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    Benign Prostatic Hyperplasia

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    Mohammed Aadeel
    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that is common in aging men, characterized by an increase in both glandular and stromal tissue in the prostate. BPH causes lower urinary tract symptoms and can lead to complications like acute urinary retention and chronic kidney damage if left untreated. Evaluation and treatment options aim to relieve symptoms, improve quality of life, and reduce complications through watchful waiting, medications, minimally invasive procedures, and surgery.

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    Benign Prostatic Hyperplasia

    Uploaded by

    Mohammed Aadeel
    343 views20 pages
    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that is common in aging men, characterized by an increase in both glandular and stromal tissue in the prostate. BPH causes lower urinary tract symptoms and can lead to complications like acute urinary retention and chronic kidney damage if left untreated. Evaluation and treatment options aim to relieve symptoms, improve quality of life, and reduce complications through watchful waiting, medications, minimally invasive procedures, and surgery.

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    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that is common in aging men, characterized by an increase in both glandular and stromal tissue in the prostate. BPH causes lower urinary tract symptoms and can lead to complications like acute urinary retention and chronic kidney damage if left untreated. Evaluation and treatment options aim to relieve symptoms, improve quality of life, and reduce complications through watchful waiting, medications, minimally invasive procedures, and surgery.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    343 views20 pages

    Benign Prostatic Hyperplasia

    Uploaded by

    Mohammed Aadeel
    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that is common in aging men, characterized by an increase in both glandular and stromal tissue in the prostate. BPH causes lower urinary tract symptoms and can lead to complications like acute urinary retention and chronic kidney damage if left untreated. Evaluation and treatment options aim to relieve symptoms, improve quality of life, and reduce complications through watchful waiting, medications, minimally invasive procedures, and surgery.

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    © All Rights Reserved
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    of 20

    BENIGN PROSTATIC

    HYPERPLASIA

    John S Kachimba
    Department of Surgery
    BENIGN PROSTATIC
    HYPERPLASIA
    BPH is the commonest benign
    tumour in in men.
    Prevalence approaches 100% by 80
    years.
    BPH is characterized by an increase
    both stromal and glandular elements
    of the prostate.
    TERMINOLOGY

    BPH denotes the histological entity.


    Benign prostatic enlargement (BPE)
    denotes a clinical finding on rectal
    examination.
    Benign prostatic obstruction (BPO)
    denotes a urodynamically-defined
    state.
    ANATOMY
    McNeal’s description (1972): 3
    zones
    1. PERIPHERAL ZONE- Site of origin
    of 60- 70% of all carcinomas of the
    prostate.
    2. CENTRAL ZONE.
    3. TRANSITIONAL ZONE- BPH
    originates in this zone.
    AETIOLOGY

    Prerequisites for the development of


    BPH:
    1. CIRCULATING ANDROGENS.
    Circulating Testosterone is
    converted to DHT by 5-alpha-
    reductase.
    2. AGEING.
    CLASSIFICATION OF LUTS
    VOIDING STORAGE
    (OBSTRUCTIVE) (IRRITATIVE)
    1. Hesitancy
    1. Frequency
    2. Poor or intermittent
    stream 2. Urgency
    3. Straining 3. Incontinence
    4. Terminal dribbling 4. Nocturnal frequency
    5. Post-micturition 5. Nocturnal enuresis
    dribbling
    6. Haematuria
    7. Dysuria
    CONSEQUENCES OF BPH

    “The swelling of the prostate is most


    common in the decline of life… when
    diseased to alter its shape and size,
    it must obstruct the passage of
    urine”
    John Hunter (1786)
    CONSEQUENCES OF BPH

    1. ACUTE RETENTION OF URINE


    2. CHRONIC RETENTION OF URINE
    3. STONE FORMATION
    4. URINARY TRACT INFECTION
    5. RENAL IMPAIRMENT
    ACUTE RETENTION OF
    URINE
    Most common complication of BPH.
    Characterized by a painful total
    inability to micturate.
    Urinary symptoms prior to onset.
    Surgical relief of the obstruction is
    indicated.
    CHRONIC RETENTION OF
    URINE
    Characterized by incomplete
    emptying of bladder.
    Interactive obstructive uropathy:
    renal impairment due to high storage
    detrusor pressure associated with
    CR.
    Initial treatment: Indwelling catheter
    till renal function improves.
    EVALUATION OF LUTS
    ASSOCIATED WITH BPO
    LUTS not disease-specific.
    Differentials include:
    1. Urethral stricture.
    2. UTI.
    3. Bladder cancer.
    4. Prostate cancer.
    5. Inflammatory conditions of the
    bladder.
    EVALUATION OF LUTS
    HISTORY:
    Detailed history
    Symptom scoring system
    PHYSICAL EXAMINATION:
    General assessment
    Abdominal assessment
    External genitalia
    DRE
    EVALUATION OF LUTS:
    INVESTIGATIONS
    1. Urinalysis
    2. Radiology:
    Abdominal U/S for complications
    Plain X-ray Abdomen (KUB)
    3. Renal biochemistry
    4. Urodynamic evaluation
    5. Flexible cystoscopy
    TREATMENT OF BPH

    AIMS OF TREATMENT:
    1. Relieve urinary symptoms.
    2. Improve quality of life.
    3. Reduce the complications of
    bladder outflow obstruction.
    TREATMENT OPTIONS FOR
    BPH
    1. Active monitoring or ‘Watchful
    waiting’.
    2. Pharmacological treatment.
    3. Minimally invasive therapies.
    4. Conventional surgery.
    Watchful Waiting

    Patients with mild symptoms


    simply need follow up.
    Over 5 years:
    30% experience progression of
    symptoms
    50% remain static
    20% will improve
    PHARMACOLOGICAL
    TREATMENT
    This is based on either:
    1. Reducing the tone of the
    prostatic smooth muscle: alpha
    adrenergic antagonists.
    2. Reduction of gland volume: 5-
    alpha-reductase inhibitors.
    MINIMALLY INVASIVE
    THERAPIES
    These include:
    1. Transurethral microwave
    thermotherapy (TUMT).
    2. Transurethral needle ablation
    (TUNA).
    3. Transurethral ethanol ablation
    (TEAP).
    CONVENTIONAL SURGERY

    1. Transurethral incision of prostate


    (TUIP).
    2. TURP.
    3. Laser TURP.
    4. Open prostatectomy.
    COMPLICATIONS OF TURP
    IMMEDIATE/ EARLY LATE
    Haemorrhage Stricture formation
    TUR syndrome Urinary incontinence
    Sepsis Erectile dysfunction
    Clot retention Retrograde
    ejaculation

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