Download Benign prostatic hyperplasia

Benign prostatic
hyperplasia
Niazy B Hussam Aldin ►
►
Benign prostatic
hyperplasia
(BPH) is the most common benign
tumour in men and responsible for
urinary symptoms in the majority of
males over the age of 50 years .
Epidemiology
Autopsy studies have revealed the ►
histological presence of (BPH) in 50% of
males aged 51-60 years ,increasing to 90%
in those over 85
it has estimated double in the size of the ►
time between the age of 31 and 50 years is
4.5 years.
Pathophsiology
The prostate is a part glandular ,part fibromuscular ►
structure about 3.5-2.5 cm in size surrounding the 1st part
of male urethra at the base of the bladder it develops at
the 12 weeks of embryonic life
The prostate can be divided into an inner and the outer ►
zone the site of malignant change.
The inner zone is generally the site of (BPH) changes ►
testosterone is converted by 5alfa-reductase to
dihydrotestosterone (DHT) an androgen with five times the
potency of testosterone. and responsible to cell division
and lead to enlargement and hyperplasia .
Histology
Histologically the hypertrophied prostate ►
can vary depending on the predominance
of the type of prostatic tissue present
,from stromal, fibromuscular or muscular
to fibroadenomatus and
fibromyoadenomatus enlargment.
BPH
Symptoms
Lower urinary tract symptoms (LUTS) can be ►
divided into symptoms of failure of urine storage
(irritative)and those caused by failure to empty
the bladder (obstructive or voiding )
(Irritative) – frequncy , nocturia, urgency ►
(Obstructive)- poor flow, hesitancy in initiation of ►
micturation, postmicturation dribble ,sensation of
in complete emptying , occasional acute retention
of urine requiring emergency treatment
Examination and investigation
Digital rectal exam (DRE) for whom suspected benign ►
prostatic hyperplasia
The most important reason for doing a rectal examination ►
is to detect prostate cancer with measurement of levels of
prostate_ specific antigen (PSA).
Urodynamic assessments- urinary flow through cystometry ►
25ml/s
Imaging – ultrasound bladder for residual volume ►
Flexible cystoscopy- to assessment type of prostatic ►
obstruction
Prostatic ultrasound scan-document the size of prostate ►
and mlignant changes .
DRE
Treatment (surgery )
Transurethral resection of prostate
►
(TRUP) is common and effective procedure
which achieve a high level of improvement
in symptoms and flow rate .
section of prostate are removed using ►
electrical loops attached to a recectoscope,
Complication such as bleeding . Urinary ►
tract infections and epididymitis and erectile
dysfunction.
TURP
surgery
Open prostectomy; involve the surgical ►
removal of an enlarged prostate and is done
under general or spinal anaesthesia .
This procedure perform for very enlarged ►
prostate gland individuals with bladder
diverticula or stones .
Open prostectomy associated with a high ►
incidence of bleeding ad other complications
.
Minimally invasive techniques
1-Thermotherapy ;such as - ►
electrovaporazation ,which heats the
prostate using bipolar diathermy to cause
vaporization of tissue, and transurethral
microwave thermotherapy .
2-Laser therapy ; varies types of laser ►
energy can be used to destroy prostatic
tissue.
Non – invasive treatment
If BPH does not progress significantly and one ‫► ه‬
management option is that called ( watchful
waiting )
Alfa- adrenoceptor blocking agent; prazocin ,
alfuzocin , indromin , doxazocin , terazocin . the
prostate gland is very responsive to adrenergic
stimulation ,50% of proststic patient response due
to increasing to adrenergic tone which potentially
reversible by drugs, alfa1-receptors predominate
and mediate the contraction of gland smooth
muscle. .
Aim of treatment
Pt with BPH frequently experience problems ►
with erectile and ejaculatory function. The
treatment aim to restore sexual function
the effect of alfa blockers on male sexual ►
functions variable and influenced by drug
chosen and patient characteristics
Tamsulosin
Selective inhibitors at alfa 1A &alfa1B ►
Increase urinary flow rates and reduces LUTs in ►
patient with BPH.
Has elimination half-life of about 10hrs allows ►
once dialy
Side effect; dizzines headche and syncope. ►
Arthralgia, back pain and myalgia affecting 11% of
patient .
Drug interaction ; cimetidine diuretic ►
antihypertensive drug .
Treatment
5alfa – reductase inhibitors
►
finasteride – Dutasteride ;
The primary androgen responsible for the
development and progression of BPH is
dihydrotestosteron.
There are two isoenzyme of 5 alfa –reductase type ►
1 is found in most producing tissue such as the
liver ,skin and hiar , type 2 is predomiant in genital
tissue, including the prostate
Finasterid reduce prostate size 30% and improve ►
symptoms, it may take 6 months before
symptomatic benefit.
Side effect ;decreased libido ,impotence , ►
Combination therapy
Alfa- adrenoceptor antagonists have no impact on ►
the rates of acute urinary retention or prostate
surgery , the 5 alfa -reductase inhibitors have little
impact on short term acute symptoms .
Combination therapy provide to manage ►
symptoms and decrease progression of BPH
Trial confirmed the additional benefits of using ►
acombination of doxazin and finasteride .
Patient care
Most men tolerate a high degree of ►
symptoms on quality of life
Formal bladder training may be undertaken
as part of a watch and wait approach or
concurrently with drug therapy
See table 48.1 include common therapeutic
problem in (BPH)
Note page 694 – 697 is recommended ►
chapter 48
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