BENIGN PROSTATIC

HYPERPLASIA

BY
D R P. M . K O S A M U
 OUTLINE

Anatomy and physiology of the prostate

Definition
Etiology and risk factors
Pathophysiology
Clinical manifestations
Complications
Diagnosis
Management
 Anatomy of prostate

 It is a walnut-sized gland located in front of the rectum and below

the bladder.
 It surrounds the urethra, the tube like channel that carries urine
and semen through the penis
 The primary function of the prostate is to produce seminal fluid,
the liquid in semen that protects, supports, and helps transport
sperm.
 Blood supply- inferior vesical artery a branch of the internal iliac
artery
 Nerve supply- neurovascular bundle lies on either side of the
prostate on the rectum.
 Derived from the pelvic plexus , arising from the S2-4 and T10-12
nerve roots. These nerves are cardinal for erectile function.
 Prostatic zonal anatomy

There are three zones of the prostate

Peripheral zone ( 70% of cancers)
Transitional zone (20% of cancers)
Central zone
 Definition

It is a progressive enlargement of the prostate gland

due to an increase in the size of epithelial cells and
stromal tissue
 Etiology and risk factors

Ageing
Excessive accumulation of prostatic androgen
Positive family history
Diet increase animal fat and saturated fatty acids
Increased alcohol consumption
Sedentary lifestyle
Smoking
Heart diseases such as hypotension
Diabetes mellitus
 Pathophysiology

The cause of BPH is not known, however studies suggest

that estradiol levels may have a relationship to the
prostate size among men with testosterone levels above
the median
Recent studies have identified smoking both current
and long standing, heavy alcohol consumption,
hypertension, heart diseases and diabetes as risk factors
of BPH
The hypertrophied lobes of the prostate may obstruct
the vesical neck or prostatic urethra, causing incomplete
emptying of the bladder and urinary retention
As a result a gradual dilatation of the ureters and
kidneys can occur. Urinary tract infections can occur
due to urine stasis.
 Clinical manifestations

Obstructive signs and symptoms

Reduced force of urine stream
Difficulty in initiating voiding
Intermittency
Post micturation dribbling
Storage signs and symptoms
Frequency
Urgency
Dysuria
Nocturia
Bladder pain
Incontinence
UTIs
Decreased volume and force of the urinary stream
Sensation that the bladder has not been completely emptied
Generalized symptoms
Fatigue
Anorexia
Nausea and vomiting
Epigastric discomfort
 Complications

Acute urinary retention

UTIs
Renal stones
Bladder damage
Hydronephrosis
Pyelonephritis
Residue urine
Sepsis
 Diagnosis

History and Physical examination

Digital rectal examination
Urinalysis
Urine MCS
Prostate specific antigen
Transrectal ultrasound
Cystourethroscopy
 Digital rectal examination findings

he prostate usually is enlarged and non-tender,

 has a rubbery consistency,
In many cases it will loose the median furrow.
Free or unobliterated median groove.
 International Prostate Scoring System

Incomplete emptying
Frequency
Intermittency
Weak stream
Urgency
Nocturia
Straining
IPSS (International Prostate Scoring System

 7 symptoms each with a score of 5 = 35 in total

< 8 Mild - Conservative Treatment
8 – 20 Moderate - Medical Treatment
> 20 Severe - Surgical Management
 Management

Medical management
1. Principles of medical management
 Restore bladder function
 Relive signs and symptoms
 Prevent and treat complications
 Management

1. Diet control
 Avoid intake of caffeine and artificial sweeteners'
 Limit spicy and acidic foods
 Reduce on alcohol consumption

 Conservative Mx
1. Regular prostatic massages may combat prostatic congestion.
2. Protect vesical tone
 Caution against excessive intake of fluid in a short period of time
 Alcohol should be forbidden
 Patient should void when he feels the urge
 Fluid intake should be limited in the evening
2. Pharmacologic therapy
 Alpha adrenergic blocker and 5-alpha
reductase inhibitors- these drugs relax the
smooth muscle of the bladder neck and prostate.
The smooth muscle blockage improves urine flow
and relieves BPH
LHRH analogues
control the secretion of LH reducing testicular
androgen secretion to castrate levels
30% prostatic volume reduction in patients
 Management cont…

Surgical management
Several approaches can be used to remove the portion of
the enlarged prostate gland
1. Closed procedures
A. Transurethral resection of the prostate-
involves the removal of the prostate tissue using a
resectoscope inserted through the urethra under
spinal or general anesthesia
B. Transurethral incision of the prostate- is an
out patient basis procedure of delivery microwaves
directly to the prostate transurethral probe