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Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

  1. 1. By: ROMMEL LUIS C. ISRAEL III
  2. 2. BENIGN PROSTATIC HYPERPLASIA - is an enlarged prostate gland > it squeezes or partly blocks the urethra causing problems with urinating. Reference: ‘BPH (Enlarged Prostate) Causes, Symptoms, Treatments, and More’ (no date). WebMD. Available at: http://www.webmd.com/men/prostate-enlargement-bph/benign-prostatic-hyperplasia-bph-topic-overview (Accessed: 1 April 2015).
  3. 3. BENIGN PROSTATIC HYPERPLASIA - also known as benign prostatic hypertrophy characterized by proliferation of the cellular elements of the prostate - there is a Chronic bladder outlet obstruction (BOO) secondary to BPH - may lead to: urinary retention renal insufficiency recurrent urinary tract infections gross hematuria bladder calculiReference: Benign Prostatic Hypertrophy (no date). Available at: http://emedicine.medscape.com/article/437359-overview (Accessed: 1 April 2015).
  4. 4. THE PROSTATE GLAND - a small gland (organ) in the male reproductive system - it makes fluid that protects and feeds sperm, - it makes about one third of the fluid that is ejaculated from the penis at orgasm - Size: > young men: about the size of a walnut, but it gets bigger with age - Location: > It sits underneath the bladder > surrounds the top part of the urethra Reference: ‘Prostate enlargement or BPH’ (no date). Andrology Australia. Available at: https://www.andrologyaustralia.org/prostate-problems/prostate-enlargement-or-bph/ (Accessed: 3 April 2015).
  5. 5. THE PROSTATE GLAND Testosterone and the size of the prostate: - Male sex hormone, made in the testes, that makes the prostate grow in size - As men get older, the prostate grows larger. - It starts to increase its level during puberty, making the prostate grow to about eight times its size - Prostate doubles in size between the ages of 21 and 50 years - almost doubles again in size between the ages of 50 and 80 years Reference: ‘Prostate enlargement or BPH’ (no date). Andrology Australia. Available at: https://www.andrologyaustralia.org/prostate-problems/prostate-enlargement-or-bph/ (Accessed: 3 April 2015).
  6. 6. EPIDEMIOLOGY BPH occurs in almost all men as they age. About half of all men older than 75 have some symptoms. It is probably a normal part of the aging process In men > caused by changes in hormone balance and in cell growth. Reference: ‘BPH (Enlarged Prostate) Causes, Symptoms, Treatments, and More’ (no date). WebMD. Available at: http://www.webmd.com/men/prostate-enlargement-bph/benign-prostatic-hyperplasia-bph-topic-overview (Accessed: 1 April 2015).
  7. 7. CAUSES - is not well understood - common in older men - it does not occur in men whose testicles are removed before puberty - factors are believed to be related to aging and the testicles may cause BPH Reference: Kidney, T. N. N. and Clearinghouse, U. D. I. (no date) Prostate Enlargement: Benign Prostatic Hyperplasia. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/#3 (Accessed: 3 April 2015).
  8. 8. CAUSES Theories: - The amount of testosterone level in the blood decreases as men age leaving a higher proportion of estrogen (a female hormone) which increases the activity of substances that promote prostate cell growth > a male hormone dihydrotestosterone (DHT), plays a role in prostate development and growth. Scientists noted that men do not develop BPH when they do not produce DHT. Older men continue to produce and accumulate high levels of DHT in the prostate, even if testosterone production is reduced as they age, which may encourage continues cell growth in the prostate.Reference: Kidney, T. N. N. and Clearinghouse, U. D. I. (no date) Prostate Enlargement: Benign Prostatic Hyperplasia. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/#3 (Accessed: 3 April 2015).
  9. 9. CAUSES Theories: - The amount of testosterone level in the blood decreases as men age leaving a higher proportion of oestrogen (a female hormone) which increases the activity of substances that promote prostate cell growth Reference: Kidney, T. N. N. and Clearinghouse, U. D. I. (no date) Prostate Enlargement: Benign Prostatic Hyperplasia. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/#3 (Accessed: 3 April 2015).
  10. 10. RISK FACTORS - age 40 years and older - family history of BPH - obesity, - cardiovascular diseases, - type 2 diabetes - Sedentary Lifestyle - erectile dysfunction Reference: Kidney, T. N. N. and Clearinghouse, U. D. I. (no date) Prostate Enlargement: Benign Prostatic Hyperplasia. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/#3 (Accessed: 3 April 2015).
  11. 11. PATHOPHYSIOLOGY - There is the development of Multiple fibroadenomatous nodules in the periurethral region of the prostate. - There is narrowing and lengthening of the lumen of the prostatic urethra progressively obstructing urine flow Reference: Benign Prostatic Hyperplasia (BPH): Benign Prostate Disease: Merck Manual Professional (no date). Available at: http://www.merckmanuals.com/professional/genitourinary_disorders/benign_prostate_disease/benign_pros tatic_hyperplasia_bph.html (Accessed: 3 April 2015).
  12. 12. PATHOPHYSIOLOGY - There is a progression to hypertrophy of the bladder detrusor, trabeculation, cellule formation, and diverticula > due to Increased pressure associated with micturition and bladder distention - Incomplete bladder emptying causes stasis > predisposes to calculus formation and infection > hydronephrosis may happen secondary to prolonged obstruction, even if incomplete,and it compromises renal functionReference: Benign Prostatic Hyperplasia (BPH): Benign Prostate Disease: Merck Manual Professional (no date). Available at: http://www.merckmanuals.com/professional/genitourinary_disorders/benign_prostate_disease/benign_pros tatic_hyperplasia_bph.html (Accessed: 3 April 2015).
  13. 13. SIGNS AND SYMPTOMS - Urinary frequency - Urinary urgency - Hesitancy (Difficulty initiating the urinary stream; interrupted, weak stream) - Straining > The need to push (Valsalva maneuver) in order to fully evacuate the bladder - Weak stream of urine Reference: Benign Prostatic Hypertrophy (no date). Available at: http://emedicine.medscape.com/article/437359- overview (Accessed: 1 April 2015).
  14. 14. SIGNS AND SYMPTOMS - Often feels the urge to urinate > may even wake you up at night. - A sense that the bladder is not completely empty after urinating - Can not urinate or extremely hard to urinate > Blocked bladder secondary to BPH > leads to bladder infections or stone formations, or kidney damage Note: BPH does not cause prostate cancer does not affect a man's ability to father children does not cause erection problemsReference: ‘BPH (Enlarged Prostate) Causes, Symptoms, Treatments, and More’ (no date). WebMD. Available at: http://www.webmd.com/men/prostate-enlargement-bph/benign-prostatic-hyperplasia-bph-topic- overview (Accessed: 1 April 2015).
  15. 15. SIGNS AND SYMPTOMS Complications: - chronic, or long lasting, urinary retention - Hematuria (blood in the urine) - acute urinary retention - UTI - bladder damage - kidney damage - bladder stones Reference: Kidney, T. N. N. and Clearinghouse, U. D. I. (no date) Prostate Enlargement: Benign Prostatic Hyperplasia. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/#3 (Accessed: 3 April 2015).
  16. 16. TESTS AND DIAGNOSIS Digital rectal exam (DRE) Urinalysis (to help rule out an infection) Blood test. (it can indicate kidney problems) Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  17. 17. TESTS AND DIAGNOSIS Prostate-specific antigen (PSA) blood test - PSA, a substance produced in the prostate, levels increase with enlarged prostate. - elevated PSA levels can also be secondary to infection, surgery or Prostate cancer. Neurological exam - can help identify causes of urinary problems other than BPHReference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  18. 18. TESTS AND DIAGNOSIS To help confirm an enlarged prostate and to rule out other conditions: Urinary flow test - urinating into a receptacle connnected to a machine > measures the strength and amount of urine flow as it determines if it gets worse over timeReference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  19. 19. TESTS AND DIAGNOSIS To help confirm an enlarged prostate and to rule out other conditions: Post-void residual volume test. - measuring if bladder emptying is complete. > by the use of ultrasound or by insertion of a catheter into the bladder after urination to measure how much urine is left in the bladder.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  20. 20. TESTS AND DIAGNOSIS To help confirm an enlarged prostate and to rule out other conditions: 24-hour voiding diary. - a record of the frequency and amount of urine > especially helpful if more than one-third of daily urinary output occurs at night.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  21. 21. TESTS AND DIAGNOSIS In a more complex condition: Transrectal ultrasound. - insertion of ultrasound probe into your rectum to measure and evaluate the prostate. Prostate biopsy - to rule out a prostate cancer > needles are inserted guided by transrectal ultrasound to take tissue samples (biopsies) of the prostate.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  22. 22. TESTS AND DIAGNOSIS In a more complex condition: Urodynamic and pressure flow studies - to measure bladder pressure and to determine how well the bladder muscles are working > A catheter is threaded through the urethra into the bladder where water (or air) is injected slowly into the bladder. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  23. 23. TESTS AND DIAGNOSIS In a more complex condition: Cystoscopy. - to visualize the bladder and urethra > a lighted, flexible cystoscope is inserted into your urethra, a local anesthetic is given before this test. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  24. 24. TESTS AND DIAGNOSIS In a more complex condition: Intravenous pyelogram or CT urogram - to detect urinary tract stones, tumors, or blockages above the bladder > a tracer is injected into a vein. X-rays or CT scans are then taken of the kidneys, bladder and the tubes that connect the kidneys to the bladder (ureters).Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Tests and diagnosis’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/tests-diagnosis/con- 20030812 (Accessed: 3 April 2015).
  25. 25. MANAGEMENT Minimally invasive or surgical therapy might be recommended for patients with: - moderate to severe symptoms - Medication that failed to relieve symptoms - urinary tract obstruction, bladder stones, hematuria or kidney problems Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  26. 26. MANAGEMENT Minimally invasive or surgical therapy might not be an option ito patients with: - untreated urinary tract infection - Urethral stricture disease - A history of prostate radiation therapy or urinary tract surgery - A neurological disorder, such as Parkinson's disease or multiple sclerosisReference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  27. 27. MANAGEMENT Possible complications depending on the type of prostate procedure: - Retrograde Ejaculation (semen goes back into the bladder instead of out the tip of the penis) - Temporary difficulty with urination - Urinary tract infection - Bleeding - Erectile dysfunction - Urinary Incontinence (loss of bladder control) > a very rare caseReference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  28. 28. MANAGEMENT Types of minimally invasive or surgical therapy TURP - Transurethral resection of the prostate > A lighted scope is inserted into the urethra, and the surgeon removes all but the outer part of the prostate - relieves symptoms quickly > post-TURP, the patyient might temporarily need a catheter to drain the bladder, > the patient is advised to do only light activity until healed.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  29. 29. MANAGEMENT Types of minimally invasive or surgical therapy TUIP - Transurethral Incision Of The Prostate > A lighted scope is inserted into the urethra, and the surgeon makes one or two small cuts in the prostate gland making urine to pass through the urethra easily. > an option for small or moderately enlarged prostate gland, especially for patients with health problems that make other surgeries too risky.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  30. 30. MANAGEMENT Types of minimally invasive or surgical therapy TUMI - Transurethral Microwave ThermoTherapy > a special electrode is inserted through the urethra into the prostate area. > the inner portion of the enlarged prostate glands are destroyed and shrink by the microwave energy from the electrode. This eases the urine flow. - generally suggested only on small prostates in special circumstances > re-treatment might be necessary.Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  31. 31. MANAGEMENT Types of minimally invasive or surgical therapy TUNA - Transurethral Needle Ablation - an outpatient procedure > a scope is passed into your urethra, needles are placed into the prostate gland, radio waves pass through the needles > excess prostate tissues blocking the flow of urine are heated and destroyed. - a good choice for patient that bleeds easily or have certain other health problems. - It might only partially relieve symptoms - it might take some time before results are noticed Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  32. 32. MANAGEMENT Types of minimally invasive or surgical therapy Laser Therapy - use of high-energy laser - destroys or removes overgrown prostate tissue - generally relieves symptoms right away - has a lower risk of side effects than does non-laser surgery - for men who did not have other prostate procedures because they take blood-thinning medications. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  33. 33. MANAGEMENT Types of minimally invasive or surgical therapy The options for laser therapy include: Ablative procedures - it vaporizes obstructive prostate tissue thus increasing urine flow - Examples: photoselective vaporization of the prostate (PVP) holmium laser ablation of the prostate (HoLAP). - causes irritating urinary symptoms post-surgery resection procedure might be done if necessary (rare case)Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  34. 34. MANAGEMENT Types of minimally invasive or surgical therapy The options for laser therapy include: Enucleative procedures - Removal of all the prostate tissue that blocks urine flow - Prevents tissue regrowth - Similar to open prostatectomy - removed tissue can be examined for prostate can - Example: holmium laser enucleation of the prostate (HoLEP) Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  35. 35. MANAGEMENT Prostate Lift - an experimental transurethral procedure > to increase the flow of urine, compression of the sides of the prostate through the use of special tags are done. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  36. 36. MANAGEMENT Embolization - an experimental procedure - selectively blocking the blood supply to or from the prostate causing the prostate to decrease in size Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  37. 37. MANAGEMENT Open or Robot-assisted Prostatectomy - an incision in the lower abdomen is performed to remove tissue of the prostate - generally for patients with a very large prostate, bladder damage or other complicating factors. - requires a hospital confinement for a short period - the patient might be at risk of needing a blood transfusion. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  38. 38. MEDICATIONS For mild to moderate symptoms BPH: Alpha blockers - to relax bladder neck muscles and muscle fibers in the prostate making urination easier - alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), silodosin (Rapaflo) - works quickly in men with relatively small prostates - Side effects: > dizziness > Retrograde Ejaculation (semen goes back into the bladder instead of out the tip of the penis, it is harmless)Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  39. 39. MEDICATIONS For mild to moderate symptoms BPH: 5-alpha reductase inhibitors. - to shrink prostate by preventing hormonal changes that cause prostate growth - finasteride (Proscar) dutasteride (Avodart) - might take up to six months to be effective - Side effect: retrograde ejaculation. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  40. 40. MEDICATIONS For mild to moderate symptoms BPH: Combination drug therapy - alpha blocker and 5-alpha reductase inhibitor is given at the same time if either medication alone isn't effective. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).
  41. 41. MEDICATIONS For mild to moderate symptoms BPH: Tadalafil (Cialis) - Studies suggest that this medication can also treat prostate enlargement and is generally prescribed to men who also experience erectile dysfunction. Reference: Staff, M. C. (2014) ‘Benign prostatic hyperplasia (BPH) Treatments and drugs’. MayoClinic. Available at: http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/treatment/con- 20030812 (Accessed: 3 April 2015).

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