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Benign Prostate Hypertrophy

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Benign Prostate Hypertrophy

  1. 1. Presented by: Rutvi Patel Guided by: Dr. Jalpa Suthar (17MPHCP006) M.Pharm (Cp)
  2. 2. Outline  Introduction  Epidemiology  Risk factors  Signs and symptoms  Pathophysiology  Diagnosis  Treatment  Complications  Recent advances  References
  3. 3. Introduction DEFINITION:  Benign prostatic hypertrophy also called BPH is a condition in men in which the prostate gland is enlarged and not cancerous.  Also called as benign prostatic hyperplasia.
  4. 4. Anatomy of prostate  The prostate: is a gland that forms part of the male reproductive system.  It is a conduit between the bladder and the urethra.  It is composed of several zones.  Peripheral, central, anterior fibromuscular stroma, and transition zones.  BPH originates in the transition zone, which surrounds the urethra.
  5. 5. Function of Prostate  The main function of the prostate gland is to secrete an alkaline fluid that comprises 70% of the seminal volume.  The secretions produce:  Lubrication and nutrition for the sperm.  Liquefaction of the seminal fluid.  Neutralize the acidic environment.
  6. 6. What is BPH ?  It is an enlarged prostate gland.  The prostate gland surrounds the urethra. As the prostate gets bigger, it may squeeze or partly block the urethra, which causes problems with urinating.  Benign prostatic hyperplasia (BPH) is a common condition which increases with age.
  7. 7.  The narrowing of the urethra and urinary retention; the inability to empty the bladder completely cause many of the problems associated with benign prostatic hyperplasia.  A combination of increased adrenergic tone in the prostatic stroma and bladder neck as well as the anatomical effects of an enlarging prostate lead to lower urinary tract symptoms (LUTSs) and bladder outflow obstruction (BOO).
  8. 8. Epidemiology  Benign prostatic hyperplasia (BPH) is the most common in men and is responsible for urinary symptoms in the majority of males over the age of 50 years.  Autopsy studies have revealed the histological presence of BPH in 50% of males aged 51–60 years, increasing to 90% in those over 85.  By the age of 80 years, virtually all men exhibit one or more of the symptoms associated with BPH.
  9. 9. Risk Factors  Aging: Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.  Family history: Having a blood relative, such as a father or brother, with prostate problems means the person likely to have problems.  Ethnic background: Prostate enlargement is less common in Asian men than in white and black men. Black men might experience symptoms at a younger age than white men.  Diabetes: Studies show that diabetes might increase the risk of BPH.  Lifestyle: Obesity increases the risk of BPH, while exercise can lower risk.
  10. 10. Signs and Symptoms The symptoms of BPH may involve problems emptying the bladder or problems with bladder storage, they include:  Urinary frequency  Urinary urgency  Incomplete bladder emptying  Nocturia  Decreased force of stream  Difficulty initiating the urinary stream; interrupted, weak stream  Dribbling - The loss of small amounts of urine due to a poor urinary stream
  11. 11. Pathophysiology:
  12. 12. Diagnosis 1. Digital rectal examination (DRE): The doctor inserts a finger into the rectum and feels the part of the prostate next to the rectum. This gives idea about size and condition of gland. 2. Prostate specific antigen (PSA) blood test: A protein produced by prostate cell is frequently present at elevated level in the blood of men and thus diagnosed. Normal range is 1.4 ng/ml or less.
  13. 13. 3. Cystoscopy: In this examination doctor inserts a small tube through the opening of urethra in the penis. This procedure is done after a solution numbs inside of the penis, so all sensation is lost. The tube is called cystoscope containing a lens and light system that helps the doctor to see inside. It allows to determine size of the gland and identify the location of obstruction. 4. Urine Flow Study: Doctor asks to urinate in special device to measure how quickly the urine is flowing. A reduced flow often suggests BPH. Uroflowmetry, which measures how rapidly the bladder releases urine.
  14. 14. Treatment
  15. 15. Non Pharmacological Treatment  Lifestyle changes: To control BPH lifestyle plays an important role. Its important to bring lifestyle changes as follows:  Exercises to strengthen pelvic floor muscles  Lower the amount of fluids taken, especially before going out or going to bed  Less caffeine and alcohol uptake.
  16. 16. Pharmacological Treatment
  17. 17. Medicines  For mild to moderate BPH, doctor might suggest medicine. Some medications work by relaxing the muscles in prostate and bladder. Others help shrink prostate. For some men, it takes a mix of medicines to get the best results. The suggested drugs are:  α1-adrenoceptor-blocking agents  5α-reductase inhibitors  Combination therapy
  18. 18. α1-ADRENOCEPTOR BLOCKERS Drugs: Terazosin, Doxazosin, Tamsulosin, Alfuzosin, & Silodosin Mechanism of action:  Works by relaxing muscles in your bladder and prostate, which makes it easier to urinate.  By inhibiting these receptors, muscle tone along these tissues will be reduced, allowing for easier passage of urine and reduction of symptoms.  Adverse effects:  Dizziness, Tiredness, Ejaculatory problems, Nasal congestion, Orthostatic hypotension
  19. 19. TAMSULOSIN  TAMSULOSIN (FLOMAX®)  Preparations: 0.4mg Cap.  Dosing: The dose may be increased after 2-4 weeks if the response is not adequate.  S/E: (anemia, nausea & vomiting, weakness, headache ).
  20. 20. 5-α REDUCTASE INHIBITORS Drugs: Finasteride & Dutasteride Mechanism of Action:  They inhibit the enzyme 5-α reductase, which is responsible for converting testosterone to the more active dihydrotestosterone (DHT).  DHT is an androgen that stimulates prostate growth. By reducing it, the prostate shrinks and urine flow improves. Adverse effects:  Sexual side effects (decreased libido, gynecomastia).
  21. 21. FENASTERIDE FENASTERIDE(PROSCAR®)  Preparations: 1.5 mg TAB.  Dosing: For 6-12 months to notice a benefit.  S/E: (decreased libido, confusion).
  22. 22. Combination therapy: Taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective. Example : Finasteride and doxazosin
  23. 23. Surgeries 1. Transurethral Needle Ablation of the Prostate: The TUNA system delivers low level frequency energy through twin needles to burn away a well defined region of prostate. Shield protects the urethra from heat damage. It improves the urine flow. Adverse effects:  UTI, hematuria.
  24. 24. 2. Transurethral microwave therapy:  FDA approved a device that uses microwaves to heat and destroy extra prostate tissue. The device sends computer based microwaves through a catheter to heat extra portions of the prostate to 45ºC for 60 mins. A cooling system protects urinary system.  Thermaspec system TUNA TUMT Radiofrequency Microwave Faster Slower For 60g size prostate For 30-100g size 60% reduction in symptom 40-70% reduction
  25. 25. 3. Open prostatectomy:  Open prostatectomy involves the surgical removal of an enlarged prostate.  Typically, an incision is made through the lower abdomen although sometimes the incision is between the rectum and the base of the penis.
  26. 26. Complications  Urinary tract infection  Hematuria  Bladder calculi  Recurrent urinary tract infections  Renal failure  Sexual dysfunction  Bladder damage
  27. 27. Recent advances in laser treatment for BPH  The treatment of BPH using lasers has been shown to lead to significant improvements in symptoms and to have excellent therapeutic effects.  Currently, 3 kinds of lasers are used: potassium-titanyl - phosphate, holmium, and thulium lasers.  The most common surgical procedures are holmium laser enucleation of the prostate (HoLEP). HoLEP is an effective surgical procedure for large prostates.
  28. 28. Case study  A 55 year old man presents for routine physical checkup. His BP is 161/98 mmHg. His only complain is that he has difficulty in urinating and he recently begun experiencing nocturia and urgency. Digital exam reveals enlargement of prostate. Which following agent would be most likely to treat man’s urinary tract symptoms as well as his HT? a. Terazosin b. Finasteride c. Labetalol d. Hydralazine
  29. 29. References: 1. Roger Walker, Clinical pharmacy and Therapeutics, published by Churchill Livingstone Elsevier, fifth edition, 2012, pg. no 753. 2.Joseph T. Dipiro, Pharmacotherapy principles and practice by The McGraw-Hill Companies, Inc. page no.791 3. International Journal of Impotence Research, by CG Roehrborn, Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA. 4. Laura J. Martin, WebMD Medical Reference Reviewed, MD.

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