Benign Prostatic Hyperplasia Dr Bandar Al Hubaishy Urology

Benign Prostatic Hyperplasia Dr. Bandar Al Hubaishy Urology Department KAUH

Clinical Presentation l l l Hesitancy Urgency Frequency Incomplete bladder emptying Drippling Decreased stream flow

Physical Examination l l 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 l l Uroflow meter l Kidney-bladder Ultrasound l TRUS biopsy

Medical Treatment l The prostate gland consists of : l Glandular tissue Fibromuscular tissue l

Medical Treatment l The prostate is rich in alpha receptors especially type 1 a 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 l l l Selective agents short-acting: prazosin, alfuzosin, and indoramin. long-acting: terazosin, doxazosin and slow-release (SR) alfuzosin. l Non selective agents Phenoxybenzamine l Partial selective agents Tamsulosin and silodosin.

alpha reductase inhibitors 5 l Finasteride (Proscar) l Dutasteride (Avodart)

Surgical management Indications: l AUR l failed voiding trials l recurrent gross hematuria l urinary tract infection. l renal insufficiency secondary to obstruction. l l l 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 : l l l very large prostates (>75 g), patients with concomitant bladder stones or bladder diverticula patients who cannot be positioned for transurethral surgery.