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benign prostatic hyperplasia

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benign prostatic hyperplasia

  1. 1. Benign prostatic hyperplasia Presented by; Nour Fawzi
  2. 2. Epidemiology • According to NIH, BPH affects 50% of men >60 years of age • Affects >90% of men over 70 years of age • Men who have undergone bilateral orchiectomies do not develop BPH • Affects Blacks, Whites, Asians • genetic predisposition
  3. 3. Pathology • nodular hyperplasia commonly affects the transitional zone of the prostate .The hyperplasia is stimulated by androgens(dihydrotestosterone)& it affects both smooth muscle cells and glandular connective tissue. • Prostatic capsule play an Important role in development of symptome.
  4. 4. BPH LUTS + enlarged prostate + BOO Conditions potentially Clinical presentation AUA Symptom leading to LUTS include ; Anoxia obstructive Index Scoring ; Aging symptom 0-7 mild High nocturnal diuresis irritative symptom 8-19 moderate Obstruction Physical Age related disease 20-35 severe examination DRE Local condition Neurologic disease
  5. 5. Investigations • 1.urialysis (infection,hematuria) • 2.renal function test : s.creatinine(obstruction) • 3.serum PSA : elevated • 4.rectal ultrasound • 5. CBC/Coagulation studies • 6.urodynamic studies for assessment of urine flow • 7. cystoscopy
  6. 6. Medical Management • A. observation • B. medication : – 5-alpha reductase inhibitors • Inhibit production of DHT • Finasteride (Proscar) • Dutasteride (Avodart) – Alpha blockers • Dilate blood vessels and relax smooth muscles in prostate and bladder neck • Tamsulosin (Flomax) • Terazosin (Hytrin) • Doxazosin (Cardura) • *Combination therapy proven superior in treatment of BPH and is now recommended by American urologic association
  7. 7. Surgical treatment • Transurethral resection of prostate (TURP) – Gold standard – Surgical procedure requiring spinal or general anesthesia – Resectoscope inserted through urethra – Gland removed in small chips by electrical cutting loop – Inpatient hospitalization required • TUIP (transurethral incision of prostate) • TUMT (transurethral microwave therapy • Other BPH Surgical Management : • Laser therapy , transurethral needle ablation , Balloon dilatation , • Prostatic stents • Open prostatectomy

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