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.

1. BENIGN PROSTATIC
HYPERPLASIA
(BPH)

2. BPH
A widely prevailing pathology
among elderly males
BPH can cause bothersome day& night LUTS
? A negative impact on quality of life (QOL)

3. Definition Of BPH
Normal prostate:
A compound tubulo-alveolar gland
composed of 3 histological elements:
-Epithelial structure: prostatic acini&ducts
(androgen dependent) lying within a :
-fibro -
-muscular smooth m. innervated by
alpha adrenergic fibres
Stroma

4. Normal prostate is about 15 g.
in the young adult
BPH results from abnormal (proliferation) of
the 3 histological elements of the prostate:
glandular (acinar)
fibrous
muscular
in different proportions
It can be regarded as a benign tumor:
fibro-myo-adenoma

5. Aetiogy Of BPH
• Aging
• Androgens

6. PATHOLOGY OF BPH
BPH arises from
the transition zone or
the peri-urethral
zone of the gland
closely relayed to urethra &
BN
What about P Ca?

7. BPH starts as one or more
hyperplasic nodules within
the gland.. gradually
enlarging ….
may coalesce together…
compressing the intervening &
outer normal prostatic tissue
which eventually forms a
surgical capsule
around the adenoma
Pathogenesis

8. The result will be:
An elongated & compressed prostatic
Urethra
Macroscopically BPH can be:
Monolobar…middle lobe
Bilobar….. 2 lateral lobes
Trilobar… 2 lateral lobes & middle lobe

9. Pathophysiology of Urethral
Obstruction in BPH
Static component:
formed by the obstructing
prostatic mass
Dynamic component:
formed by the tone of
smooth muscle within
the stroma & capsule

10. Pathological complications of BPH
Increased intravesical pressure:
Early… bladder muscle hypertrophy
Later…. atony..
thinning out of bladder muscle
…diverticulation
The result will be:
High intra-vesical (P) …Bil hydroureteronephrosis
Outlet obstruction…significant amount of
PV residual urine….Stasis:
Rec UTI
Stone formation

11. Diagnosis of BPH
Clinical Picture
Symptoms:
Old male (over 50 ys) suffering from LUTS
Storage symptoms:
Urinary frequency
nocturia
urgency ,..urgency incontinence
Evacuation symptoms:
Straining during voiding
diminished force & calibre of the stream
bifurcated stream
interrupted stream
PV dribbling
AUR

12. Symptoms of complications
Rec. UTI
Haematuria
Bladder stone
chronic retention:
SP mass (full bladder)
overflow incontinence
renal insufficiency

13. Physical examination
• General examination
• Abdominal examination:
? Renal swelling (hydronephrosis)
? SP area ( full bladder)
Hernial orifices
• Genital examination
? associated epididymo-orchitis
• Digital rectal examination (DRE)
size , shape, symmetry, consistency
Is it suspicious of P Ca ?

14. Investigations
Lab investigations
Urinalysis
Serum creatinine
Serum PSA

15. Imaging
Abdominal ultrasonography:
size of the gland, PVR,
associated stones
? hydronephrosis,
KUB:
radio-opaque calculi
Intravenous Urography:
secretory function of the kidney
?basal smooth filling defect in
the bladder
Uroflowmetry
to document obstruction
Urethro-cystoscopy
in case of hematuria

16. Differential Diagnosis
Other causes of LUTS
Bladder & urethral calculi
Bladder cancer
BN fibrosis
Prostate cancer
Urethral stricture
Neurogenic voiding dysfunction

17. TREATMENT of BPH
Non- symptomatic BPH
Reassurance---- Follow up
Symptomatic BPH:
Conservative Treatment:
non-specific measures
* Avoid causes of prostatic congestion
* Phytotherapy

18. Specific medical treatment:
5- alpha - reductase inhibitors
prevent the conversion of testosterone
to 5-dihydro testosterone
gradual atrophy of the glandular
component of BPH
(slow effect on static component)
Alpha adrenergic blockers
Cause decrease of the smooth muscle
tone within the prostatic stroma&capsule
better urine flow
(rapid effect on dynamic component)

19. Surgical Intervention
Indications
Repeated AUR
Chronic UR
Severe obstructive symptoms
Failure of medical treatment
Haematuria
Complications:
Rec. UTI
Hydronephrosis
Bladder stones or diverticula

20. Methods of Surgical intervention
Trans-urethral resection
of the prostate (TURP)
Gold standard 90% of cases
Open surgical prostatectomy
( enucleation adenectomy)
when ?
Very large BPH
Concomitant bladder lesion that needs
open surgery
Patient limitation (limited hip joint mobility)

21. TURP

22. Conclusions
• BPH is a disease of aging males
• It can cause disabling LUTS (QOL)
• Corner stone of diagnosis
old male,.. LUTS,
DRE….. sonography
exclude cases of suspected P ca

23. Conclusions(cont.)
• Most cases ( 70 – 90 % ) can be managed
by medical treatment with reasonable pt.
satisfaction
Only a small percentage will need surgical
intervention where TURP is the standard
of care