BENIGN PROSTATIC
HYPERPLASIA
BPH
Outline
Introduction
Anatomy
Definition
Diagnosis
Complication
Treatment
PROSTATE
Introduction
– larger than a walnut.
– Felt during a rectal exam.
ducts are lined with transitional epithelium
– can be divided in two different ways:
by zone, or by lobe.
.
.
• 3.2cm
• 20cc • 4cm • 4.3cm • 5cm • 6.3
• 33cc • 65cc
• 40cc • 65cc
ANATOMY
ZONES
classification is more often used in pathology.
Lobes
The "lobe" classification is more often used in gross anatomy .
BPH
DEFINITION
o to a regional nodular growth of varying
combinations of glandular and stromal proliferation
Histopathologic
o increased number of epithelial and stromal cells in
the periurethral area of the prostate
Macroscopic
o refers to organ enlargement due to the cellular
changes
Clinical
o refers to the lower urinary tract symptoms thought
due to benign prostatic obstruction.
BPH
• AGE…………risk factors for BPH
– 25 % of men age 40 to 50 year
– 50 % of men age 50 to 60
– 65 % of men age 60 to 70
– 80 % of men age 70 to 80
– 90 % of men age 80 to 90
• 25 to 50 % of individuals with microscopic and
macroscopic evidence of BPH will progress to clinical
BPH
DIAGNOSIS /BPH
–History
–Digital rectal and focused P/E
–Urinalysis
–Urine cytology in those with significant
irritative symptoms
–Serum creatinine
–Trans-rectal ultrasound
–Renal ultrasound (if creatinine abnormal)
–A standardized symptom assessment,
such as the AUA symptom index
DIAGNOSIS/BPH
Symptoms
• Lower Urinary Tract Symptoms (LUTS)
Voiding (emptying) symptoms
(obstructive symptoms)
• . poor urinary stream Impairment in the
size/force
• Hesitancy and/or abdominal straining
• Intermittent or interrupted flow
• A sensation of incomplete emptying
DIAGNOSIS/BPH
Filling and storage symptoms
(irritative symptoms)
•Nocturia
•Daytime frequency
•Urgency
•Urge incontinence
•Dysuria.
DIAGNOSIS/BPH
Signs
– Physical (PR)
–Size……… enlarged
–Consistency……Rubbery
–Surface……..smooth
–Mobility…….Mobile
Imaging. …….Trans rectal US
American Urological Association (AUA) symptom index
URODYNAMIC
Urodynamic
o In patients with more severe symptoms or who are being considered for
active treatment
o Flow metry and residual urine volume are recommended
features:
– Decreased mean and peak flow rates, an abnormal flow pattern
characterized by a long low plateau
– Elevated detrusor pressures at the initiation of and during flow
– May or may not have increased residual urine
– 50 percent of BPH patients are found to have bladder hyperactivity during
filling.
o Endoscopic examination if other lower urinary tract pathology is suspected
BPH
Complication
• Bladder changes
Bladder wall thickening
Trabeculation (which are also associated with involuntary
bladder contractions)
Bladder diverticula
Bladder calculi
Bladder decompensation and gross bladder distention can result.
Chronically increased residual urine volumes
Persistent urinary infection
Acute urinary retention
Azotemia
• Upper tract changes.
Ureterectasis, hydroureter, and/or hydronephrosis
BPH TREATMENT
INDICATIONS
GOAL of Treatment
Relieving LUTS
< ing BOO
Improve empyting
Ameliorate over activity
Reverse RF
Prevent progression
BPH TREATMENT
MANAGEMENT OF ACUTE URINARY RETENTION
– Catheterization
– Suprapubic cystostomy
TREATMENT
Watchful Waiting (Observation)
Decrease Fluid intake
Decrease Alcohol
Decrease Caffeine containing
Time – Voiding schedule
Plant extract (phyto therapy)
BPH Treatment
Medical Treatment
a. Alpha-Adrenergic Antagonists
Tamsulosin
b. 5-a Reductase Inhibitors
Finasteride/ Dutasteride
C. Combination ……. Dutasteride +Tamsulosin
Surgical
Indications
– Recurrent haematuria
– Renal impairment or hydronephrosis
– Recurrent urinary tract infections
– Large residual urine (>200 ml)
– No improvement on medical treatment
Medical treatment
BPH SURGICAL TREATMENT
Type
Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP)
Open prostatectomy (TVP/RPP)
NEW MINIMALLY INVASIVE PROCEDURES
• Laser
• Transurethral microwave therapy (TUMT)
use of microwave energy
• Transurethral needle ablation of the prostate (TUNA)
• High-intensity focused ultrasound (HIFU)
It delivers heat to prostate tissue, with the subsequent
process of thermal injury.
COMPLICATIONS
Elderly dream
or
fantasy
