Medical notes (BPH)

Pic- urology.jhu.edu/prostate/bph.php
Urology

Benign prostatic hypertrophy

(Benign enlargement of prostate)

Etiology
Hormonal theory- decreased androgen and increased estrogen leads to hypertrophy.
Neoplatic theory- benign neoplasm of fibrous, muscular and grandular parts of prostate.

Pathogenesis
There is obstruction of urethra by the elongated prostate.
- Urethral changes- elongates, narrows.
- Bladder changes- hypertrophies with folds, I.e fasciculations and sacculation, the urine is caught up in them and may even cause diverticuli or stones due to stasis.
Kidney changes- hydronephrosis (enlargement due to stasis of urine).

Clinical features

Frequency- due to ineffective emptying of bladder.
Urgency
Hesitancy to pass urine because it is ineffective.
Acute and chronic retention of urine.
Hematuria.

Complications
Diverticuli
Stone
Hydronephrosis
UTI
Renal failure

Investigation

Urea, creatinine- rule out hydronephrosis and renal failure
Uroflowmetry- measures the flow of urine with a flow meter. If the flow is less than 10 ml/sec its peak obstruction.
Ultrasounds- prostate, bladder, kidney.
CT, MRI.

Staging
1- 1-2 cm on rectal exam
2- 2-3 exam on rectal exam
3- 3-4 cms on rectal exam
4- more than 4 cm mass.

Treatment.
If there is no obstruction and not much symptoms no medication, just advice them avoid alcohol.

Drugs-
Finastride acetate
Alpha adnenergic drugs.

Surgery

Indications- urinary retention
Frequency is unbearable, complication.

Transurethral resection a prostate

A resectoscope is sent via the ureter, constant irrigation is applied with water, prostate is cut into pieces.
Post op recovery is smooth, but water intoxication can happen.

Transvesical suprapubic prostectomy
If gland weighs more than 100 g
The prostate is accessed via the extra peritoneal approach, and ennucleated (removal of the entire organ without cutting) with fingers.
Malicot's catheter is used to drain the bladder.
Prostatic Urethra is dissected, but a new one develops along the foley's catheter by fibrosis.

Retro pubic prostectomy

Other method
YAG laser.