Benign prostatic hyperplasia
Benign prostatic hyperplasia BPH
IS INCREASINGLY COMMON WITH AGE AND IS PRESENT IN AN ESTIMATED 50%OF MEN OVER THE AGE OF 60 YERAS AND IN NEARLY 88% BY THE AGE OF 88 YEARS
THIS IS A HISTOLOGICAL DIAGNOSIS AND IS DUE TO THE HYPERPLASIA OF THE PERIURETHRAL GLAND IN THE TRANSITIONAL ZONE OF THE PROSTATE . THIS ENLARGEMENT CAUSES VARYIBG DEGREE OF OBSTRUCTION TO THE FLOW OF URINE AND LEADS TO
A GROUP OF SYMPTOMS CATEGORIZED
AS LOWER URINARY TRACT SYMPTOMS (LUTS) . THE EXTEND OF THE PROSTATIC ENLARGEMENT MAY NOT BE DIRECTLY PROPORTIONAL TO THE DEGREE OF BLADDER OUTFLOW NOR TO THE AMOUNT OF SYMPTOMS
THE CLINICAL DEFINITION OF BPH IS THEREFOR A COMBINATION OF LUTS , PALPABLE BENIGN PROSTATIC ENLARGEMENT AND URODYNAMIC EVIDENCE OF BLADDER OUTFLOW OBSTRUCTION
Benign prostatic hyperplasia BPH
IS INCREASINGLY COMMON WITH AGE AND IS PRESENT IN AN ESTIMATED 50%OF MEN OVER THE AGE OF 60 YERAS AND IN NEARLY 88% BY THE AGE OF 88 YEARS
THIS IS A HISTOLOGICAL DIAGNOSIS AND IS DUE TO THE HYPERPLASIA OF THE PERIURETHRAL GLAND IN THE TRANSITIONAL ZONE OF THE PROSTATE . THIS ENLARGEMENT CAUSES VARYIBG DEGREE OF OBSTRUCTION TO THE FLOW OF URINE AND LEADS TO
A GROUP OF SYMPTOMS CATEGORIZED
AS LOWER URINARY TRACT SYMPTOMS (LUTS) . THE EXTEND OF THE PROSTATIC ENLARGEMENT MAY NOT BE DIRECTLY PROPORTIONAL TO THE DEGREE OF BLADDER OUTFLOW NOR TO THE AMOUNT OF SYMPTOMS
THE CLINICAL DEFINITION OF BPH IS THEREFOR A COMBINATION OF LUTS , PALPABLE BENIGN PROSTATIC ENLARGEMENT AND URODYNAMIC EVIDENCE OF BLADDER OUTFLOW OBSTRUCTION
PRESENTATION
Patients may have no symptoms and are found to have a palpable bladder due to chronic retention of urine and occasionally in post renal obstructive renal failure LUTS can be divided into two groups
Obstructive symptoms
Associated with voiding which are hesitancy poor stream , straining , prolonged micturition postmicturition dribbling and a feeling of incomplete emptying and
Irritative symptoms
associated with filling which are frequency nocturia and urgency . patients may also present with acute retention haematuria and urinary tract infection
Patients may have no symptoms and are found to have a palpable bladder due to chronic retention of urine and occasionally in post renal obstructive renal failure LUTS can be divided into two groups
Obstructive symptoms
Associated with voiding which are hesitancy poor stream , straining , prolonged micturition postmicturition dribbling and a feeling of incomplete emptying and
Irritative symptoms
associated with filling which are frequency nocturia and urgency . patients may also present with acute retention haematuria and urinary tract infection
Diagnosis and investigations
Physical examination of the abdomen will indicate a palpable or percussable bladder and digital rectal examination will assess the prostate . patients are evaluated by using a validated symptom scoring system such as international prostate symptom score (1-PSS) and a quality of life score due to urinary symptoms . routine investigation include urine analysis renal function estimation and PSA (prostatic specific antign) uroflowmetry and ultrasound of the urinary tract with assessment of postmicturation volume will suggest the degree of bladder outflow obstruction and in equivocal cases cystometry may be required to prove a high pressure low flow picture . a post void volume of over 100 ml usually indicates significant obstruction
In certain cases cystoscopy and transrectal ultrasound may be required to rule out any urethral or bladder pathology and to assess the size and morphology of the gland and to take biopsies
Management or treatment
.The choice of therapy depends on the severity of symptoms , the impact on quality of life and the complicating effects of bladder outflow obstruction
surgical intervention
Is indicated for urinary retention which has failed a trial of voiding without the catheter recurrent urinary tract infections
renal failure ,recurrent gross haemturia ,bladder stones and
failure of other modalities of management which are as follow
Watchful waiting
Pharmacotherapy
as phytotherapy in recent years the use of plant extracts (saw palmetto)have become popular
Alpha - adrenergic antagonists these agents block the action of noradrenaline on the prostatic smooth muscle to cause relaxation and thereby better emptying of the bladder
Also 5 alpha -reductase inhibitor as finasteride block the enzyme 5 alpha -reductase which inhibits the conversion of testerone to dihydrotesterone . this reduce intracellular activity and brings about a decrease in the prostatic volume
Minimally invasive procedures
These are mostly experimental and have not yet found their way into clinical practice and include prostatic stents , balloon dilatation of the prostate electrovapourization , endoscopic lazer ablation of the prostate (ELAP) high- intensity focused ultrasound)HIFU) transuretheral microwave thermotherapy (TUMT) transurethral needle ablation TUNA
TUIP|TURR transurethral resection of prostate
Is the gold standerd for small gland incision of the prostate may be used to open up the prostatic urethra
Retropubic prostatectomy
Is an open procedure and is considered when the gland is large it is also indicated if there is an additional pathology requiring intervention as bladder stones
.The choice of therapy depends on the severity of symptoms , the impact on quality of life and the complicating effects of bladder outflow obstruction
surgical intervention
Is indicated for urinary retention which has failed a trial of voiding without the catheter recurrent urinary tract infections
renal failure ,recurrent gross haemturia ,bladder stones and
failure of other modalities of management which are as follow
Watchful waiting
Pharmacotherapy
as phytotherapy in recent years the use of plant extracts (saw palmetto)have become popular
Alpha - adrenergic antagonists these agents block the action of noradrenaline on the prostatic smooth muscle to cause relaxation and thereby better emptying of the bladder
Also 5 alpha -reductase inhibitor as finasteride block the enzyme 5 alpha -reductase which inhibits the conversion of testerone to dihydrotesterone . this reduce intracellular activity and brings about a decrease in the prostatic volume
Minimally invasive procedures
These are mostly experimental and have not yet found their way into clinical practice and include prostatic stents , balloon dilatation of the prostate electrovapourization , endoscopic lazer ablation of the prostate (ELAP) high- intensity focused ultrasound)HIFU) transuretheral microwave thermotherapy (TUMT) transurethral needle ablation TUNA
TUIP|TURR transurethral resection of prostate
Is the gold standerd for small gland incision of the prostate may be used to open up the prostatic urethra
Retropubic prostatectomy
Is an open procedure and is considered when the gland is large it is also indicated if there is an additional pathology requiring intervention as bladder stones
.jpg)
.jpg)
0 comment:
Post a Comment