Benign Prostatic Hyperplasia

1
Benign Prostatic Hyperplasia

• Dr.Bandar Al Hubaishy
• Urology Department
• KAUH

2
Clinical Presentation

• Hesitancy
• Urgency
• Frequency
• Incomplete bladder emptying
• Drippling
• Decreased stream flow

3
Physical Examination

• Suprapubic area for sign of bladder distension
• DRE
• Prostate gland
• size , nodularity , masses, surface,
  tenderness, anal tone

4
investigations

• Laboratory tests
• CBC
• UE
• PSA
• Urine analysis
• Urine culture and sensitivity

• Uroflow meter
• Kidney-bladder Ultrasound
• TRUS biopsy

5
Medical Treatment

• The prostate gland consists of
• Glandular tissue
• Fibromuscular tissue

6
Medical Treatment

• The prostate is rich in alpha receptors
  especially type 1a which are responsible for LUTS
  in those patient. So, blocking these receptors
  can decrease the resistance along the bladder
  neck, urethra and prostate

7
Alpha blockers

• Selective agents
• short-acting
• prazosin, alfuzosin, and indoramin.
• long-acting
• terazosin, doxazosin and slow-release (SR)
  alfuzosin.

• Non selective agents
• Phenoxybenzamine
• Partial selective agents
• Tamsulosin and silodosin.

8
5 alpha reductase inhibitors

• Finasteride (Proscar)
• Dutasteride (Avodart)

9
Surgical management

• Indications
• AUR
• failed voiding trials
• recurrent gross hematuria
• urinary tract infection.
• renal insufficiency secondary to obstruction.

• failure of medical therapy,
• a desire to terminate medical therapy
• financial constraints associated with medical
  therapy.

10
Transurethral resection of prostate (TURP)

• Complications Hemorrhage, urinary incontinence,
  impotance, retrograde ejaculation

11
Open prostatectomy

• Indications
• very large prostates (gt75 g),
• patients with concomitant bladder stones or
  bladder diverticula
• patients who cannot be positioned for
  transurethral surgery.

12
Thank you