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BENIGN PROSTATIC
HYPERPLASIA (BPH)
Dr. Nurul Akbar, Sp. U
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INCIDENCE most common benign tumor in men
its incidence is age-related
symptoms of prostatic obstruction are also
age-related (decrease in the force andcaliber of their urinary stream).
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EPIDEMIOLOGY isk factors for the de!elopment of "#$ are
poorly understood
Some studies ha!e suggested a genetic
predisposition, and some ha!e noted racialdifferences.
Appro%imately &' of men under the age of '
*ho undergo surgery for "#$ may ha!e a
heritable form of the disease.
+his form is most likely an autosomal dominant
trait, and first-degree male relati!es of such
patients carry an increased relati!e risk of
appro%imately -fold.
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ETIOLOGY
not completely understood
multifactorial and endocrine controlled
prostate is composed of both stromal and
epithelial elements "#$ is under endocrine control
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PATHOLOGY
"#$ de!elops in the transition one
t is truly a hyperplastic process resulting from an increase in
cell number
/icroscopic e!aluation re!eals a nodular gro*th pattern that
is composed of !arying amounts of stroma and epithelium. Stroma is composed of !arying amounts of collagen and
smooth muscle
alpha-blocker therapy may result in e%cellent responses in
patients *ith "#$ that has a significant component of
smooth muscle, "#$ predominantly composed of epithelium might respond
better to &-reductase inhibitors
#atients *ith significant components of collagen in the
stroma may not respond to either form of medical therapy
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PATHOPHYSIOLOGY mechanical obstruction 0 intrusion into the
urethral lumen or bladder neck, leading to a
higher bladder outlet resistance
Dynamic obstruction 0+he prostatic stroma,composed of smooth muscle and collagen, is
rich in adrenergic ner!e supply. +he le!el of
autonomic stimulation thus sets a tone to the
prostatic urethra. Use of alpha-blockertherapy decreases this tone, resulting in a
decrease in outlet resistance.
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+he irritati!e !oiding complaints 0 result
from the secondary response of the bladder
to the increased outlet resistance
"ladder outlet obstruction leads to detrusormuscle hypertrophy and hyperplasia as *ell
as collagen deposition (seen as trabeculation
on cystoscopic e%amination)
f left unchecked, mucosal herniationbet*een detrusor muscle bundles ensues,
causing di!erticula formation
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SYMPTOMS 1bstructi!e 0 hesitancy, decreased force and
caliber of stream, sensation of incomplete
bladder emptying, double !oiding (urinating
a second time *ithin 2 h of the pre!ious!oid), straining to urinate, and post-!oid
dribbling.
rritati!e 0 urgency (difficult to postpone
urination), fre3uency (4 times per day),and nocturia (nocturnal fre3uency 42 times)
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IPSS '56 0 mild 7U+S
859: 0 moderate 7U+S
2'5;& 0 se!ere 7U+S
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SIGNS
D, transrectal ultrasound, andbiopsy).
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LABORATORY FINDINGS urinalysis 0 e%clude infection or hematuria
serum creatinine 0 to assess renal function
Serum #SA
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IMAGING intra!enous pyelogram or renal ultrasound
recommended only in the presence of
concomitant urinary tract disease or
complications from "#$ (eg, hematuria,urinary tract infection, renal insufficiency,
history of stone disease).
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ADDITIONAL TESTS /easurement of flo* rate
post-!oid residual urine
urodynamic profiles 0 reser!ed for patients
*ith suspected neurologic disease or those*ho ha!e failed prostate surgery
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DIFFERENTIAL DIAGNOSIS urethral stricture
bladder neck contracture
bladder stone
?a# urinary tract infection
neurogenic bladder
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TREATMENT *atchful *aiting
/edical +herapy (alpha blocker and & A)
surgical (recurrent urinary tract infection,
hematuria, bladder stones, renalinsufficiency or large bladder di!erticula)
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CONVENTIONAL SRGICAL
THERAPY +ransurethral esection of the #rostate
(+U#)
+ransurethral ncision of the #rostate
1pen Simple #rostatectomy
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MINIMALLY INVASIVE THERAPY 7aser +herapy
+ransurethral
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Smiths Beneral Urology
+hank you