Benign

Prostatic Hyperplasia
(BPH)
 what is the prostate gland
n Prostate gland : is a fbromuscular and glandular

organ lying Just inferior to the bladder .

n According to Mcneal , the prostate has a peripheral

zone , central zone and transitional zone.

n According to Lowsley , the prostate has posterior

,two lateral , anterior and middle lobes

Benign prostatic hyperplasia (BPH)

n Half of all men over the age of 60 will

develop an enlarged prostate
n By the time men reach their 70s and 80s,
80% will experience urinary symptoms
Etiology : is not completely understood , but it seems
to be multifactorial and endocrine controlled .
Hormones :
androgen deprivation in older man reduces
prostate size , additional investigation have
demonstrated a positive correlation between level of
free testesterone and estrogen and the volume of the
BPH .
Stromal - epithelial interaction theory. This caused
by various growth factors.
 Pathology :

BPH develops in the transitional zone . It is

truly hyperplasia process resulting from
increase in cell number .
Microscopically reveal a nodular growth
pattern that it is composed of varying amount
of stromal and epithelial tissue, stromal tissue
composed from collagen and smooth
muscle
 Pathophysiology
n obstructive component
of BPH .
Mechanical obstruction .
Dynamic obstruction .

n Irritative voiding
complaints
n Clinical Feachers:

Symptoms:
Irritative symptoms
Obstructive symptoms
Signs:
Neurological examination .
Digital rectal examination ,it shows size of
the prostate (not compatible with severity
of the symptoms)
In BPH ,it reveals smooth,firm,elastic
enlargement of the prostate .
 n Lab. Findings:

Urinalysis
Renal function
There is 10% renal insufficiency observed in BPH.
PSA (prostatic specific antigen)
Imaging :
IVP and ultrasound are indicated in concomitant
urinary tract disease or complicated BPH
Cystoscopic examination
Additional testes : cystometrogram and urodynamic
prophile for patient with
Neurological disease .
Failed prostatic surgery .
Complications of BPH:
Bladder stones
UTI
Hematuria
Bladder decompensation
Renal failure
Acute and chronic urine retention
 Treatment :
1. Watchful waiting
2. Medical treatment
a- alpha blockers :
-Phenoxybenzamine , it is non selective
blocker (Dose 10mg ).
-prazosin it is short acting selective 1
blocker .
-terazosin (5mg,10mg ),doxazosin (4mg,
8mg) ,these are long acting 1
blockers .
-tamsulosin (0.4mg,0.8mg),silodosin
(8mg) 1a selective blocker. This is
the most potent blockers.
Side effects :
-orthostatic hypotension
-dizziness
-tiredness
-retrograde ejaculation
-rhinitis
-headack
b- 5-reductase inhibitors :

Side effects :
-decreased libido
-decreased ejaculatory volume
-impotence
c-Combination therapy :

d-Phyto therapy
 3-conventional surgical therapy :

(a)Taransurethral resection
of the prostate (TURP)
90% of simple prostatectomy
can be done endoscopically
,symptoms and flow rate
improvement is superior to
that of any minimally invasive
therapy .
 Complications:

Impotence
Incontinence
Bleeding
May require blood
transfusion
Retrograde ejaculation.
TUR syndrome :
 TUR syndrome :

It is a clinical manifestation of nausea

,vomiting, confusion ,hypertension
bradycardia and visual disturbance .

Treatment:
1-Diuresis
2-Hypertonic saline in severe case .
b-Transurethral incision of the
prostate (TUIP)
C- open
prostatectomy
Indications:
prostate gland over 100 gm .
BPH with bladder diverticule .
BPH with vesical stone .
if dorsal lithiotomy position is not
possible .
Minimally invasive therapy :
(1) Laser therapy

Advantages:
-minimal blood loss .
-rare instance of TUR syndrome .
-ability to treat patient with anti coagulant
therapy .
-ability to done in out patient procedure.
Disadvantages :
--longer postoperative catheterization
time
-more irritative voiding complaints.
-high cost of laser fibers and generators.
2- Transurethral evaporization of
the prostate
3-hyperthermia

Micro wave thermal therapy

(4) High Intensity Focused Ultrasound
(HIFU):
(5) Intra urethral stents
Transurethral balloon dilation of the
prostate
Thank You