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- 4. DEFINITION OF BPH PROGRESSION SYMPTOMATIC DETERIORATION. INCREASING BOTHERSOMENESS URINARY RETENTION PROGRESSION TO SURGERY RENAL INSUFFICIENCY
- 5. MASICON 2011
- 7. •Pathophysiology of Benign Prostatic Hypertrophy •Prostate growth •Increased urethral resistance •Decreased force of stream and intermittency, primarily obstructive symptoms •Detrusor response to maintain flow •Frequency, urgency, and nocturia, primarily detrusor (failure to store) symptoms
- 8. LUTS Symptom Group -Frequency -Poor stream -Straining to void -Hesitancy -Intermittency -Sensation of incomplete evacuation -Dribbling -Urgency -Nocturia
- 18. Natural History Of Benign Prostatic Hyperplasia 1-Histological prevalance- 30%at the age of 50 years 80% at the age of 80 years 2-IPSS Score >7 12% -26% at the age of40-49 years 46% at the age >70 years 3-Likelihood of treatment 3/1000 person-years at the age 40-49 years 30/1000 person-years at the age >70 years 4-Progression of disease over 5 years 37%-40% 5-Risk of urinary retention over 5 years 3%-7%
- 19. Candidates For Medical Therapy 1- Moderate to severe symptoms 2- Lack of absolute indications for surgery Recurrent urinary retention Recurrent or persistent gross hematuria Bladder stones Renal insufficiency
- 22. Adverse Effects Of Alfa Blockers • 1-Hypo tension • 2-Dizziness • 3-Headache • 4-Sexual dysfunction • 5-Fatigue • 6-Syncope • 7-Nasal congestion
- 23. Adverse Effects Of Hormonal Therapy • 1-Impotence • 2-Loss of libido • 3-Ejaculatory disorder • 4-Hot Flushes • 5-Gynacomastia • 6-Diarrhea
- 31. *TURP* *Indications -Age<80 yrs -Moderate to severe LUTS(IPSS>7) -Prostate size>20ml<80ml. *Procedure: -Perioperative antibiotics -Resection time<1hr -Resectoscope sheath</=24F -Avoid extensive bladder neck resection -keep patient warm -iso-osmotic&isothermal irrigation fluid *Postoperatively: -Foleys catheter 20-22F with continuous bladder irrigation -remove Foleys ASAP
- 33. *TURP* • Early complications:- • hemorrhage • myocardial infarction • TUR syndrome • urinary tract complications • Late Complications: • stress incontinence • urethral stricture • bladder neck contracture • erectile dysfunction • reoperation