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Benign prostatic hyperplasia

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Benign prostatic hyperplasia

  1. 1. ANATOMY
  2. 2. BENIGN PROSTATIC HYPERPLASIA
  3. 3. INCIDENCE  Most prevalent Benign Tumor  > 50 yr old  50% at 50 yr have histological evidence  >90 % after 80 yrs
  4. 4. ETIOLOGY  ENDOCRINE  Low Testosterone  High Estrogens  Sensitization of Androgen Receptors
  5. 5. PATHOPHYSIOLOGY  HYPERPLASIA  Epithelium  Stroma (Smooth muscle)  Urethra  Mechanical (Prostate Enlargement)  Dynamic (Smooth Muscle in Stroma)  Irritable (Bladder Response to outlet reistance )
  6. 6. Consequences of BPH ■ No symptoms, no BOO ■ No symptoms, but urodynamic evidence of BOO ■ LUTS, no evidence of BOO ■ LUTS and BOO ■ Others (acute/chronic retention, haematuria, urinary infection and stone formation)
  7. 7. SYMPTOMS (LUTS) OBSTRUCTIVE SYMPTOMS IRRITATIVE SYMPTOMS  Hesitancy  decreased force and caliber of stream  Sensation of incomplete bladder emptying  double voiding (urinating a second time within 2 hours of the previous void)  straining to urinate  Dribbling (post-void )  Episodes of near retention  Intermittant stream  urgency,  frequency  Nocturia  Urge incontinence  enuresis
  8. 8.  MILD 0-7  MODERATE 8-19  SEVERE 20-35
  9. 9. SYMPTOMS (BOO)  Ac. Retention  Ch. Retention  Hematuria  Impaired bladder emptying
  10. 10. SIGNS  Digital Rectal Examination (DRE)  DRE typically takes less than a minute to perform. In this procedure, the physician inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess the size, shape, and consistency of the gland. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard, and often asymmetrical or stony, like the bridge of the nose.
  11. 11. INVESTIGATION  CUE  PSA  USG  IVU  CYSTOSCOPY
  12. 12.  URODYNAMIC STUDIES  < 10 ml s–1  > 80 cmH2O
  13. 13. DIFFERENTIAL DIAGNOSIS  UTI  Ca Prostate  Urethral stricture  Bladder neck contracture  Vesical stone
  14. 14. TREATMENT  WATCHFUL WAITING  MEDICAL  SURGICAL
  15. 15. Medical  Alpha Blockers  5α-Reductase Inhibitors(finasteride)  Combination Therapy  Phytotherapy
  16. 16. Alpha Blockers  Non Selective-Prazocin  Selective(alpha 1a)-Tamsolin
  17. 17. 5α-reductase Inhibitors  Finasteride  Epithelial component  Minimum-6 months(20% reduction in size)  Large prostate(40cm3)
  18. 18. Combination Therapy  Risk of progression  Large gland  High PSA
  19. 19. Phytotherapy  saw palmetto berry (Serenoa repens)  the bark of Pygeum africanum,  the roots of Echinacea purpurea and Hypoxis rooperi,  pollen extract,  leaves of the trembling poplar
  20. 20. Surgical Management INDICATIONS  refractory urinary retention (failing at least one attempt at catheter removal),  recurrent urinary tract infection  recurrent gross hematuria  bladder stones  Ch. Retention & renal insufficiency  large bladder diverticula  Severe Symptoms
  21. 21. Surgical CONVENTIONAL  TURP  TUIP  Open Prostatectomy
  22. 22. TURP  Complication  Retrograde ejaculation  Impotence  Incontinence  TUR syndrome  Bleeding  Stricturestenosis 
  23. 23. Transurethral Incision Of Prostate  Indication  Moderate-Severe Symptoms  Small Prostate with post Commisure Hyperplasia(elevated bladder neck)  Procedure  5 & 7 O clock
  24. 24. Open Prostatectomy  Indication  Glands >100 g  concomitant bladder diverticulum  Bladder stone  dorsal lithotomy positioning is not possible.  Approaches  Suprapubic  Retropubic (Millon)  Perineal(young)
  25. 25. Surgical MINIMALLY INVASIVE  Laser  TULIP  Visual contact ablative laser therapy  Interstitial laser therapy  Transurethral electrovaporization of the prostate  Hyperthermia  Transurethral needle ablation of the prostate  High-intensity focused ultrasound  Intraurethral stents

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