Benign Prostatic Hyperplasia

BENIGN PROSTATIC HYPERPLASIA Benign enlargement of prostate commonly occurring in men over 50 yrs. 50% men over 60 yrs have BPH PATHOLOGY: Commonest lobe to be involved is either the median lobe &/ or the posterior lobe Enlarged median lobe projets into the bladder base whereas the lateral lobes cause narrowing of the urethra The urethra above the verumontanum gets elongated and narrowed Enlarged prostate presses on the prostatic venous plexus, may cause bleeding, - decoy prostate Initially bladder takes up the pressure burden- trabaculatiions, muscle hypertrophy, diverticula Later hydroureter and hydronephrosis Secondary asceding infection can cause acute or chronic pyelonephritis, renal failure Rarely, impotence. PATHOGENESIS:

Testosterone by autocrine and paracrine action is responsible for BPH. Estrogen sensitizes the cells to the action of testosterone.

CF: LUTS(LOWER URINARY TRACT SYMPTOMS): A. VOIDING: ‘hesitancy DIPS” HESITANCY DRIBBLING INTERMITTENT(starts and stops) POOR STEAM SENSE OF INCOMPLETE EVACUATION. B. STORAGE: Fun FREQUENCY URGENCY URGE INCONTINENCE NOCTURIA NOCTURNAL ENURESIS DUE TO uti- FEVER, CHILLS n RIGORS. Tenderness in the suprapubic area with tender palpable kidney due to chronic retention, hydronephrotic kidney may be palpable. Hematuria PR – enlarged prostate. INVESTIGATION: 1. transrectal USG 2. PSA n ACIPD PHOSPHATASE 3. urine- microscopy, C/S 4. USG abdomen- residual urine in the bladder 5. cystoscopy 6. serum urea, creatinine 7. IVU. TREATMENT: A. MEDICAL LINE 1. α BLOCKERS: TAMSULOSIN( alpha 1a selective inhibitor): 0.2 to 0.5 mg OD Inhibits smooth muscle contraction of the prostate. 2. 5 α REDUCTASE INHIBITORS: FINASTERIDE: 5mg OD Inhibits conversion of testosterone into dihydrotestosterone. B. SURGERY: INDICATIONS: 1. Elective prostatectomy for severe symptoms

2. 3. 4. 5.

hematuria acute retention of urine chronic retention with residual volume more than 200 ml complications of BPH( bladder diverticul, hydroureter, hydronephrosis, chronic UTI, stones etc.)

SURGERIES DONE: 1. TURP 2. FREYERS SUPRAPUBIC TRANSVESICAL PROSTATECTOMY 3. MILLINS RETROPUBIC PROSTATECTOMY(bladder is not opened) 4. YOUNGS PERINEAL APPROACH.

TURP: Using a cystoscope the enlarged prostate is identified It is resected using a loop with a hand control using high frequency diathermy. Following surgery continous bladder irrigation is done using a in situ foleys catheter left in place for about three days Antibiotic coverage to prevent infection. COMPLICATIONS: 1. LOCAL A. hemorrhage B. bladder neck contracture C. urethral stricture D. incontinence E. retrograde ejaculation F. impotence 2. GENERAL G. DVT H. Sepsis I. Water intoxication with CCF( TURP SYNDROME) 3. PULMONARY J. atelectasis K. pneumonia.