BPH risk: BPH progression factors: >40g,

BPH ma biwasel la p cancer but

age >40yo &PSA>1.5
both are related to aging so nfs
hormones

Benign prostatic hyperplasia is a benign, very common and age related condition. It
corresponds to the hyperplasia (not hypertrophy) of glandular and stromal cells of the
prostate. This happens in the transitional zone most commonly (periurethral) and
central zone = lateral lobes and median lobe (posterior to urethra and above the
ejaculatory duct)

- Median lobe inc volume intravesicaly

- Cancer rarely happens in transitional zone (10% of cases) and central zone (5% of
cases)
- Peripheral zone (in contact with rectum) (80% of glandular tissue): area where
most p cancer develops
- 3 zones (CZ, TZ, PZ) and 5 lobes (anterior/nongland, posterior, 2 lateral and
median)
- Endoscopy: external sphincter and verumentum  hypertrophied lateral lobes
 median lobe  trigone and ureteral orifice

Signs and symptoms: lower urinary tract symptoms (storage/ irritative and obstructive),
no anatomico-clinical parallelism

Irritative/ storage LUTS (OAB: overactive) Obstructive/ voiding LUTS (BOO)

Dysuria, frequency (pollakiuria), urgency
and nocturia
(FUNWISE)
 BOO  detrusor overactivity
&involuntary detrusor contraction
during bladder filling  irritative
symtpome
Upper urinary tract: Chronic obstructive renal failure can develop bcz of reflux and
bilateral dilation of pelvic-calycial cavities
Hesitancy (difficult to initiate urination),
straining to urinate, dribbling, poor
intermittent Week stream and sensation
of incomplete voiding. Acute urinary
retention
 Leads to increased pressure while
voiding  detrusor muscle
hypertrophy  bladder
trabeculations and pseudodiverticula
formation
 Bladder wall weekens  incomplete
void and stasis predisposing to UTI,
Stones and acute/ chronic urinary
retention (+overflow urination)

- Hyperplastic nodules formation is what obstructs the urethra  DRE: regular

and smooth (msh nodules), firm, non-tender and elastic. Enlarged volume >20g
and no median furrow
 - If hard or nodular suggest cancer  do biopsy regardless of PSA level, if tender
suggest prostatitis

IPSS to assess severity of s and sexual dysfunction (impairement of QOL)

IPSS (5 symptoms, 5 grads max) QOL

0-7 mild symptoms 1-2
8-19 moderate (medical tx) 3-4
20-35 severe (medical and surgical tx) 5-6

Complications:

Acute urinary retention infections Hematuria Acute

obstructive
renal failure
Dx: Hx+PE enough usually (+-US) Due to urinary BPH>>cancer cz it is R/O acute
S: suprapubic fullness and pain stasis cz week periurethral instead of urinary retention
faj2a, cant void and urge to void or bladder wall and peripheral
dribbiling residual urine -GH and dx of exclusion
Tx: drainage by catheter or prostatitis , -vascularity of p increases due
Suprapubic catheter + alpha epididimytits to hyperplasia + friable vessels
blocker

Chronic bladder retention Stasis lithiasis Chronic obstructive renal failure (CORF)
Painless, no need to Bladder stones  can cause -Bilateral dilation of pyelocaliceal cavities
urinate, overflow hematuria or repetitive UTI (KUB, (chronic and painless)
incontinence US) -uretero-hydronephrosis  thin renal
parenchyma and CORF
Notes: Postrenal ARF is caused by an acute obstruction that affects the normal flow of urine out
of both kidneys. The blockage causes pressure to build in all of the renal nephrons (tubular
filtering units that produce urine). The excessive fluid pressure ultimately causes the nephrons
to shut down

Differential diagnosis: 6

Neurogenic bladder Urinary Stenosis of Bladder Chronic prostatitis Bladder tumors

stones urethra neck (infections)
disease
Under or overactive Causing Due to Khel2a sghir Young age (30-40) Do cystoscopy if
so can mimic obstruction urethritis or and young hematuria to R/o
symptoms trauma age
 Exams:

1- PSA: >4  indication for biopsy. PSA specific for p but not for cancer
2- Creatinine: to evaluate upper urinary tract and detect chronic renal insufficiencies
(order it always when BOO)
3- To R/O infections (UTI) cz nfs l symptoms  cytological urine exam (-ve culte and no
WBC)
4- Urodynamic tests measuring urine flow (debimetry): measures urine volume, max
flow, average flow, time of urination  if BOO due to BPH or urethra stenosis
flattened curve (flow rate M10 ml/s if dysuria). Done if neurogenic bladder
suspected or diagnostic doubt
5- US for KBP: K: pyelocaliceal cavity dilation, thin renal parenchyma and
dedifferentiation of corticomedulla
- Bladder: hypertrophy, stones, diverticula or voiding residue (incomplete voiding)
6- If hematuria (indication)  cystoscopy (to ro tumorS)

Treatment
Conservative,flattened curve (flow rate M10 ml/s if dysuria). Done if neurogenic bladder
suspected or diagnostic

surveillence Medical tx Surgical tx

Indications: - uncomplicated moderate severe symptoms Complicated BPH, moderate
-mild moderate s + no and impaired QOL severe and resistant to medical
QOL affected and no tx
complications
Educate px Alpha blocker: fast relieve in 48 hrs. orthostatic Excise adenoma (only cure for
hypo &retrograde ejaculation. Ntbho in elderly, BPH)
CAD, anti-htn taken
No alcohol, caffeine, 5alpha reductase inhibitors: 3-6m to work, not -open surgery (>100g): RE
constipation or drugs rapid relieve, PSA after 1 y of tx isn’t accurate -cervico-prostatic incision
causing dysuria. (x2). -transurethral resection of
- If P>40g prostate (TURP): can cause
- Gyncomastia & dec lipido (if young ma retrograde ejaculation (RE),
mnaati) hematuria, stenosis
- After open prostatectomy send to pathology (ma tamale surgery ela eza urine
culture negative)
- TURP syndrome: rare. ka2ene aam buhfor kousa, eza na2aret l capsule and im
cleaning with fluid  fluid gets to circulation (hypotonic, sugar)  hyponatremia
and volume overload (dilution)  hypotension, headache, brady, chest pain,
visual disorders. Ma taamloha aktar mn 90 hrs