This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy of the prostate gland and defines BPH as non-malignant prostate tissue growth due to aging. Risk factors for BPH include increasing age and family history. Clinical evaluation involves history, physical exam including digital rectal exam, and testing like PSA and ultrasound. Treatment options range from lifestyle changes and medications like alpha blockers and 5-alpha-reductase inhibitors for mild-moderate BPH to surgical interventions like TURP for severe cases. The document provides details on evaluation and management approaches for BPH.
4. About Prostatic Gland
Male sex gland
Pear-shape, weight 7-16 gm
Size of walnut
Help to control urine outflow.
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02
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Produces fluid component of the
semen.
Produces prostate specific antigen
(PSA)
5.
6. 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.
Prostatic Gland
8. 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.
• BPH.
13. RISK FACTORS
• Age.
• Family Hx.
• Black Men.
• Use Of Beta-blockers.
• Lack Of Physical Exercise.
• Obesity.
BPH does not predispose to the development of
prostate cancer.
15. Clinical Manifestations. (LUTS)
Voiding Symptoms
Straining
Dribbling At The End Of Urination
Decrease In The Urinary Stream
Hesitancy
Burning During Urination
Feeling Of Incomplete Bladder E
mptying.
Irritative Symptoms
Frequency
Urgency
Dysuria
Nocturia
Incontinence
16. Differential Diagnosis
• Urethral stricture
• Bladder neck contracture
• Carcinoma of the prostate
• Carcinoma of the bladder
• Bladder calculi
• Urinary tract infection and prostatitis
• Neurogenic bladder
17. 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).
3. STDs
4. Fever, dysuria, gross hematuria, pain suggestive of stones.
18. 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.
20. 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.
21. Investigation
Urinalysis.
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.
26. AUA symptom score
# Used to :
-assess the severity of symptoms of BPH.
-measure the outcome of BPH treatments.
# It consists of 7 questions:
1-Frequency 2-nocturia
3-weak urinary stream 4-hesitancy
5-incomplete emptying 5-intermittence
7-urgency
31. Alpha blockers.
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).
MOA:
Relaxing smooth muscle in the bladder neck,prostate capsul
e, and prostatic urethra.
Side effects:
• 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
33. 5-alpha-reductase inhibitors.
MOA:
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
s.
Side effects.
• Ejaculation Disorder, Decreased Libido.
• Erectile Dysfunction
Decrease PSA About 50% 3 to 6 months
35. Anticholinergic agents.
MOA:
Anticholinergic agents block the effects of acetylcholine on muscarinic rece
ptors in the bladder, resulting in decreased bladder contractions.
Side effects.
• Dry mouth and eyes.
• constipation.
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37. Herbal therapy.
Data of herbal therapies for BPH are confl
icting.
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.
38. 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.
39. Surgical Or Invasive Management.
Is considered the gold-standard surgical tr
eatment for BPH.
Transurethral Resection Of The Prostate (TURP)
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42. Postoperative guidelines for the patient
There may be urgency even to the point of incontinence for a few
days.
Bleeding can occur intermittently for 3 weeks, so increase fluid i
ntake.
Avoid intercourse for 3 weeks.
Orgasms continue but there is usually no emission with ejaculati
on. The semen is ejaculated back into the bladder.
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44. 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)
Hematuria.
Bladder calculi.
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
