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BPH#Benign Prostate Hyperplasia#Benign Prostate enlargement#BPE#Prostate#BOO#LUTS#TURP#Dr Mahesh#Urinary system#

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BPH#Benign Prostate Hyperplasia#Benign Prostate enlargement#BPE#Prostate#BOO#LUTS#TURP#Dr Mahesh#Urinary system#

  1. 1. Benign Prostatic Hyperplasia (BPH) DR MAHESH KUMAR M.S.(Ay) Assistant Professor चौधरी ब्रह्म प्रकाश आयुर्वेद चरक संस्थान नई ददल्ली 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 1 पौरुष ग्रंदथ र्वृद्धि बुढ़ापे में गदू द प्रोस्टेट का बढ़ना बुढ़ापे में मूत्र त्याग में ददक्कत होना
  2. 2.  Prostate is an organ found in male.  It is walnut-shaped gland that forms part of the male reproductive system  The prostate surrounds the urethra at the Urinary bladder neck  Prostate has 5 lobes- Ant., Post., 2 lateral, median  Common disease of prostate are BPH, CA Prostate, Prostatitis.  The fascia of Denon-villier is part of pelvic peritoneum prevent the spread of CA prostate in rectum 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 2 PROSTATE
  3. 3. BPH is a benign enlargement of the prostate gland It is nonmalignant in nature BPH caused by cellular hyperplasia of both glandular and stromal elements that leads to troublesome LUTS in men BPH- most common benign tumor in men BPH is not a precancerous condition 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 3 Benign Prostate Hyperplasia BPH
  4. 4. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 4 BPH- clinical condition consist of BPE+LUTS+BOO
  5. 5. Seondary effects in BPH 1. Effect on urethra occurs 2. Changes in U.B 3. Changes at Ureter and Kidney level BACK PRESSURE EFFECTS ON UB AND KIDNEY LIKE FASCICULATION, SACCULATION, HYDRONEPHROSIS. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 5 CHANGES IN BPH – Histologic: stromal and glandular hyperplasia • May be associated with – Clinical: presence of bothersome LUTS – Anatomic: enlargement of the gland (BPE = Benign Prostatic Enlargement)1 – Pathophysiologic: compression of urethra and compromise of urinary flow BOO
  6. 6. BPH is part of the natural aging process, Androgens/Estrogens Lifestyle Hereditary(genetic)/Unknown 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 6 n n n n WHAT CAUSES BPH ? 2 theories popular regarding aetiopathogenesis- 1.HORMONALTHEORY 2. NEOPLASTICTHEORY
  7. 7.  Frequent and urgent need to urinate, especially at night  Dribbling or leaking after urination  weak stream  Urinary Retention  Straining to urinate  Pain or burning during urination  Feeling that the bladder never completely empties -FREQUENCY -URGENCY -HESITANCY -URINE RETENTION- ACUTE/CHRONIC 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 7 SIGN-SYMPTOMS
  8. 8. • Prostate grows with age and time • Pressure on the urethra restricts urine flow smoothly. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 8 Why symptoms appear ? Later if not treated- Risk of bladder and kidney damage  Impact on quality of life
  9. 9. Urinary retention Renal impairment RENAL FAILURE UTI DIVERTICULI Hematuria Bladder stones Bladder decompensation Overflow incontinence as a result of retention RENAL FAILURE 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 9 Complications
  10. 10. History taking LOCAL & systemic Examination DRE Blood Investigations, BU, S.creatinine Urinary flow test- uroflowmetry Serum PSA levels USG- Abdominal /TRUS IVP, ystoscopy, Biopsy if needed 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 10 How to make Diagnosis ?
  11. 11. BPH needs to be treated ONLY IF: Symptoms, enough to affect quality of life Symptoms like  frequent UTI-urinary tract infections  Bleeding  damage to kidneys  Damage to UB  stones etc 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 11 n n When to treat ?
  12. 12. Wait and watch….. On observation Medical treatment • alpha blockers • 5-alpha reductase inhibitors (finasteride, dutasteride) • Combination alpha-blocker & 5 ARI Surgical treatment • TURP • Minimally invasive surgeries • Open prostatectomy 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 12 MANAGEMENT
  13. 13. Regular Exercise,avoid weight gain Limit fluid intake, decrease bladder irritants-caffeine, alcohol; avoid anticholinergic drugs, narcotics and muscle relaxants Consult Urologist if symptoms worsen or aggravate 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 13 Wait and watch…..Lifestyle
  14. 14. Indications • Signs and symptoms of BPH • Patients not fit or unwilling to undergo surgery • For the management at Before surgery & Post surgery 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 14 Medical Management Two types of medicine prescribe Muscle relaxants - relax the prostate and provide a larger urethral opening (Tamsulosin, Alfuzosin) Shrink the prostate gland (Dutasteride, Finasteride)
  15. 15. Benefits of medical Mx Convenient No loss of work time Minimal risk Disadvantages of Medical Mx • Expensive • Drug Interactions • Must be taken every day • Manages the problem instead of fixing it 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 15 n n n Medical Management……………………………..contd
  16. 16. • Alpha blockers: best monotherapy, immediate symptom relief • 5 alpha-reductase inhibitors: prevent disease progression • Combination therapy ( alpha blocker + 5 alpha-reductase inhibitor) is considered most effective treatment for symptoms and progression in case moderate-to-severe symptoms 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 16 Drugs……………
  17. 17. • This combination is most effective • Dual mechanism of action • Reduce clinical progression of BPH • Improve LUTS symptoms • Improve maximum urinary flow rates 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 17 • Long-acting selective 1- blockers – Terazosin – Doxazosin – Tamsulosin – Alfuzosin – Silodosin
  18. 18. Surgery - Gold standard in symptomatic pt Surgery is recommended in patients in whom BPH causes: – Renal insufficiency – Urinary retention – Recurrent urinary tract infection – Bladder calculi – Hydronephrosis – Post void residual volume >500 mL 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 18 Surgical Management
  19. 19. Suprapubic & retro pubic prostatectomy Transurethral resection of prostate (TURP) Laser prostatectomy Transurethral incision of prostate Intraprostatic stent Balloon dilatation of prostatic urethra Prostatic hyperthermia 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 19 Surgical Methods
  20. 20. “Gold Standard” of care for BPH Uses an electrical “knife” to surgically cut and remove excess prostate tissue Effective in relieving symptoms and restoring urine flow TURP (transurethral resection of the prostate) n n n 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 20
  21. 21. Open Prostatectomy • Conventional method • Not done routinely • When prostate too large forTURP (>100mL) • Concomitant conditions - bladder diverticulum or bladder stone present. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 21
  22. 22. TUMT -transurethral microwave therapy TUNA- transurethral needle ablation Urinary Stents Laser Prostatectomy 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 22
  23. 23. CONCLUSION BPH is an old age disease of men. Many of BPH patient are asymptomatic or have only mild symptoms, and may not require therapy,. Some are manage with conservatively –Medical therapy. Combined therapy is now in practice. The alpha blocker like tamsulosin and 5-AR inhibitor like finesteride therapy are good, for long-term Treatment TURP is the GOLD STANDARD for - an invasive procedure, most popular procedure in urology. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 23
  24. 24. THANKS THANK YOU SO MUCH FOR YOUR PATIENCE LISTENING………….. धन्यर्वाद 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 24 Note- for the teaching purpose of BAMS students only….

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