Bengin Prostatic Hyperplasia _ صفاء Flashcards
what’s the location of the prostate ?
The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut
located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm.
what’s the causes of BPH ?
Hyperplasia of epithelial and stromal components of prostate
what’s the sequle of the disease ?
1-Hyperplasia of epithelial and stromal components of prostate
2- then obstruction of urinary outflow in bladder
3- Increased activity of detrusor muscle(hypertrophy of the mucle )
4- this then lead to obstructive symptomas as Frequency, nocturia ,Poor flow and intermittent stream
and irriative symptomas as Hesitation and post voiding dribbling
The prostate is divided into several lobes
the anterior lobe
the median lobe
the lateral lobes
and the posterior lobe.
The prostate gland is composed of different types of zones:
The peripheral zone
The central zone
The transition zone
whats the benfit of the zones ?
CA of the pancreas arise from the periphery while
begnin arise from the transtional zone
why the BPH increase after age of 30 ?
beca
what’s the type of facia in the prostate ?
The rectoprostatic fascia (Denonvilliers’ fascia)
is a membranous partition at the lowest part of the rectovesical pouch. It separates the prostate and urinary bladder from the rectum.
prevent the invasion to the rectum
why pt over age of 50 are more liable for the BPH ?
-because with increase the age the testestrone will decrease (testes) but the 5alpha reductase enzyme increase which convert the the testesrone into the dyhydrotestrone which is more potent (long half life )
will inhibit the apptosis and increase the growth and development of the cells as the basal and the luminal cells
Prevalence of BPH …
+Men > 50 = 41% have symptoms of LUTS
+Only 18% have a diagnosis because of educational level of the pt so many of them diagnosis as UTI or overactive bladder
+Only 10% aware of drugs or surgery that will help it
pt Men > 50 will 41%
41% have symptoms of LUTS
Risk factors of the BPH
Age over 50
obesity they have relation with hyperlipdema because the precsor of the androgen is the cholestrol
Differential diagnosis of BPH …
-Poorly controlled diabetes
because DM lead to destruction of the scaral plexus that supply the detrusor muscle of the bladder
-Urinary tract infections
specailly the trigiontis which the most senstive part that lead to irrative symptomas
-Neurological disorders
as neurogenic bladder cause spastic to the bladder and obstruction
-Overactive bladder
-Drugs – diuretics, anticholinergics, antidepressants
these drugs act agnist the parasympathtic system and lead to increase the symathic and spasm of the bladder neck with retention
- Lifestyle factors – caffeine, alcohol, xs fluids
- Abacterial prostatitis
+bladder may be over active , neurogenic or infected
Abnormal symptoms in BPH indicated …
that the pt should be referred to urologist for do futher assessment
what’re the Abnormal symptoms …
-Urinary incontinence
involuntary leakage of urine
- Retention
- Dysuria
- Haematuria
-Acute change in symptoms
some of sometimes changes from mild to sever
pt with BPH and urinary retention indicate
paraxosmal incontinence
Examination of BPH
- enlarged bladder
most important one
-enlarged kidneys
retention of urine
-constipation
the prostate in the front of the ampula of rectum
- but may be the prostate is palpate in the suprapubic area
Rectal examination -------------------------------- Size and consistency of prostate gland if the firm is BPH But if hard its CA
difference between the acute and chronic retention ,,
acute is painful ,lead to enlarge bladder
while the chronic is less painful , the bladder enlagment lead to the bladder reach the epigastrium
Urinary retention is the inability to voluntarily urinate. Acute urinary retention is the sudden and often painful inability to void despite having a full bladder. 1 Chronic urinary retention is painless retention associated with an increased volume of residual urine and bladder that remains palpable after voiding
Investigations pf BPH …
-Fasting blood sugar
to exclude the DM
- erythrocyte sedimentation rate (ESR)
- Urea and electrolytes (U&Es)
- Renal function test
- complete blood count
for infection
level rises with increasing volume of prostate gland
- Infection
- haematuria
this special investigation done if we have suspison of ureter stricture rather than the prostate
or pt have neurogenic bladder
assess the dtrusor muscle contraction and tell us if the the removal of the prostate is indicated of not
Ultrasound ----------------------- -assess the size of prostate -congensity BPH have iso- echoic picture while CA have hypo-ehoic picture
- estimate residual urine
by draining the bladder with a thin flexible tube (catheter) or by using ultrasound normal is (0-20cc )
less than 50 mL is considered normal
Visual inspection of bladder and uerethra
- used in dysuria or haematuria because pt may have tumor in the bladder in addation to the BPH
- see if there is uerethra stricture
+ Renal function test
include
2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. … ACR is a urine test to see how much albumin (a type of protein) is in your urine.
+Post-void residual volume (PVR) is the amount of urine retained in the bladder after a voluntary void
what’re the special investigation
done before the prostate removal
- Uroflowmetry
- Bladder pressure studies (cystometry)
Uroflowmetry
max flow rate and volume of residual urine after voiding
this special investigation done if we have suspison of ureter stricture rather than the prostate
or pt have neurogenic bladder
– low flow rate indicates need for TURP
+Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate. An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder
Bladder pressure studies (cystometry)
pressure measurement during filling and emptying (cystometry) gives information on over/under activity of detrusor muscle and obstruction of bladder outlet. Predicts response to treatment. Use antimuscarinics for over activity and turp for bladder outlet obstruction
assess the dtrusor muscle contraction and tell us if the the removal of the prostate is indicated of not
Ultrasound
-assess the size of prostate
-congensity
BPH have iso- echoic picture while CA have hypo-ehoic picture
- estimate residual urine
by draining the bladder with a thin flexible tube (catheter) or by using ultrasound normal is (0-20cc )
less than 50 mL is considered normal
Urethroscopy
Visual inspection of bladder and uerethra
- used in dysuria or haematuria because pt may have tumor in the bladder in addation to the BPH
- see if there is uerethra stricture
Assesment of the BPH
by international prostate symptom scale.
IPSC
it’s 7 symptoms for each 5 score
1 – 7 mild—–conservative TRT
8 – 19 moderate——-
20 – 35 severe———- both need surgery
this need hight awarnace of the pt
so the surgery of BPH depend on
assessment and special investigation
mangment of the BPH …
start from simple into more complex
Lifestyle modification ----------------------------------- Reduce fluid intake Stop diuretics if possible Avoid xs night time fluid intake/caffeine /alcohol Empty bladder before long trips/meetings
Diabetes
UTI
Drug therapy ------------------------- Alpha blockers as Tamsulosin and alfuzosin Improve bladder and prostate smooth muscle tone More effective
5 alpha reductase inhibitors
Reduce prostate volume
Reduces risk of prostate cancer, increases risk of high grade disease
Combined therapy
Men with large prostate > 40g or PSA >4 or moderate to severe symptoms combined therapy will prevent 2 episodes of clinical progression per 100men over 4yrs. Much less effective for men with smaller prostates
Surgery ------------------------------- -TURP( Transurethral resection of the prostate ) Greatest improvement in symptoms 5% severe haemorrhage risk Requires GA
- Ultrasound
- Laser
- microwave
Men with symptoms of urinary urgency, frequency, small, urine volumes and nocturia in the absence of serious obstructive symptoms are categorised as
over active bladder
over active bladder
Men with symptoms of urinary urgency, frequency, small, urine volumes and nocturia in the absence of serious obstructive symptoms are categorised as
Alternative energy sources for TURP
Ultrasound
Laser
microwave
Adverse effects of surgery
- Loss of ejaculation
- Erectile dysfunction
- Retrograde ejaculation
- Incontinence
- Stricture formation
- Urinary retention
