Benign Prostatic Hyperplasia - VPNG

Rohan Hall

Goldfields Urology

Bendigo

Full Steam Ahead

Full Stream Ahead

LUTS

Age <45 – 20%

Age 65-79 – 48%

Age 80> - 70%

OAB (urgency, frequency, nocturia, UUI)

BOO (hesitancy,poor flow, incomplete emptying)

BPH

Aetiology

?

Testosterone

DHT

Oestrogen

Family history

Pathophysiology

Smooth muscle

Glandular tissue

Prostatic capsule

Intravesical extension / middle lobe

Clinical Sequelae

OAB – Urgency and urge incontinence

Urinary retention

Detrusor failure

UTI

High pressure storage or voiding – renal failure

Ejaculatory dysfunction

Medical Management

Smooth muscle

Alpha blockade

- selective

Glandular tissue

Dutasteride/fina

steride

OAB / detrusor

irritability

Ditropan

Vesicare

Betmiga

Diet

Surgical Management

Divide high bladder neck

Resect intravesical middle lobe

Dilemma:

Retrograde ejaculation

Urethral stricture

Urgency/Urge Urinary Incontinence

Risk of anaesthetic

Open Prostatectomy

Traditional approach prior to endoscopy

Large prostates

Pro’s – tissue for examination, less risk to

urethra

Con’s – surgical risk, incontinence risk,

TURP

“Re-bore”

“ Coring out an apple”

“Gold Standard”

Pro’s – physically remove obstruction, tissue for pathology

Con’s – issues with large glands, retrograde ejaculation, anticoagulation, stricture

Laser Ablation

Vaporisation

Pro’s – anticoagulation, 19Fr sheath

Con’s – anticoagulation, length of operation,

urethral strictures, no tissue for pathology,

depth of ablation, need for second procedure

Urolift

“0% sexual side effects”

Better for smaller gland

Less bleeding

In reality…….

HOLEP

Established as safe in trials

Pro’s – tissue for pathology, large volume

removed

Con’s - retrograde ejaculation, morcellation,

urethral stricture

Hydrodissection

New

Aquablation

Dissection versus ablation

Embolisation

Controversial

Proven for menorrhagia

Erectile dysfunction

CBI

Why?

Virchow’s triad

Solution

2 bags – why

Counting bags

Titration

Recovery – tips

Bladder spasm – ditropan (2.5-5mg prn)

Traction

Manual washout

Questions?