Benign Prostatic Hyperplasia

Dr.Bandar Al Hubaishy

Urology Department

KAUH

Clinical Presentation

Hesitancy Urgency Frequency Incomplete bladder

emptying Drippling Decreased stream flow

Physical Examination

Suprapubic area for sign of bladder distension

DRE:

Prostate gland

size , nodularity , masses, surface, tenderness, anal tone

investigations

Laboratory tests:

CBC

U&E

PSA

Urine analysis

Urine culture and sensitivity

Uroflow meter

Kidney-bladder Ultrasound

TRUS biopsy

Medical Treatment

The prostate gland consists of :

Glandular tissue Fibromuscular tissue

Medical Treatment

The prostate is rich in alpha receptors especially type 1a which are responsible for LUTS in those patient. So, blocking these receptors can decrease the resistance along the bladder neck, urethra and prostate

Alpha blockers

Selective agents short-acting:

prazosin, alfuzosin, and indoramin.

long-acting:

terazosin, doxazosin and slow-release (SR) alfuzosin.

Non selective agents

Phenoxybenzamine

Partial selective agents

Tamsulosin and silodosin.

5 alpha reductase inhibitors

Finasteride (Proscar)

Dutasteride (Avodart)

Surgical management

Indications: AUR failed voiding trials recurrent gross

hematuria urinary tract infection. renal insufficiency

secondary to obstruction.

failure of medical therapy,

a desire to terminate medical therapy

financial constraints associated with medical therapy.

Transurethral resection of prostate (TURP)

Complications: Hemorrhage, urinary incontinence, impotance, retrograde ejaculation

Open prostatectomy

Indications : very large prostates (>75 g), patients with concomitant bladder stones or bladder

diverticula patients who cannot be positioned for transurethral

surgery.