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. hematuria

3. acute retention of urine

4. chronic retention with residual volume more than 200 ml

5. 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.