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![Microscopic anatomy
The prostate is historically divided in to
three zones [MCNEAL]
1. the transition zone
it surrounds the urethra
it is small in young adult, grows through out
life
responsible for about 20% BPH cases.
1. central zone
area surrounding the ejaculatory duct
only a very small percentage of cancer begins
from here[<5%]
1. peripheral zone
contain the majority of prostatic glandular
tissue, it is felt on DRE.
About 70-80% cancers begin from this zone
BPH 56-Apr-19](https://image.slidesharecdn.com/bph-190406123953/75/BPH-5-2048.jpg)
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BPH
- 1. BENIGN PROSTATE HYPERPLASIA (BPH) PRESENTER:KUWABOMWENDABAI DATE: 23/02/18 KABWE GENERALHOSPITAL BPH16-Apr-19
- 2. CONTENT 1. DEFINATION OFTHE PROSTATE 2. GROS ANATOMY 3. BLOOD SUPPLY 4. BPH DEFINATION 5. PATHOPYSIOLOGY 6. AETIOLOGY 7. CLINICAL PRESENTATION 8. COMPLICATIONS 9. INVESTIGATIONS 10.MANAGEMENT BPH 2 6-Apr-19
- 3. THE PROSTATE This isis a male reproductive organ whose main function is to secret prostate fluid,one of the components of semen.it is found in front of the rectum and just below the bladder BPH 36-Apr-19
- 4. • A normalprostate gland is approximately 15g-20g in weight. 3cm in length, 4cm wide, and 2cm in depth. However, when men get older, the prostate variable in size secondary to BPH • The gland is located posterior to the pubic symphysis, superior to the perineal membrane, inferior to the bladder, and anterior to the rectum. GROSS ANATOMY OF THE PROSTATE BPH 46-Apr-19
- 5. Microscopic anatomy The prostateis historically divided in to three zones [MCNEAL] 1. the transition zone it surrounds the urethra it is small in young adult, grows through out life responsible for about 20% BPH cases. 1. central zone area surrounding the ejaculatory duct only a very small percentage of cancer begins from here[<5%] 1. peripheral zone contain the majority of prostatic glandular tissue, it is felt on DRE. About 70-80% cancers begin from this zone BPH 56-Apr-19
- 6.
- 7. BLOOD SUPPLY OFTHE PROSTATE ARTERIAL SUPPLY Branches of internal iliac artery • Branches from inferior vesicle artery. • Branches from middle rectal artery. • Branches from internal pudendal artery. There are two types of branches • Capsular and Urethral • Urethral branches mainly supply the median lobe Capsular artery supply the glandular tissue. VENOUS DRAINAGE • Veins from the prostatic plexus drain into the internal iliac vein.BPH 76-Apr-19
- 8.
- 9. DEFINITION • BPH isthe enlargement of the prostate. The prostate often enlarges to a point where urination becomes difficult. BPH is more prone to adults above the age of 50,usually betwen 60 and 70 years(SRB manual of surgery) • benign prostatic hyperplasia is non cancerous growth of the prostate gland. BPH 96-Apr-19
- 10. PATHOPHYSIOLOGY Although thecause of BPH is not completely understood, it is thought BPH results from endocrine changes associated with the aging process. Prostate causes may include excessive accumulation of hormones like estrogen. Typically BPH develops in the inner part of the prostate. This enlargement gradually compresses the urethra eventually leading to partial or complete obstruction. 10BPH 6-Apr-19
- 11. Patho cont.... Itis the compression of the urethra that ultimately leads to development of clinical symptoms. There is no direct relationship between the size of the prostate and the degree of obstruction. It is the allocation of the enlargement that is significant in the development obstructive symptoms. For example, it is possible for mild hyperplasia to cause severe obstruction; likewise it is possible for extreme hyperplasia to cause to few obstructive symptoms. 11BPH 6-Apr-19
- 12. AETIOLOGY • There isno known cause (Idiopathic)+ Predisposing factors Age : over 50 years as part of natural aging process(increase in androgen receptors) Hormone imbalance between testosterone and estrogen Chronic prostitis : common affects men over 50 years. Obesity :(increase in abdominal girth)-especially if they are inactive(physical activities exerts protection against prostatic enlargement) family history : involving first degree relatives BPH 126-Apr-19
- 13. CLINICAL PRESENTATION (LUTS/Prostatism) IRRITATIVE SYMPTOMS •Frequency • Nocturia • Urgency • Urge incontinence OBSTRUCTIVE SYMPTOMS • Hesitancy • Dysuria • Intermittency • Poor stream • Residual volume • Post-micturitional dribblingBPH 136-Apr-19
- 14. BLADDER OUTFLOW OBSTRUCTION (BOO) Thiscan also be caused by BPH. Its symptoms are: • Abdominal pain • Continuous filling of a full bladder • Frequent urination • Acute Urinary Retention • Dysuria • Urinary Hesitancy • Slow urine flow • Intermittence • Nocturia BPH 146-Apr-19
- 15. INVESTIGATION • FBC • Ultrasound,IntravenousVenourogram (IVU),trasrectal US • Biopsy • Urine M/C/S or urinalysis • U & Es • Cystoscopy • Post voiding residual urine: Normal < 100mls • Flow Rates: Normal = 15mls/sec , Abnormal(Low): <10mls/sec • Prostate Specific Antigen (PSA) -rule out cancer • Acid phosphotase BPH 156-Apr-19
- 16. Examination 1.Digital rectal examinations: reveals smooth, firm, elastic and enlarged prostate. 2.0n abdomen palpation: enlarged bladder, kidney and constipation BPH 166-Apr-19
- 17. WHEN SHOULD BPHBE TREATED? BPH needs to be treated only if: The symptoms are severe enough to bother patient and affect the quality of life. Renal insufficiency Frequent urinary tract infection. NOTE: if the above are not a problem....management is ''watctful waiting'' BPH 176-Apr-19
- 18. MANAGEMENT MEDICATION *two major types: Alpha-1-blocker-relax the prostate and provide a larger urethral opening prazosin terazosin 5-alpha reductase inhibitor-shrink the prostate gland finasteride (proscar) Antibiotics (if suspected UTIs) Conservative therapy (catheterisation) BPH 186-Apr-19
- 19. Possible side effectsof medication Impotence Dizziness Headache Fatigue Loss of sexual drive BPH 196-Apr-19
- 20. Management cont.…… Management ofBPH is based on patient’s complaints and clinical assessment IPSS (International Prostate Score System) 7 symptoms each with a score of 5 = 35 in total 1. feelling of incomplete bladder emptying, 2. frequecy, 3. intermitency, 4. urgency, 5. weak stream, 6. straining and 7. nocturia score (points) symptoms management 0-7 mild conservative 8-19 moderate medical treatment 20-35 severe surgical BPH 206-Apr-19
- 21. MANAGEMENT….cont’d • Failure ofMedical Tx • Hematuria • Acute retention of urine • Complications (stone formation,hydronephrosis,recurent infections) • When IPSS > 20 • Pt’s choice • Bladder diverticulum • Post voiding residual urine: more than 100mls INDICATIONS FOR SURGERY BPH 216-Apr-19
- 22. • “Gold Standard”of care for BPH • Uses an electrical “knife” to surgically cut and remove excess prostate tissue • Effective in relieving symptoms and restoring urine flow Transurethral Resection of the Prostate(TURP) BPH 226-Apr-19
- 23. Surgical treatment Complications ofTURP hemorrhage TURP syndrome hypothermia septicemia NOTE: TURP syndrome is caused by hyponatremia due to constant flushing during surgery (nausea, vomiting, fatigue, disorientation, seizures or brain edema ) BPH 236-Apr-19
- 24. Other Procedures Transurethral Resectionof the prostate This is the surgical procedure involving the removal of the prostate tissue using a resectoscope inserted through the urethra. This has been considered the gold standard surgical treatment for obstructing BPH. No external surgical incision is made. Transurethral incision of the prostate The procedure can even be done under local anesthesia. No surgical incision is required. Suprapubic prostatectomy This operation may be chosen when the prostate is large and when bladder surgery is indicated as well Retropubic prostatectomy This is a useful approach if the prostate is too large or cancer is suspected. An abdominal incision is made above the bladder 24BPH 6-Apr-19
- 25. Differentials stricture urethra bladder tumor bladdercarcinoma neurogenic causes (Diabetes) idiopathic detrusor activity bladder neck stenosis BPH 256-Apr-19
- 26. COMPLICATIONS Hemorrhage-Due to sippageof a ligature during surgery Infection- On the incision due to lack of aseptic techniques during wound cleaning Shock- Due to bleeding Acute urine retention-Due to poor irrigation Urethral stricture-Due to damage during surgery like in transurethral prostatectomy 8/20/2013 26
- 27. COMPLICATIONS Acute or chronicrenal failure-Due to hydronephrosis Hydronephrosis-Due to incomplete bladder irrigation UTI –Due to urine stasis Pyelonephritis-Due to delayed treatment of acute urine retention Detrusor muscle hypertrophy- Due to urine stasis. 8/20/2013 27
- 28.
- 29. REFERENCES • SHORT PRACTICEof SURGERY 25th Edition, N Williams, et al, Hodder Arnold Publishers, 2008 • Medscape.com • Revised Magic Notes (Surgery) • SRB manual for surgery • wwww.Uptodate BPH 296-Apr-19