Benign Prostatic Hypertrophy is an enlargement of the prostate gland characterized by proliferation of cellular elements. It is common in aging men, affecting about 50% of men in their 50s and over 90% of men in their 80s. Symptoms include frequent and urgent urination, weak urine stream, and inability to fully empty the bladder. Treatment options include watchful waiting, medications to reduce symptoms, minimally invasive procedures, and surgery if other options provide inadequate relief.
BPH, which causes lower urinary tract symptoms LUTS , is common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non modifiable can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive or Irritative or can affect the patient after micturition. BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigation before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical intervention. Dr. Anjali Gupta "BPH and Its Scope in Homeopathy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-7 , December 2022, URL: https://www.ijtsrd.com/papers/ijtsrd52548.pdf Paper URL: https://www.ijtsrd.com/medicine/urology/52548/bph-and-its-scope-in-homeopathy/dr-anjali-gupta
BPH, which causes lower urinary tract symptoms LUTS , is common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non modifiable can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive or Irritative or can affect the patient after micturition. BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigation before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical intervention. Dr. Anjali Gupta "BPH and Its Scope in Homeopathy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-7 , December 2022, URL: https://www.ijtsrd.com/papers/ijtsrd52548.pdf Paper URL: https://www.ijtsrd.com/medicine/urology/52548/bph-and-its-scope-in-homeopathy/dr-anjali-gupta
This is a powerpoint presentation on the Topic of Male and female genital tract, based on Robbin's textbook of pathology. Prepared by Dr. Ashish Jawarkar, who is Assistant professor at Parul institute of medical sciences and research, Vadodara. Please subscribe to our youtube channel https://www.youtube.com/channel/UCwjkzK-YnJ-ra4HMOqq3Fkw . Our facebook page: facebook.com/pathologybasics
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
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
It’s work is regulated by androgens which are responsible for male sex characteristics
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
easy description of common lut disorders. improvements on the slides accepted. text includes congenital and acquired disorders. more so the causes of bladder outlet obstructions. also management of the disorders are breifly described.
Symptoms and Signs of different Diseases in UrologyAbdullah Mohammad
How would you approach a Urological Patient? This presentation will tell you how to take a history and examination along with symptoms and common signs of different diseases in urology
This is a powerpoint presentation on the Topic of Male and female genital tract, based on Robbin's textbook of pathology. Prepared by Dr. Ashish Jawarkar, who is Assistant professor at Parul institute of medical sciences and research, Vadodara. Please subscribe to our youtube channel https://www.youtube.com/channel/UCwjkzK-YnJ-ra4HMOqq3Fkw . Our facebook page: facebook.com/pathologybasics
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
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
It’s work is regulated by androgens which are responsible for male sex characteristics
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
easy description of common lut disorders. improvements on the slides accepted. text includes congenital and acquired disorders. more so the causes of bladder outlet obstructions. also management of the disorders are breifly described.
Symptoms and Signs of different Diseases in UrologyAbdullah Mohammad
How would you approach a Urological Patient? This presentation will tell you how to take a history and examination along with symptoms and common signs of different diseases in urology
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2. prostate gland is a pyramidal shaped
fibromuscular and glandular organ which
surrounds the prostatic urethra.
develops in the 12th week of embryonic life
under androgens from the fetal testis.
contains a number of individual glands
composed of 30-50 lobules leading to 15-30
secretory ducts that open into the urethra
lateral to the colliculus seminalis.
Anatomy
Medrockets.com
3. from the bladder neck to the urogenital
diaphragm.measures about 3.5 X 2.5cm,
averages 20G.
The prostate is found in the male while its
homologous in the female, formerly
known as the paraurethral gland of skene
now named female prostate.
Medrockets.com
4.
5.
6. • divided into zones
• Peripheral
• Transitional
• Central
• Pre prostactic tissue
• Non glandular fibro muscular portion
Medrockets.com
7. The Central Zone
• Surrounds the ejaculatory duct.
• it is in contact with the urethra at the
upper end of the colliculus seminalis.
• resp for 25% of glandular tissue of
prostate
• site of 10% of Ca P
• ≠ bph
8.
9. Anterior lobe (or isthmus) roughly
corresponds to part of transitional zone
Posterior lobe roughly corresponds to
peripheral zone
Lateral lobes spans all zones
Median lobe (or middle lobe) roughly
corresponds to part of central zone
Medrockets.com
10. The prostatic capsule
These are normally two, pathologically three, in
number.
1. The true capsule
2. Fibrous Sheath – condensed extraperitoneal
fascia. Between layers 1 and 2 lies the prostatic
venous plexus.
3. the pathological capsule- occurs in BPH in
which the normal peripheral part of the gland
becomes compressed into a capsule .
Medrockets.com
11. The prostate gland comprises secretory epithelium
which consists of
a. Epithelial
b. Basal
c. Neuroendocrine cells
d. Connective tissue
e. Smooth muscles
Only the epithelia1 cells secrete PSA and so cancer of
the neuroendocrine cells, connective tissue, smooth
muscle, transitional epithelium and
anaplastic cells can be present with a normal PSA
Medrockets.com
12. smooth muscle is regulated by the
autonomic nervous system primarily; the
alpha-1A adrenergic receptors constitute
70%.
Medrockets.com
13. The arterial blood supply of the prostate
gland arises from the middle rectal and
inferior vessical artery.
The venous drainage is into the prostati
plexus. The plexus also receives the dorsal
vein of the penis and drains into the internal
iliac veins. There are connections with no
valves between the prostatic plexus and
vertebral veins.
Hence retrogression to the vertebrae.
Blood supply
Medrockets.com
14. Lymphatic drainage
The prostatic lymphatics drain into lymph
nodes lying alongside the internal iliac
vessels. They also have a connection with
the sacral spinal lymphatics.
Medrockets.com
15. The prostatic fluid helps maintain the vitality
of the sperms, and contains calcium,
sodium, potassium, magnesium, chloride,
bicarbonate, zinc, spermine, citrate, lipid
cholesterol and 4 major proteins
◦ the prostatic specific antigen {PSA),
◦ prostatic acid phosphatase (PAP),
◦ the prostatic specific membrane antigen (PSMA)
and
◦ prostatic specific protein - 94(PSP-94).
functions
Medrockets.com
16. Benign prostate hyperplasia is not always
progressive, patient must be thoroughly
investigated to rule out malignancy and
institute proper treatment.
Benign prostatic hyperplasia (BPH), also known as
benign prostatic hypertrophy, is an enlargement of the
prostate characterized by proliferation of the cellular
elements of the prostate.
Benign Prostatic Hypertrophy
Medrockets.com
17. Age
◦ below 40 years - 8 %,
◦ 57-60 years - 50% and
◦ 80 years -90%.
Prevalence of symptoms of BPH by International
prostatic Symptoms Score (IPSS) in men aged
40 years is 14%,
50-year olds is 25%,
60-year olds 43% and
50% in 75-year olds.
epidemiology
Medrockets.com
18. Aetiology
Age
Positive familial and genetic factors
DHT
increase in 5-alpha reductase activity
oestrogen imbalance
Increased epithelial cell hyperplasia
decreased cell death of epithelial and stromal cells,
increased activity of growth factors (GF) -
FGF,TGF,EGF,KGF, IGF, endoGF - epithelial mitogens
and non androgenic testicular substances
Race , enviroment.
Medrockets.com
19. a fibromyoadenoma
the nodules first develop in the peri-urethral
transition zone (TZ) of the prostate
All BPH nodules develop either in the TZ or in the
peri-urethral region
As the disease progresses, the capsule of the
prostate transmits the pressure of tissue
expansion to the urethra.which produces the
symptoms.
pathology
Medrockets.com
20. Histological studies show increase in cell
numbers (Hyperplasia) but not
hypertrophy.
Gross appearance of hyperplastic tissue
may show lateral and/or middle lobe
enlargement and/or posterior
commissural hyperplasia
The hyperplastic nodules compress the
normal periphery of the gland which
forms the false capsule.
Medrockets.com
21. initially response to obstruction straining,
intermittency, poor stream and incomplete
bladder emptying.
There is compensatory hypertrophy of dextrusor
smooth muscles due to increased detrusor
collage. Hence trabeculation with widening of
gaps between them to form saccules.
With continued changes, the saccules develop
into diverticula.
Medrockets.com
22. This leads to detrusor instability or decreased
compliance or neural detrusor response which
manifests clinically by the symptom complex of
frequency, urgency and nocturia.
Decreased detrusor contractility (atonic bladder)
leads to poor urine stream, intermittency,
incomplete bladder emptying or increased
residual urine, and hesitancy
Acute urinary retention may supervene.
Medrockets.com
23. The nature of bph
In patients observed with mild to
moderate symptoms prospectively up to 7
years, 55% became worse, 30% remained
stable and 15% improved.
Overall, there’s very slow progression in
most cases of BPH
Medrockets.com
24. Symptoms
Initial recognition
◦ The early presentation of BPH is insidious and may not be
noticed by patient
Irritative symptoms
◦ Frequency
◦ Urgency
◦ Nocturia
◦ Urge incontinence.
Obstructive symptoms
◦ Weak (poor) stream
◦ Feeling of incomplete bladder emptying
◦ Straining on micturition
◦ Intermittency.
Clinical features
Medrockets.com
25. Others are:
◦ Difficulty of micturition associated with
◦ Hesitancy
◦ Prolong micturition
◦ Urinary retention: This may be acute/acute on
chronic or chronic.
◦ Haematuria- Microscopic/macroscopic
◦ Recurrent UTI such as cystitis, epididymo-orchitis,
pyelonephritis, bacteraemia, septicaemia etc
◦ Renal failure - This could be acute or chronic
associated with thirst, lethargy, headaches, uraemia
Medrockets.com
26. General physical examination: may
demonstrate signs of chronic renal
impairment (anaemia, dehydration,
headaches, lethargy)
Abdominal examination: normal except for
retention (distended bladder).
Rectal examination: in BPH, posterior
surface is usually smooth, convex with a firm
consistency. Rectal mucosa moves freely
over it.
Neurological examination: to eliminate
neurological lesions.
examination
Medrockets.com
27. INTERNATIONAL PROSTATE
SYMPTOM SCORE (IPSS)
This is a structured symptoms questionnaire
which was developed by the American Urological
Association and was adopted by the WHO in
1994.
It is used for assessment of obstructive and
irritative symptoms.
4 obstructive symptoms of BPH (when there is no
retention)
◦ Incomplete bladder emptying.
◦ Intermittency.
◦ Weak stream.
◦ Straining. Medrockets.com
28. Assessment Of 3 Irritative Symptom
◦ Frequency
◦ Urgency.
◦ Nocturia.
Each symptom is scored from 0-5 and the
maximum score is 35. The interpretation of IPSS
score values are
◦ Mild O-8.
◦ Moderate 9-19.
◦ Severe 20-35.
The Quality of Life due to BPH Urinary Symptoms
is scored from 0-6
Medrockets.com
29. SCORING
0 – not at all in the past one month
1 – less than once in the past one month
2 – less than half the time in the past one
month
3 – about half the time in the past one month
4 – more than half of the time in the past one
month
5 – almost always in the past one month
Medrockets.com
30. Differential Diagnosis Of
Symptoms
Causes Of Irritative Symptoms
UTI
Bladder Stones
Interstitial Cystitis
Cancer of the Bladder
Cancer of the Prostate
Chronic Cystitis
Bilharziasis
Neurological Disorders
CVA
Brain Tumour
Internal Hydrocephalus
Parkinsonism
Multiple Sclerosis
Syringomyelia
DM
Medrockets.com
31. 2. Obstructive Symptoms
◦ Urethral stricture.
◦ Carcinoma of prostate.
◦ Bladder cancer.
◦ Bladder calculi.
◦ Phimosis
◦ paraphimosis
◦ Neurogenic bladder.
Others are :
◦ ageing, psychiatric disorders such as depression,
diuretics, chronic renal failure, polydipsia and
excessive consumption of beverages such as tea and
coffee.
Medrockets.com
32. diverticulitis
infection
calculi- mostly struvite due to urease producing
orgs (proteus, pseudomonas, pyocyanea,
klebsiella) also Ca Oxalate calculi
hematurai
chronic retention
post obstructive diuresis
post obstructive hemorrhage
recurrent infection
Renal failure
Complications of bph
Medrockets.com
33. INVESTIGATIONS
1. Urinalysis: check for blood, glucose, protein.
Mid steam urine for bacteriology.
2. Urine culture for infection.
3. Full Blood Count.
4. BUE, serum creatinine, urea and electrolytes
5. Serum Prostatic Specific Antigen (PSA)
6. Abdominal ultrasonography, plain abdominal X-
ray, IVU,
7. Urethrocystoscopy.
8. Urine Flowrate, Post-void Residual Urine,
Pressure Flow Urodynamics. Medrockets.com
34. – Transrectal Ultrasound of The Prostate
(TRUS) And TRUS-Guided Prostatic Biopsy
– Colour Doppler Imaging Of The Prostate
– Retrograde Urethro-Cystography
– Chest X-ray
Medrockets.com
35. MANAGEMENT OF BPH
Watchful Waiting
Medical Therapy
Minimally Invasive Treatment
Surgery- Surgery for BPH is most commonly
performed endoscopically; however, if the
prostate gland is greater than 60g, an open
prostatectomy is performed.
◦ Transurethral incision of prostate
◦ Transurethral resection of prostate
◦ Transvesical prostatectomy
◦ Retropubic prostatectomy( millin’s) Medrockets.com
36. Watchful waiting
This option is usually offered to patients
with IPSS of 8 or less who are not much
bothered by the symptoms due to BPH.
This involves regular assessment of IPSS,
PFR, PSA and PVR, abdominal
ultrasonography and DRE
Watchful waiting can be replaced by
medical therapy or surgical treatment if
the condition changes. Medrockets.com
37. Medical Therapy For BPH
The ideal candidates are those with IPSS scores
under 19 with bothersome symptoms but with
no complications such as haematuria, stones,
retention or uraemia. They are carefully followed
up for continuation or change in therapy.
1. Alpha Adrenergic Blockers. long-acting alpha-l-
adrenergic blockers Terrazosin and doxazosin
and the selective alpha 1A tramulzosin.
◦ Side-effects are minor and reversible and include a
flu-like syndrome and dizziness..
◦ The drugs are expensive but they are effective for
medical therapy of BPH.
38. Androgen Suppression: The rationale is to reduce the
level of dihydrotestosterone and thereby shrink the
prostate volume so as to relieve the obstruction.
5-Alpha reductase inhibitors
◦ finesteride (proscar) and episteride
◦ The side-effects include loss of libido and erectile
dysfunction.
Zanoterone
◦ This is a steroid competitive androgen receptor antagonist.
◦ Its side-effects include breast pain and gynaecomastia.
Flutamide
– It is an androgen receptor antagonist.
Aromatase Inhibitor (Atamestame)
Medrockets.com
39. The list include:
i) Hypoxis roopers (South African grass).
ii) Urtica spp (stinging nettle).
iii) Sabal serrulatum (dwarf palm).
iv) Serenoa repens B (American dwarf
palm).
v) Cucurbitapepo (pumpkin seed).
vi) Pygeum africannum (African plum)
phytotherapy
Medrockets.com
40. Indications for minimally invasive surgery include
◦ patients with moderate symptoms scores (IPSS 8 -19).
◦ and patients with severe symptoms but handicapped
or unfit for surgery.
Available Minimally Invasive Techniques are
◦ High intensity focused ultrasound (HIFU).
◦ Transurethral vaporization of prostate.
◦ Transurethral laser therapy (TULIP).
◦ Hyperthermia and thermotherapy.
◦ Intra-urethral stents.
◦ Transurethral needle ablation of prostate (TUNA).
◦ Transurethral balloon dilatation.
Medrockets.com
41. Indications For Prostatectomy
Acute refractory urinary retention.
Chronic urinary retention
Recurrent episodes or severe haematuria
Bladder stones secondary to BPH
Recurrent UTI
Large bladder diverticula
Hydroureter and hydronephrosis
Uraemia (azotaemia) due to BPH.
Others include
– Symptoms of bladder outlet obstruction due to BPH which are moderate to
severe, bothersome and interfere with the patient’s quality of life (usually
IPSS score from 19 to 35) but which are not relieved by medical therapy or
minimally invasive surgery
42. Frail elderly patients.
Patients with severe CO-morbidity such as
myocardial infarct, heart disease, liver
failure, pulmonary disease,
carcinomatosis etc
A severe bleeding tendency and patients
on anticoagulant.
Medrockets.com
43. TURP
The standard endoscopic procedure for
BPH is a transurethral resection (TUR) of
the prostate. TUR is performed with a
nonhemolytic fluid such as 1.5% glycine. it
is the Gold standard for reducing
symptom scores.
Medrockets.com
44. Complications of TURP
Primary haemorrhage (5-15%)
Secondary haemorrhage
Urinary incontinence
Urethral stricture
Sexual Dysfunction
TUR syndrome
Medrockets.com
45. Haemorrhage
Clot retention
Urinary tract infection
Epididymo-orchitis
Persistent vesico-cutaneous fistula
Wound infection
Incontinence of urine
Complications of Open
Prostatectomy
Medrockets.com
47. Management of Acute Retention
The procedure should first be explained to the patient.
The suprapubic, scrotal and perineal areas are shaved and washed if necessary
diazepam 10mg given for sedation
A sterile trolley is set up containing an antiseptic (cetrimide, povidone iodine or
chlorhexidine), sterile towels, swabs, penile clamp, syringe, catheters and a
specimen bottle for urine.
A nurse should be on hand
positioning the patient comfortably
About 5-10m1 of lidocaine 1 %jelly is instilled into the urethra & massaged into
it, retained by applying pressure with the thumb and finger
The urethra is anaesthetized in 4-5 minutes
A suitable catheter is selected - Jacques, Foley's, Nelaton Tiemann's or
Gibbon's
Medrockets.com
48. A wide-bore 3-way or 2-way Foley's catheter is used
if bleeding or irrigation is anticipated and a Nelaton
catheter if not for indwelling. Otherwise a narrow
(12F) plastic Jacques catheter is selected. An
indwelling catheter should not fit tightly so that the
secretions of the paraurethral glands can drain
alongside it.
The penis is held straight and the catheter inserted
into the external meatus and gently advanced into
the urethra.
Urine is collected in a sterile bottle for culture and
sensitivity, sugar and protein tests.
The urine is then drained and the catheter removed
Medrockets.com