BENIGN PROSTATIC HYPERPLASIA
BENIGN PROSTATIC HYPERPLASIA (BPH)
- BPH is a benign enlargement of prostate.
- Prostate is divided into following 3 zones:
- Peripheral zone- which lies in the outer part of prostate but mainly posteriorly.
- Central zone: which lies posterior to the urethral lumen and above the ejaculatory ducts as they pass through the prostate.
- Periurethral transitional zone (TZ).

ETIOLOGY-
- 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-
- Symptoms of voiding-
i) Hesitancy
ii) Dribbling
iii) Poor bladder emptying
2. Symptoms of storage-
i) Frequency
ii) Nocturia
iii) Urgency

INVESTIGATIONS-
- Digital rectal examination-
- Enlarged lateral lobes can be felt
- Blood urine and creatinine is elevated
- Urodynamics (uroflowmetry)-
a) Urine flow rate >15 ml/sec- normal
b) Voiding pressure
- >80 is high
- 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-
- 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
- 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.
Indications for surgery-
a) Acute retention
b) Chronic retention
c) Prostatism
d) Complications- haematuria, hydroureteronephrosis, prostatic diverticulosis, vesical calculus, recurrent infections.
- Surgeries-
- 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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