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Benign prostatic hyperplasia

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Benign prostatic hyperplasia

  1. 1. BENIGN PROSTATIC HYPERPLASIA (BPH)
  2. 2. BPH A widely prevailing pathology among elderly males BPH can cause bothersome day& night LUTS ? A negative impact on quality of life (QOL)
  3. 3. Definition Of BPH Normal prostate: A compound tubulo-alveolar gland composed of 3 histological elements: -Epithelial structure: prostatic acini&ducts (androgen dependent) lying within a : -fibro - -muscular smooth m. innervated by alpha adrenergic fibres Stroma
  4. 4. Normal prostate is about 15 g. in the young adult BPH results from abnormal (proliferation) of the 3 histological elements of the prostate: glandular (acinar) fibrous muscular in different proportions It can be regarded as a benign tumor: fibro-myo-adenoma
  5. 5. Aetiogy Of BPH • Aging • Androgens
  6. 6. PATHOLOGY OF BPH BPH arises from the transition zone or the peri-urethral zone of the gland closely relayed to urethra & BN What about P Ca?
  7. 7. BPH starts as one or more hyperplasic nodules within the gland.. gradually enlarging …. may coalesce together… compressing the intervening & outer normal prostatic tissue which eventually forms a surgical capsule around the adenoma Pathogenesis
  8. 8. The result will be: An elongated & compressed prostatic Urethra Macroscopically BPH can be: Monolobar…middle lobe Bilobar….. 2 lateral lobes Trilobar… 2 lateral lobes & middle lobe
  9. 9. Pathophysiology of Urethral Obstruction in BPH Static component: formed by the obstructing prostatic mass Dynamic component: formed by the tone of smooth muscle within the stroma & capsule
  10. 10. Pathological complications of BPH Increased intravesical pressure: Early… bladder muscle hypertrophy Later…. atony.. thinning out of bladder muscle …diverticulation The result will be: High intra-vesical (P) …Bil hydroureteronephrosis Outlet obstruction…significant amount of PV residual urine….Stasis: Rec UTI Stone formation
  11. 11. Diagnosis of BPH Clinical Picture Symptoms: Old male (over 50 ys) suffering from LUTS Storage symptoms: Urinary frequency nocturia urgency ,..urgency incontinence Evacuation symptoms: Straining during voiding diminished force & calibre of the stream bifurcated stream interrupted stream PV dribbling AUR
  12. 12. Symptoms of complications Rec. UTI Haematuria Bladder stone chronic retention: SP mass (full bladder) overflow incontinence renal insufficiency
  13. 13. Physical examination • General examination • Abdominal examination: ? Renal swelling (hydronephrosis) ? SP area ( full bladder) Hernial orifices • Genital examination ? associated epididymo-orchitis • Digital rectal examination (DRE) size , shape, symmetry, consistency Is it suspicious of P Ca ?
  14. 14. Investigations Lab investigations Urinalysis Serum creatinine Serum PSA
  15. 15. Imaging Abdominal ultrasonography: size of the gland, PVR, associated stones ? hydronephrosis, KUB: radio-opaque calculi Intravenous Urography: secretory function of the kidney ?basal smooth filling defect in the bladder Uroflowmetry to document obstruction Urethro-cystoscopy in case of hematuria
  16. 16. Differential Diagnosis Other causes of LUTS Bladder & urethral calculi Bladder cancer BN fibrosis Prostate cancer Urethral stricture Neurogenic voiding dysfunction
  17. 17. TREATMENT of BPH Non- symptomatic BPH Reassurance---- Follow up Symptomatic BPH: Conservative Treatment: non-specific measures * Avoid causes of prostatic congestion * Phytotherapy
  18. 18. Specific medical treatment: 5- alpha - reductase inhibitors prevent the conversion of testosterone to 5-dihydro testosterone gradual atrophy of the glandular component of BPH (slow effect on static component) Alpha adrenergic blockers Cause decrease of the smooth muscle tone within the prostatic stroma&capsule better urine flow (rapid effect on dynamic component)
  19. 19. Surgical Intervention Indications Repeated AUR Chronic UR Severe obstructive symptoms Failure of medical treatment Haematuria Complications: Rec. UTI Hydronephrosis Bladder stones or diverticula
  20. 20. Methods of Surgical intervention Trans-urethral resection of the prostate (TURP) Gold standard 90% of cases Open surgical prostatectomy ( enucleation adenectomy) when ? Very large BPH Concomitant bladder lesion that needs open surgery Patient limitation (limited hip joint mobility)
  21. 21. TURP
  22. 22. Conclusions • BPH is a disease of aging males • It can cause disabling LUTS (QOL) • Corner stone of diagnosis old male,.. LUTS, DRE….. sonography exclude cases of suspected P ca
  23. 23. Conclusions(cont.) • Most cases ( 70 – 90 % ) can be managed by medical treatment with reasonable pt. satisfaction Only a small percentage will need surgical intervention where TURP is the standard of care

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