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    Bedah Benign Prostatic Hyperplasia

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    Rs93
    Benign prostatic hyperplasia (BPH) is the most common benign tumor in men that occurs more frequently with age. The incidence and symptoms of prostatic obstruction also increase with age. BPH develops in the transition zone of the prostate and is caused by an increase in cell number through a hyperplastic process. Symptoms include problems with urination such as hesitancy, decreased urine flow, urgency and frequency. Diagnosis involves a digital rectal exam, urinalysis, measurement of prostate-specific antigen and assessment of urine flow. Treatment options include watchful waiting, medications that target the prostate such as alpha blockers and 5-alpha reductase inhibitors, and surgical procedures ranging from transurethral resection of

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    Bedah Benign Prostatic Hyperplasia

    Uploaded by

    Rs93
    43 views27 pages
    Benign prostatic hyperplasia (BPH) is the most common benign tumor in men that occurs more frequently with age. The incidence and symptoms of prostatic obstruction also increase with age. BPH develops in the transition zone of the prostate and is caused by an increase in cell number through a hyperplastic process. Symptoms include problems with urination such as hesitancy, decreased urine flow, urgency and frequency. Diagnosis involves a digital rectal exam, urinalysis, measurement of prostate-specific antigen and assessment of urine flow. Treatment options include watchful waiting, medications that target the prostate such as alpha blockers and 5-alpha reductase inhibitors, and surgical procedures ranging from transurethral resection of

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    Benign prostatic hyperplasia (BPH) is the most common benign tumor in men that occurs more frequently with age. The incidence and symptoms of prostatic obstruction also increase with age. BPH develops in the transition zone of the prostate and is caused by an increase in cell number through a hyperplastic process. Symptoms include problems with urination such as hesitancy, decreased urine flow, urgency and frequency. Diagnosis involves a digital rectal exam, urinalysis, measurement of prostate-specific antigen and assessment of urine flow. Treatment options include watchful waiting, medications that target the prostate such as alpha blockers and 5-alpha reductase inhibitors, and surgical procedures ranging from transurethral resection of

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    43 views27 pages

    Bedah Benign Prostatic Hyperplasia

    Uploaded by

    Rs93
    Benign prostatic hyperplasia (BPH) is the most common benign tumor in men that occurs more frequently with age. The incidence and symptoms of prostatic obstruction also increase with age. BPH develops in the transition zone of the prostate and is caused by an increase in cell number through a hyperplastic process. Symptoms include problems with urination such as hesitancy, decreased urine flow, urgency and frequency. Diagnosis involves a digital rectal exam, urinalysis, measurement of prostate-specific antigen and assessment of urine flow. Treatment options include watchful waiting, medications that target the prostate such as alpha blockers and 5-alpha reductase inhibitors, and surgical procedures ranging from transurethral resection of

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    BENIGN PROSTATIC

    HYPERPLASIA (BPH)
    Dr. Nurul Akbar, Sp. U

    INCIDENCE

    most common benign tumor in men


    its incidence is age-related
    symptoms of prostatic obstruction are also
    age-related (decrease in the force and
    caliber of their urinary stream).

    EPIDEMIOLOGY

    Risk factors for the development of BPH are


    poorly understood
    Some studies have suggested a genetic
    predisposition, and some have noted racial
    differences.
    Approximately 50% of men under the age of 60
    who undergo surgery for BPH may have a
    heritable form of the disease.
    This form is most likely an autosomal dominant
    trait, and first-degree male relatives of such
    patients carry an increased relative risk of
    approximately 4-fold.

    ETIOLOGY

    not completely understood


    multifactorial and endocrine controlled
    prostate is composed of both stromal and
    epithelial elements
    BPH is under endocrine control

    PATHOLOGY

    BPH develops in the transition zone


    It is truly a hyperplastic process resulting from an increase in
    cell number
    Microscopic evaluation reveals a nodular growth pattern that
    is composed of varying amounts of stroma and epithelium.
    Stroma is composed of varying amounts of collagen and
    smooth muscle
    alpha-blocker therapy may result in excellent responses in
    patients with BPH that has a significant component of
    smooth muscle,
    BPH predominantly composed of epithelium might respond
    better to 5-reductase inhibitors
    Patients with significant components of collagen in the
    stroma may not respond to either form of medical therapy

    PATHOPHYSIOLOGY

    mechanical obstruction : intrusion into the


    urethral lumen or bladder neck, leading to a
    higher bladder outlet resistance
    Dynamic obstruction :The prostatic stroma,
    composed of smooth muscle and collagen, is
    rich in adrenergic nerve supply. The level of
    autonomic stimulation thus sets a tone to the
    prostatic urethra. Use of alpha-blocker
    therapy decreases this tone, resulting in a
    decrease in outlet resistance.

    The irritative voiding complaints : result


    from the secondary response of the bladder
    to the increased outlet resistance
    Bladder outlet obstruction leads to detrusor
    muscle hypertrophy and hyperplasia as well
    as collagen deposition (seen as trabeculation
    on cystoscopic examination)
    If left unchecked, mucosal herniation
    between detrusor muscle bundles ensues,
    causing diverticula formation

    SYMPTOMS

    Obstructive : hesitancy, decreased force and


    caliber of stream, sensation of incomplete
    bladder emptying, double voiding (urinating
    a second time within 2 h of the previous
    void), straining to urinate, and post-void
    dribbling.
    Irritative : urgency (difficult to postpone
    urination), frequency (> 6 times per day),
    and nocturia (nocturnal frequency >2 times)

    IPSS

    07 : mild LUTS
    819 : moderate LUTS
    2035 : severe LUTS

    SIGNS
    DRE:
    Size : does not correlate with severity of
    symptoms or degree of obstruction)
    Consistency : smooth, firm, elastic
    enlargement
    Induration : possibility of cancer , need for
    further evaluation (ie, prostate-specific
    antigen [PSA], transrectal ultrasound, and
    biopsy).

    LABORATORY FINDINGS

    urinalysis : exclude infection or hematuria


    serum creatinine : to assess renal function
    Serum PSA

    IMAGING

    intravenous pyelogram or renal ultrasound


    recommended only in the presence of
    concomitant urinary tract disease or
    complications from BPH (eg, hematuria,
    urinary tract infection, renal insufficiency,
    history of stone disease).

    ADDITIONAL TESTS

    Measurement of flow rate


    post-void residual urine
    urodynamic profiles : reserved for patients
    with suspected neurologic disease or those
    who have failed prostate surgery

    DIFFERENTIAL DIAGNOSIS

    urethral stricture
    bladder neck contracture
    bladder stone
    CaP
    urinary tract infection
    neurogenic bladder

    TREATMENT

    watchful waiting
    Medical Therapy (alpha blocker and 5 ARI)
    surgical (recurrent urinary tract infection,
    hematuria, bladder stones, renal
    insufficiency or large bladder diverticula)

    CONVENTIONAL SURGICAL
    THERAPY

    Transurethral Resection of the Prostate


    (TURP)
    Transurethral Incision of the Prostate
    Open Simple Prostatectomy

    MINIMALLY INVASIVE THERAPY

    Laser Therapy
    Transurethral Electrovaporization of the
    Prostate
    Hyperthermia
    Transurethral Needle Ablation of the Prostate
    High-Intensity Focused Ultrasound
    Intraurethral Stents
    Transurethral Balloon Dilation of the Prostate

    Smiths General Urology

    Thank you

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