About Prostatic Gland
Male sex gland
Pear-shape, weight 7-16 gm
Size of walnut
Help to control urine outflow.
Produces fluid component of the
Produces prostate specific antigen
The prostate gland is made up of differe
nt types of cells:
- gland cells that produce the fluid
portion of semen.
-muscle cells ( epithelial ) control
urine flow and ejaculation.
-fibrous cells ( stromal )provide the
supportive structure of gland.
What’s Benign Prostatic Hyperplasia ?
Benign prostatic hyperplasia (BPH) refers to neoplastic,
non- malignant proliferation of the prostatic tissue surrounding the urethra.
BPH is a condition that occurs in aging men as the prostate gland
undergoes exposure to androgenic and estro- genic stimulation over time.
Other names include:
• Benign prostatic hypertrophy.
• Enlarged prostate.
Clinical Manifestations. (LUTS)
Dribbling At The End Of Urination
Decrease In The Urinary Stream
Burning During Urination
Feeling Of Incomplete Bladder E
• Urethral stricture
• Bladder neck contracture
• Carcinoma of the prostate
• Carcinoma of the bladder
• Bladder calculi
• Urinary tract infection and prostatitis
• Neurogenic bladder
Complete Hx Taking.
• The goals of the history are to clarify symptoms consistent with BPH
and exclude conditions that mimic BPH.
• Important point for pt. with symptoms of BPH.
1. Onset and duration of symptoms.
2. Urethral or bladder trauma (including instrumentation).
4. Fever, dysuria, gross hematuria, pain suggestive of stones.
Important Hx. point for pt. with symptoms of BPH.
5. Medication use is helpful because medications account for 10%
of LUTS in men.
6. DM, tobacco use, intake of bladder irritants (e.g., Caffeine),
7. Sexual dysfunction, or conditions resulting in neurologic impairm
ent (e.g., Neurogenic bladder),
8. Family history of prostate or bladder cancer.
The examination for suspected BPH focuses on the:
Digital rectal examination (DRE)
• A digital rectal examination is recommended by the
American Urological Association (AUA).
• Performed to assess the size, consistency, and
shape of the prostate .
• Nodularity, and asymmetry, which may raise
suspicion for malignancy.
Serum prostate-specific antigen (PSA).
U/S of the prostate.
Serum Cr. is not indicated.
because the incidence of baseline renal in
sufficiency in men with BPH is similar to th
at in the general population.
Post-void residual urine should be performed if
history and physical examination suggest urinary
AUA symptom score
# Used to :
-assess the severity of symptoms of BPH.
-measure the outcome of BPH treatments.
# It consists of 7 questions:
3-weak urinary stream 4-hesitancy
5-incomplete emptying 5-intermittence
Mild to moderate symptoms with little ”bother” Manage with
watchful waiting & lifestyle modification :
• Losing weight.
• Decreasing evening fluid intake.
• Avoiding excess alcohol, caffeine, or highly seasoned foods
• Limiting medications that cause lower urinary tract symptoms.
• Double voiding to empty the bladder more completely.
Mild to moderate symptoms of BPH whose symptoms have a
sufficient effect on quality of life we suggest initial treatment with
Alpha blockers. (Grade 2A).
Relaxing smooth muscle in the bladder neck,prostate capsul
e, and prostatic urethra.
• Hypotension, dizziness.
• Ejaculatory Dysfunction.
• Interaction with phosphodiesterase-5 inhibitors
The AUA recommends avoidance of all alpha blockers in men with planned catara
ct surgery because of the risk of intraoperative floppy iris syndrome.
2 to 4 weeks after initiation
block the conversion of testosterone to dihydrotestosterone, resulting in a gradual decr
ease in prostatic volume.
The combination of alpha blockers and 5-alpha reductase inhibitors is eff
ective for long-term management of BPH and demonstrated large prostate
• Ejaculation Disorder, Decreased Libido.
• Erectile Dysfunction
Decrease PSA About 50% 3 to 6 months
Anticholinergic agents block the effects of acetylcholine on muscarinic rece
ptors in the bladder, resulting in decreased bladder contractions.
• Dry mouth and eyes.
Data of herbal therapies for BPH are confl
Commonly used in Europe.
Until additional studies of herbals are perfo
rmed, we do not suggest using these f
or the treatment of BPH.
No herbal therapies have been approved
by the FDA for BPH.
Surgical Or Invasive Management.
Out-patient based therapies:
• Transurethral microwave therapy (TUMT)
• Transurethral needle ablation (TUNA)
OR based therapies:
• Open simple prostatectomy.
• Transurethral Resection Of The Prostate TURP.
• Transurethral incision of the prostate.
• Laser photoselective vaporization of the prostate (PVP).
• Laser Prostatectomy.
Surgical Or Invasive Management.
Is considered the gold-standard surgical tr
eatment for BPH.
Transurethral Resection Of The Prostate (TURP)
Postoperative guidelines for the patient
There may be urgency even to the point of incontinence for a few
Bleeding can occur intermittently for 3 weeks, so increase fluid i
Avoid intercourse for 3 weeks.
Orgasms continue but there is usually no emission with ejaculati
on. The semen is ejaculated back into the bladder.
Indications For Referral.
Complications of Bladder outflow Obstruction :
-upper tract (hydronephrosis , renal insufficiency)
-lower tract (urinary retention, recurrent UTI )
- bladder decompensation
Symptoms following invasive treatment of the urethra or prostate.
Abnormality on prostate exam (nodule, induration, asymmetry)
In addition to onset and duration of symptoms, any history of fever, dysuria, gross hematuria, pain suggestive of stones, or previous urethral instrumentation should be obtained. Identification of medication use is helpful because medications account for 10% of lower urinary tract symptoms in men.4 Other key information includes history of diabetes mellitus, tobacco use, intake of bladder irritants (e.g., caffeine), sexual dysfunction, or conditions resulting in neurologic impairment (e.g., neurogenic bladder), and a personal or family history of prostate or bladder cancer.2,5 Assessing overall health can guide eligibility for future medical and surgical interventions.2
Digital rectal examination (DRE) is performed to assess the size, consistency, and shape of the prostate.
Transurethral microwave therapy TUMT :A device delivers heat transurethrally to destroy prostatic tissue. Transurethral needle ablation (TUNA) :A needle delivers radio frequency energy to ablate the prostate Benefits Office treatments Local anesthesia Minimally invasive disadvantge High retreatment rate Increased dysuria, and urinary retention compared with TURP Lack of large, high-quality studies with long-term outcomes
Laser photoselective vaporization of the prostate (PVP). :A high-power potassium titanyl phosphate (KTP) laser vaporizes prostate tissue
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