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BPH-
Benign enlargement of Prostate (occurs after 50 years)
BPH affects both glandular epithelium & connective tissue stroma
Etiology - not known
Involuntary hyperplasia-Androgens & Estrogen hormone imbalance
(with age TS level drops slowly but fall of estrogen level is not equal)
BPH arises from submucosal glands of periurethral transitional zone with stromal proliferation and adenosis (abnormal change in gland)
BPH usually involve median or lateral lobe.
Clinical features-
Frequency- due to cystitis & urethritis
Initially less frequent in day time
After that more frequent in night time
Urgency-due to enlargement of prostate, internal sphincter of urethra is stretched & partly opened
Hesitancy- due to infection
Hematuria- due to enlarged prostate compresses prostatic venous plexus causing congestion
Hydronephrosis- kidney or ureter backpressure
Renal failure- due to severe obstruction
Stone- due to impaired bladder emptying
Retention of urine
Pain in suprapubic region & loin due to cystitis & hydronephrosis
Tenderness in suprapubic region, with palpable enlarged bladder
Urinary infection features- fever, chills, burning micturition
Per rectal Examination- Done when bladder empty
Consistency- smooth to firm
Enlarged lateral lobe can be easily felt
Rectal mucosa over prostate freely movable
Lab investigation-
Blood urea & Serum creatinine
Urine microscopic and C/S
Urodynamics- urine flow (15-20ml/sec- normal)
IVP (intravenous pyelogram)- exclude hydronephrosis
USG abdomen- for residual urine
Cystoscopy
PSA (4ng/ml)
Management-
If patient present-
Acute retention- urethral catheterization if fails then SPC (suprapubic cystostomy)
Uraemia- urethral catheterization must that allow kidney to function adequately
Serum electrolyte correct
Medicinal T/t- mostly preferable when residual urine less then 180ml
flow rate grater then 10-15 ml/sec
Avoid alcohol
Alpha 1 adrenergic blocking agent(Prazosin, Terazocin)- improve urine flow (Reduce bladder neck resistance)
5- alpha reductase Inhibitor- inhibit conversion of testosterone to dihydrotestosterone (contraindicated in obstructive uropathy or carcinoma prostate)
Surgical-
Indication-
Prostatism (frequency, urgency, dysuria)
Residual urine grater then 200ml
Flow rate less then 10ml/sec
Severe complication like Hematuria
Hydronephrosis & hydroureter
Acute urine retention
Stone formation
Recurrent infection
Surgical Treatment-
Trans-urethral resection of the prostate (TURP)- most common
Supra- pubic trans vesical Prostatectomy- Abdominal incision
Laser treatment- using holmium
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