Here is an overview of benign prostatic hyperplasia.

1. Benign Prostatic
Hyperplasia
(BPH)
DR MAHESH KUMAR
M.S.(Ay)
Assistant Professor
चौधरी ब्रह्म प्रकाश आयुर्वेद चरक संस्थान नई ददल्ली
8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 1
पौरुष ग्रंदथ र्वृद्धि
बुढ़ापे में गदू द
प्रोस्टेट का बढ़ना बुढ़ापे में मूत्र त्याग में ददक्कत होना

2.  Prostate is an organ found in male.
 It is walnut-shaped gland that forms part of the
male reproductive system
 The prostate surrounds the urethra at the
Urinary bladder neck
 Prostate has 5 lobes- Ant., Post., 2 lateral,
median
 Common disease of prostate are BPH, CA
Prostate, Prostatitis.
 The fascia of Denon-villier is part of pelvic
peritoneum prevent the spread of CA prostate
in rectum
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PROSTATE

3. BPH is a benign enlargement of the prostate gland
It is nonmalignant in nature
BPH caused by cellular hyperplasia of both glandular and
stromal elements that leads to troublesome LUTS in men
BPH- most common benign tumor in men
BPH is not a precancerous condition
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Benign Prostate
Hyperplasia BPH

4. 8/31/2021 7:04 AM BPH -Dr Mahesh Kumar 4
BPH- clinical
condition consist of
BPE+LUTS+BOO

5. Seondary effects in BPH
1. Effect on urethra
occurs
2. Changes in U.B
3. Changes at Ureter
and Kidney level
BACK PRESSURE
EFFECTS ON UB AND
KIDNEY LIKE
FASCICULATION,
SACCULATION,
HYDRONEPHROSIS.
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CHANGES IN
BPH
– Histologic: stromal and glandular
hyperplasia
• May be associated with
– Clinical: presence of bothersome
LUTS
– Anatomic: enlargement of the
gland (BPE = Benign Prostatic
Enlargement)1
– Pathophysiologic: compression of
urethra and compromise of
urinary flow BOO

6. BPH is part of the
natural aging
process,
Androgens/Estrogens
Lifestyle
Hereditary(genetic)/Unknown
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n
n
n
n
WHAT CAUSES
BPH ?
2 theories popular
regarding
aetiopathogenesis-
1.HORMONALTHEORY
2. NEOPLASTICTHEORY

7.  Frequent and urgent need to
urinate, especially at night
 Dribbling or leaking after
urination
 weak stream
 Urinary Retention
 Straining to urinate
 Pain or burning during urination
 Feeling that the bladder never
completely empties
-FREQUENCY
-URGENCY
-HESITANCY
-URINE
RETENTION-
ACUTE/CHRONIC
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SIGN-SYMPTOMS

8. • Prostate grows with age and time
• Pressure on the urethra restricts urine
flow smoothly.
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Why symptoms appear ?
Later if not treated-
Risk of bladder and kidney damage
 Impact on quality of life

9. Urinary retention
Renal impairment RENAL FAILURE
UTI
DIVERTICULI
Hematuria
Bladder stones
Bladder decompensation
Overflow incontinence as
a result of retention
RENAL FAILURE
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Complications

10. History taking
LOCAL & systemic Examination
DRE
Blood Investigations, BU, S.creatinine
Urinary flow test- uroflowmetry
Serum PSA levels
USG- Abdominal /TRUS
IVP, ystoscopy, Biopsy if needed
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How to make Diagnosis ?

11. BPH needs to be treated ONLY IF:
Symptoms, enough to affect quality of life
Symptoms like
 frequent UTI-urinary tract infections
 Bleeding
 damage to kidneys
 Damage to UB
 stones etc
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n
n
When to treat ?

12. Wait and watch….. On observation
Medical treatment
• alpha blockers
• 5-alpha reductase inhibitors (finasteride,
dutasteride)
• Combination alpha-blocker & 5 ARI
Surgical treatment
• TURP
• Minimally invasive surgeries
• Open prostatectomy
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MANAGEMENT

13. Regular Exercise,avoid weight gain
Limit fluid intake,
decrease bladder irritants-caffeine, alcohol;
avoid anticholinergic drugs, narcotics and muscle
relaxants
Consult Urologist if symptoms worsen or aggravate
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Wait and watch…..Lifestyle

14. Indications
• Signs and symptoms of BPH
• Patients not fit or unwilling to undergo surgery
• For the management at Before surgery & Post
surgery
8/31/2021 7:04 AM
BPH -Dr Mahesh Kumar
14
Medical Management
Two types of medicine prescribe
Muscle relaxants - relax the prostate and provide a larger
urethral opening (Tamsulosin, Alfuzosin)
Shrink the prostate gland (Dutasteride, Finasteride)

15. Benefits of
medical Mx
Convenient
No loss of work
time
Minimal risk
Disadvantages of
Medical Mx
• Expensive
• Drug Interactions
• Must be taken every
day
• Manages the
problem instead of
fixing it
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n
n
n
Medical Management……………………………..contd

16. • Alpha blockers: best monotherapy,
immediate symptom relief
• 5 alpha-reductase inhibitors: prevent disease
progression
• Combination therapy ( alpha blocker + 5
alpha-reductase inhibitor) is considered
most effective treatment for symptoms and
progression in case moderate-to-severe
symptoms
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Drugs……………

17. • This combination
is most effective
• Dual mechanism of
action
• Reduce clinical
progression of BPH
• Improve LUTS
symptoms
• Improve maximum
urinary flow rates
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• Long-acting
selective 1-
blockers
– Terazosin
– Doxazosin
– Tamsulosin
– Alfuzosin
– Silodosin

18. Surgery - Gold standard in symptomatic pt
Surgery is recommended in patients
in whom BPH causes:
– Renal insufficiency
– Urinary retention
– Recurrent urinary tract infection
– Bladder calculi
– Hydronephrosis
– Post void residual volume >500 mL
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Surgical Management

19. Suprapubic & retro pubic prostatectomy
Transurethral resection of prostate (TURP)
Laser prostatectomy
Transurethral incision of prostate
Intraprostatic stent
Balloon dilatation of prostatic urethra
Prostatic hyperthermia
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Surgical Methods

20. “Gold Standard” of care for BPH
Uses an electrical “knife” to surgically cut and
remove excess prostate tissue
Effective in relieving symptoms and restoring
urine flow
TURP
(transurethral resection of the prostate)
n
n
n
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21. Open Prostatectomy
• Conventional method
• Not done routinely
• When prostate too large forTURP (>100mL)
• Concomitant conditions - bladder diverticulum or
bladder stone present.
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22. TUMT
-transurethral microwave therapy
TUNA- transurethral needle ablation
Urinary Stents
Laser Prostatectomy
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23. CONCLUSION
BPH is an old age disease of men.
Many of BPH patient are asymptomatic or have only
mild symptoms, and may not require therapy,. Some
are manage with conservatively –Medical therapy.
Combined therapy is now in practice.
The alpha blocker like tamsulosin and 5-AR inhibitor
like finesteride therapy are good, for long-term
Treatment
TURP is the GOLD STANDARD for - an invasive
procedure, most popular procedure in urology.
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24. THANKS
THANK YOU SO MUCH FOR YOUR PATIENCE LISTENING…………..
धन्यर्वाद
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Note- for the teaching purpose of BAMS students only….