BENIGN PROSTATIC HYPERPLASIA (BPH)

• BPH is a benign enlargement of prostate.
• Prostate is divided into following 3 zones:

1. Peripheral zone- which lies in the outer part of prostate but mainly posteriorly.
2. Central zone: which lies posterior to the urethral lumen and above the ejaculatory ducts as they pass through the prostate.
3. Periurethral transitional zone (TZ).

 

ETIOLOGY-

1. Hormonal theory-

• Age advances –> androgens ↓ –> ↑oestrogen –> stimulates prostatic gland –> BPH

 

    2. Neoplastic theory-

• BPH is benign neoplasm called as fibromyoadenomas
• Proliferation of fibrous, muscular and glandular of prostate –> fibromyoadenomas

 

PATHOLOGY-

• Involves median (enlarges) and lateral (narrow) lobes.
• Bladder musculature hypertrophies and appears trabeculated.

 

CLINICAL FEATURES-

• Triad of BPH- urinary frequency, urgency, hesitancy
• Overflow and terminal dribbling
• Difficulty in micturition
• Acute retention of urine
• Impaired bladder emptying
• Haematuria
• Renal failure
• Prostatism- frequency at day and night, delay initiation and difficulty in micturition
• Chronic retention- tenderness in suprapubic region with enlarged bladder.
• Carcinoma of prostate arises most commonly in the peripheral zone
• Benign prostatic hyperplasia originates in the transition zone

Lower Urinary Tract symptoms-

1. Symptoms of voiding-

i) Hesitancy

ii) Dribbling

iii) Poor bladder emptying

     2. Symptoms of storage-

i) Frequency

ii) Nocturia

iii) Urgency

 

INVESTIGATIONS-

1. Digital rectal examination-

• Enlarged lateral lobes can be felt

1. Blood urine and creatinine is elevated
2. Urodynamics (uroflowmetry)-

a) Urine flow rate >15 ml/sec- normal

b) Voiding pressure

• >80 is high

1. Ultrasonogram-

• Assess size and weight of prostate

     2. Cystoscopy

     3. Transrectal US is useful to find nodules or possibility of carcinoma prostate

 

 

TREATMENT-

I) Medical treatment-

a) 5α reductase (finasteride acetate)- prevents of hyperplasia of the prostate

b) α– adrenergic blockers (tamsulosin)- for better drainage of bladder

 

II) Surgical treatment-

Indications for surgery-

a) Acute retention

b) Chronic retention

c) Prostatism

d) Complications- haematuria, hydroureteronephrosis, prostatic diverticulosis, vesical calculus, recurrent infections.

• Surgeries-

1. Transurethral resection of prostate (TURP)

• Most popular method today

     2. Transvesical suprapubic prostatectomy (Freyer’s)

     3. Retropubic prostactectomy (Millin’s)

     4. Perineal prostatectomy

III) Newer treatments-

• Holmium- YAG laser
• Intraurethral stents

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