BENIGN PROSTATIC HYPERPLASIA

BENIGN PROSTATIC HYPERPLASIA


                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

Exam Important

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.
Treatment-
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
Don’t Forget to Solve all the previous Year Question asked on BENIGN PROSTATIC HYPERPLASIA
Click Here to Start Quiz

Module Below Start Quiz

Leave a Reply

%d bloggers like this:
Malcare WordPress Security