 years old, with over 90% of men having it by age 80. Symptoms include problems with urination like hesitancy, weak stream, and incomplete emptying. Diagnosis involves digital rectal exam, prostate-specific antigen level, and urodynamic tests. Treatment includes watchful waiting, medications like alpha blockers and 5-alpha reductase inhibitors, and surgeries like transurethral resection of the prostate. Newer minimally invasive options for surgically treating BPH include lasers, electrovaporization, and high-intensity focused ultrasound.
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Benign prostatic hyperplasia
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- 4. INCIDENCE Most prevalentBenign Tumor > 50 yr old 50% at 50 yr have histological evidence >90 % after 80 yrs
- 5. ETIOLOGY ENDOCRINE LowTestosterone High Estrogens Sensitization of Androgen Receptors
- 6. PATHOPHYSIOLOGY HYPERPLASIA Epithelium Stroma (Smooth muscle) Urethra Mechanical (Prostate Enlargement) Dynamic (Smooth Muscle in Stroma) Irritable (Bladder Response to outlet reistance )
- 9. Consequences of BPH ■No symptoms, no BOO ■ No symptoms, but urodynamic evidence of BOO ■ LUTS, no evidence of BOO ■ LUTS and BOO ■ Others (acute/chronic retention, haematuria, urinary infection and stone formation)
- 10. SYMPTOMS (LUTS) OBSTRUCTIVE SYMPTOMS IRRITATIVESYMPTOMS Hesitancy decreased force and caliber of stream Sensation of incomplete bladder emptying double voiding (urinating a second time within 2 hours of the previous void) straining to urinate Dribbling (post-void ) Episodes of near retention Intermittant stream urgency, frequency Nocturia Urge incontinence enuresis
- 13. MILD 0-7 MODERATE 8-19 SEVERE 20-35
- 14. SYMPTOMS (BOO) Ac.Retention Ch. Retention Hematuria Impaired bladder emptying
- 15. SIGNS Digital RectalExamination (DRE) DRE typically takes less than a minute to perform. In this procedure, the physician inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess the size, shape, and consistency of the gland. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard, and often asymmetrical or stony, like the bridge of the nose.
- 16. INVESTIGATION CUE PSA USG IVU CYSTOSCOPY
- 17. URODYNAMIC STUDIES < 10 ml s–1 > 80 cmH2O
- 18. DIFFERENTIAL DIAGNOSIS UTI Ca Prostate Urethral stricture Bladder neck contracture Vesical stone
- 19. TREATMENT WATCHFUL WAITING MEDICAL SURGICAL
- 20. Medical Alpha Blockers 5α-Reductase Inhibitors(finasteride) Combination Therapy Phytotherapy
- 21. Alpha Blockers NonSelective-Prazocin Selective(alpha 1a)-Tamsolin
- 22. 5α-reductase Inhibitors Finasteride Epithelial component Minimum-6 months(20% reduction in size) Large prostate(40cm3)
- 23. Combination Therapy Riskof progression Large gland High PSA
- 24. Phytotherapy saw palmettoberry (Serenoa repens) the bark of Pygeum africanum, the roots of Echinacea purpurea and Hypoxis rooperi, pollen extract, leaves of the trembling poplar
- 25. Surgical Management INDICATIONS refractoryurinary retention (failing at least one attempt at catheter removal), recurrent urinary tract infection recurrent gross hematuria bladder stones Ch. Retention & renal insufficiency large bladder diverticula Severe Symptoms
- 26. Surgical CONVENTIONAL TURP TUIP Open Prostatectomy
- 27. TURP Complication Retrogradeejaculation Impotence Incontinence TUR syndrome Bleeding Stricturestenosis
- 28. Transurethral Incision OfProstate Indication Moderate-Severe Symptoms Small Prostate with post Commisure Hyperplasia(elevated bladder neck) Procedure 5 & 7 O clock
- 29. Open Prostatectomy Indication Glands >100 g concomitant bladder diverticulum Bladder stone dorsal lithotomy positioning is not possible. Approaches Suprapubic Retropubic (Millon) Perineal(young)
- 31. Surgical MINIMALLY INVASIVE Laser TULIP Visual contact ablative laser therapy Interstitial laser therapy Transurethral electrovaporization of the prostate Hyperthermia Transurethral needle ablation of the prostate High-intensity focused ultrasound Intraurethral stents