Jan 06, 2016
Benign Prostatic HyperplasiaDr.Bandar Al HubaishyUrology DepartmentKAUH
Clinical PresentationHesitancyUrgencyFrequencyIncomplete bladder emptyingDripplingDecreased stream flow
Physical ExaminationSuprapubic area for sign of bladder distension DRE: Prostate gland size , nodularity , masses, surface, tenderness, anal tone
investigationsLaboratory tests:CBCU&E PSAUrine analysis Urine culture and sensitivity
Uroflow meter
Kidney-bladder Ultrasound
TRUS biopsy
Medical TreatmentThe prostate gland consists of :
Glandular tissueFibromuscular tissue
Medical TreatmentThe 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 blockersSelective 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 trialsrecurrent 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 diverticulapatients who cannot be positioned for transurethral surgery.