for undergraduate

1. BENIGN PROSTATIC
HYPERTROPY (HYPER
PLASIA) {BPH}
COMMONEST CAUSE OF
URINE RETENTION IN MALES,
50 YEARS & ABOVE.

2. BPH- a disease
• Aging males
• Very uncommon in the eunuchs and males
castrated before puberty.
• Symptoms usually referred to as
prostatism.

3. Types of enlargement.
glandular muscular Mixed
Huge Smallish Moderate in
size
Firm Very firm- hard Firm
Rubbery Rubbery Rubbery
Good cleavage No cleavage Mixed cleavage
plane

4. Types contd.
• Depends on the dominant component of
enlargement.
– Glandular usually massive.
– Stromal (parenchymal or muscle & fibre
components), moderate in size.
– Mixed; glandular & /or parenchymal.

5. Pathophysiology.
• This is a pathologic process that contribute
to, but is not the sole cause of lower
urinary tract symptoms (LUTS), in aging
men.
• Divided into 3 parts.
– Point of obstruction
– Distal segment
– Proximal segment.

6. Point of obstruction
• Capsule limits external encroachment
• Urethra narrowed into a slit
• Urethral elongation.
• Increase in the urethral curvature.
• Total closure and urine retention.
• Median lobal involvement-ball valve
effects & double micturition.

7. Distal segment.
• Empties its contents b/4 obstruction
• Undergoes physiological hibernation.
• No observable physiological changes

8. Proximal segment.
• Two major changes.
– Compensational changes.
– Decompensational changes.

9. compensation
• Mobilization of all the reserves.
• Intermittent painful contractions
• Hypertrophy of detrusor muscles.
• Trabeculations
• Sacculations
• Diverticulations.
• Ascending damages

10. Decompensation.
• Tired bladder, becomes flabby.
• Ascending structural damages.
– Tortuous ureters
– Hydroureters,
– Hydrocalycosis.
– Hydronephrosis

11. Decompensation contd.
• Stagnation & sedimentation forming nidus for
stone building.
– Cystolithiasis.)
– Ureterolithiasis) chronic irritations plus
?haemorrhage
– Nephrolithiasis)
ASCENDING INFECTIONS.
cystitis, ureteritis, nephritis.
seminal vesiculitis, epidydimitis, orchitis etc.

12. SYMPTOMS.
• DYSURIA
• FREQUENCY
• NOCTURIA
• URGENCY & URGE INCONTINENCE
• INTERMITENCY
• TERMINAL DRIBBLING
• INCONTINENCE
• FEELING OF INCOMPLETE BLADDER EMPTYING.
• +/- HAEMATURIA
• SYMPTOMS OR COMPROMISED KIDNEY
FUNCTIONS

13. PHYSICAL EXAMINATION
• General:- outlook, anemia, constitutional
changes
• Local assessment e.g. full bladder,
ballotable kidneys.
• DRE which compulsorily must be done

14. Investigations.
• Base line.
• Specific.
– Microbiology
– Haematology
– Chem path.
– Radiological
– +/-hitopathology.

15. Special compulsory tests
• P.s.a
• A.c.p
• R.f.t
• Abd. u/s
• +/- ivu.

16. Other tests.
• Uro-dynamic studies
– Residual urine after voiding.
– Uroflowmetry, Q
• Qmax = 15mls/sec
-cystometry
-urethral pressure profile.

17. Treatment.
• There are absolute indications for
treatment of BPH
– Urine retention
– Damage to the upper tracts.
– Profuse haematuria.
– Others are relative and depends on the
patient choice and disposition.

18. Quantifying symptoms.
• This is obtained after careful evaluation of the
history. Serves as a guide to helping patient
choose whether to be treated or not
• American Urological Association developed a
urological symptom score that enables both the
surgeons and the patient to decide on whether
to be treated or not.
• Initially 73 questions
• W H O set up another committee that came out
with the symptoms scores in recent use.

19. INTERNATIONAL PROSTATE
SYMPTOMS SCORE (IPSS)
• THERE ARE 7 QUESTIONS
• Each question scores from 0 - 5points
– Good (masterly inactivity + pt’s choice {0-7}
– Equivocal (Pt’s choice) {8-19)
– No choice ( Requires treatment) {20 & above.}

20. Questions.
Over the past year how often:-
1. do you have feeling of incomplete voiding?
2. do you urinate less than 2 hours after you finished
urinating?
3. Have you stopped and started during micturition?
(intermittency.)
4. Find it difficult to postpone micturition?-urgency.
5. Do you have weak stream of urine while urinating?
6. Do you push or strain to begin urinating?
7. Do you typically get up at night to urinate?

21. Answers.
Marked 0 – 5.
• 0 = not at all
• 1. = less than 1 time.
• 2 = less than half the time.
• 3 = about half the time
• 4 = more than half the time
• 5 = almost always.

22. .

23. Treatment
Masterly inactivity.
Medical .
Surgical.