what is BPH?

Benign Prostatic Hyperplasia

n It is NOT cancer (benign) n Enlargement of the prostate gland

incidence

Half of all men over the age of 60 will develop an enlarged prostate
By the time men reach their 70s and 80s, 80% will experience urinary symptoms

-Walnut-shaped gland

-forms part of the male reproductive system

-4x3x2 cms -wt= 8gms

-Surrounds the urethra

5 lobed : anterior posterior median lateral(2 lobes- right and left) 3 zones : peripheral(site of CA) central transition (Prone for BPH)

Physiology of the prostate

-Secretion forms 10-20% of semen -Alkaline in nature -During orgasm, prostate muscles contract and propel ejaculate out of the penis

BPH is part of the natural aging process, like getting gray hair or wearing glasses BPH cannot be prevented BPH can be treated

n Frequent and urgent

need to urinate, especially at night

n

Dribbling or leaking after urination

Intermittent or weak n stream

-Straining to urinate -Pain or burning during urination -Feeling that the bladder never completely empties

n Prostate
n Pressure

grows with age and time

on the urethra restricts urine flow similar to a clamp on a garden hose

Risk of bladder and kidney damage Impact on quality of life

AUA Symptom Score (questionnaire) Medical history Physical examination Prostate exam Urinalysis PSA blood test Transrectal ultrasound of prostate

BPH needs to be treated ONLY IF:

n

Your symptoms are severe enough to bother you and affect your quality of life You have frequent urinary tract infections

treatment options

Watchful waiting

Medication

Heat therapies
Surgical approaches
open procedures TURP New laser treatment

ALTERNATIVE line of defence

2 MAJOR groups:
1. 2.

Alpha blockers 5-alpha reductase inhibitors

medication
Benefits
n

Disadvantages
Expensive Drug Interactions Must be taken every day

Convenient No loss of work time

Minimal risk

Manages the problem instead of fixing it

 Impotence

Dizziness
Headaches

Fatigue
Loss

of sexual drive

Open

procedures

Scopic

procedures

 Retropubic Suprapubic Perineal

prostatectomy(Millins) prostatectomy(Freyers)

prostatectomy(Youngs)

TURP

TUNA

TUIP

TURP
(transurethral resection of the prostate)
Gold Standard of care for BPH

Uses an electrical knife to surgically cut and remove excess prostate tissue Effective in relieving symptoms and restoring urine flow

Benefits
n
n n

Disadvantages
n

Widely available

Effective
Long lasting
n n n

Greater risk of side effects and complications 1-4 days hospital stay 1-3 days catheter 4-6 week recovery

TURP
n n n

Impotence
Incontinence

Bleeding
n

May require blood transfusion

Electrolyte imbalance (TUR Syndrome)

n

May result in ICU (Intensive Care Unit)