Download Benign Prostatic Hyperplasia (BPH)

Benign
Prostatic Hyperplasia
(BPH)
what is the prostate gland
n
Prostate gland : is a fbromuscular and glandular
organ lying Just inferior to the bladder .
n
According to Mcneal , the prostate has a peripheral
zone , central zone and transitional zone.
n
According to Lowsley , the prostate has posterior
,two lateral , anterior and middle lobes
Benign prostatic hyperplasia (BPH)
n
Half of all men over the age of 60 will
develop an enlarged prostate
n
By the time men reach their 70’s and 80’s,
80% will experience urinary symptoms
Etiology : is not completely understood , but it seems
to be multifactorial and endocrine controlled .
Hormones :
androgen deprivation in older man reduces
prostate size , additional investigation have
demonstrated a positive correlation between level of
free testesterone and estrogen and the volume of the
BPH .
Stromal - epithelial interaction theory. This caused
by various growth factors.
Pathology :
BPH develops in the transitional zone . It is
truly hyperplasia process resulting from
increase in cell number .
Microscopically reveal a nodular growth
pattern that it is composed of varying amount
of stromal and epithelial tissue, stromal tissue
composed from collagen and smooth
muscle
Pathophysiology
n obstructive component
of BPH .
Mechanical obstruction .
Dynamic obstruction .
n
Irritative voiding
complaints
n Clinical Feachers:
Symptoms:
Irritative symptoms
Obstructive symptoms
Signs:
Neurological examination .
Digital rectal examination ,it shows size of
the prostate (not compatible with severity
of the symptoms)
In BPH ,it reveals smooth,firm,elastic
enlargement of the prostate .
n
Lab. Findings:
Urinalysis
Renal function
There is 10% renal insufficiency observed in BPH.
PSA (prostatic specific antigen)
Imaging :
IVP and ultrasound are indicated in concomitant
urinary tract disease or complicated BPH
Cystoscopic examination
Additional testes : cystometrogram and urodynamic
prophile for patient with
Neurological disease .
Failed prostatic surgery .
Complications of BPH:
Bladder stones
UTI
Hematuria
Bladder decompensation
Renal failure
Acute and chronic urine retention
Treatment :
1. Watchful waiting
2. Medical treatment
a- alpha blockers :
•
-Phenoxybenzamine , it is non selective
α blocker (Dose 10mg ).
• -prazosin it is short acting selective α1
blocker .
• -terazosin (5mg,10mg ),doxazosin (4mg,
8mg) ,these are long acting α 1
blockers .
• -tamsulosin (0.4mg,0.8mg),silodosin
(8mg) α1a selective blocker. This is
the most potent α blockers.
Side effects :
-orthostatic hypotension
-dizziness
-tiredness
-retrograde ejaculation
-rhinitis
-headack
b- 5α-reductase inhibitors :
Side effects :
-decreased libido
-decreased ejaculatory volume
-impotence
c-Combination therapy :
d-Phyto therapy
3-conventional surgical therapy :
(a)Taransurethral resection
of the prostate (TURP)
90% of simple prostatectomy
can be done endoscopically
,symptoms and flow rate
improvement is superior to
that of any minimally invasive
therapy .
Complications:
Impotence
Incontinence
Bleeding
May require blood
transfusion
Retrograde ejaculation.
TUR syndrome :
TUR syndrome :
It is a clinical manifestation of nausea
,vomiting, confusion ,hypertension
bradycardia and visual disturbance .
Treatment:
1-Diuresis
2-Hypertonic saline in severe case .
b-Transurethral incision of the
prostate (TUIP)
C- open
prostatectomy
Indications:
prostate gland over 100 gm .
BPH with bladder diverticule .
BPH with vesical stone .
if dorsal lithiotomy position is not
possible .
Minimally invasive therapy :•
(1) Laser therapy
Advantages:
-minimal blood loss .
-rare instance of TUR syndrome .
-ability to treat patient with anti coagulant
therapy .
-ability to done in out patient procedure.
Disadvantages :
--longer postoperative catheterization
time
-more irritative voiding complaints.
-high cost of laser fibers and generators.
2- Transurethral evaporization of
the prostate
3-hyperthermia
Micro wave thermal therapy
(4) High Intensity Focused Ultrasound
(HIFU):
(5) Intra urethral stents
Transurethral balloon dilation of the
prostate
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