college of medicine- Baghdad university

1. Benign prostatic hyperplasia
Presented by;
Nour Fawzi

2. Epidemiology
• According to NIH, BPH affects 50% of
men >60 years of age
• Affects >90% of men over 70 years of age
• Men who have undergone bilateral
orchiectomies do not develop BPH
• Affects Blacks, Whites, Asians
• genetic predisposition

3. Pathology
• nodular hyperplasia commonly affects the
transitional zone of the prostate .The
hyperplasia is stimulated by
androgens(dihydrotestosterone)& it affects
both smooth muscle cells and glandular
connective tissue.
• Prostatic capsule play an
Important role in development of
symptome.

4. BPH
LUTS + enlarged prostate +
BOO
Conditions potentially Clinical
presentation
AUA Symptom
leading to LUTS include ;
Anoxia obstructive Index Scoring ;
Aging symptom 0-7 mild
High nocturnal diuresis irritative symptom 8-19 moderate
Obstruction Physical
Age related disease 20-35 severe
examination DRE
Local condition
Neurologic disease

5. Investigations
• 1.urialysis (infection,hematuria)
• 2.renal function test :
s.creatinine(obstruction)
• 3.serum PSA : elevated
• 4.rectal ultrasound
• 5. CBC/Coagulation studies
• 6.urodynamic studies for assessment of
urine flow
• 7. cystoscopy

6. Medical Management
• A. observation
• B. medication :
– 5-alpha reductase inhibitors
• Inhibit production of DHT
• Finasteride (Proscar)
• Dutasteride (Avodart)
– Alpha blockers
• Dilate blood vessels and relax smooth muscles in prostate and bladder neck
• Tamsulosin (Flomax)
• Terazosin (Hytrin)
• Doxazosin (Cardura)
• *Combination therapy proven superior in treatment of
BPH and is now recommended by American urologic
association

7. Surgical treatment
• Transurethral resection of prostate (TURP)
– Gold standard
– Surgical procedure requiring spinal or general anesthesia
– Resectoscope inserted through urethra
– Gland removed in small chips by electrical cutting loop
– Inpatient hospitalization required
• TUIP (transurethral incision of prostate)
• TUMT (transurethral microwave therapy
• Other BPH Surgical Management :
• Laser therapy , transurethral needle ablation , Balloon dilatation ,
• Prostatic stents
• Open prostatectomy