Benign prostate hyperplasia. increase in size of the prostate

Benign prostate hyperplasia

1. .Benign prostate hyperplasia
(Bph)
benign PROSTATE HYPERPLASIA
26-Sep-24
PRESENTED
BY
MUTEGEKI ADOLF

2. DEFINITION:
•Benign Prostatic Hyperplasia (BPH) is a non-
cancerous enlargement of the prostate gland,
typically occurring in older men.
•It is characterized by an overgrowth of
prostatic tissue that can lead to urinary
obstruction due to its location surrounding
the urethra

3. WHAT IS BPH?
Itisanenlargedprostategland.
Theprostateglandsurroundstheurethra.Asthe
prostategetsbigger,itmaysqueezeorpartlyblock
theurethra,whichcausesproblemswithurinating.
Itisalsoknownasbenignprostatichypertrophy.

4. ANATOMY
Theprostate:isaglandthatformspartofthe
malereproductivesystem.
Itisaconduitbetweenthebladderandthe
urethra.
Itiscomposedofseveralzones.(Peripheral,
central,anteriorfibromuscularstroma,and
transitionzones).
BPHoriginatesinthetransitionzone,which
surroundstheurethra.

5. BPH
oThemainfunctionoftheprostategland
istosecreteanalkalinefluidthat
comprises70%oftheseminalvolume.
oThesecretionsproduce:
lubricationandnutritionforthesperm.
liquefactionoftheseminalplug.
neutralizetheacidicvaginal
environment.

6. AETIOLOGY (CAUSES):
•Hormonal changes: The primary cause is
thought to be age-related changes in hormone
levels, particularly an imbalance between
testosterone and dihydrotestosterone(DHT),
which stimulates prostate growth.
•Aging: Men over 50 years are more prone to
BPH due to the long-term exposure to male
hormones.

7. •Genetic factors: Family history may
contribute to the risk of BPH.
•Lifestyle factors: Obesity, diabetes,
lack of physical activity, and poor diet
may increase the risk of BPH.

8. PATHOPHYSIOLOGY:
•Hormonal Influence: The prostate is highly sensitive
to hormonal changes, especially DHT, a potent
androgen derived from testosterone via the enzyme 5-
alpha-reductase.
•DHT promotes the proliferation of prostate stromal
and epithelial cells.
•Prostatic Enlargement: Over time, hyperplasia of the
gland leads to mechanical compression of the urethra
(urethral narrowing), increasing bladder outlet
resistance.

9. •Bladder Changes: The obstruction leads to
changes in bladder function, including
detrusor hypertrophy (thickening of the
bladder wall) and increased bladder
contractility to overcome obstruction.
•This results in symptoms of urinary
frequency, urgency, and incomplete bladder
emptying.

12. PATHOPHYSIOLOGY
oProstaticenlargementdependsonthepotent
androgendihydrotestosterone(DHT).Inthe
prostategland,typeII5-alpha-reductase
metabolizescirculatingtestosteroneintoDHT,
whichworkslocally,notsystemically.
oDHTbindstoandrogenreceptorsinthecellnuclei,
potentiallyresultinginBPH.

13. PATHOPHYSIOLOGY
vitrostudieshaveshownthatlargenumbersofalpha-1-adrenergic
receptorsarelocatedinthesmoothmuscleofthestromaand
capsuleoftheprostate.Stimulationofthesereceptorscausesan
increaseinsmooth-muscletone,whichcanworsenLUTS.
Microscopically,BPHischaracterizedasahyperplasticprocess.The
hyperplasiaresultsinenlargementoftheprostatethatmayrestrict
theflowofurinefromthebladder,resultinginclinical
manifestationsofBPH.
Theprostateenlargeswithageinahormonallydependentmanner.
Notably,castratedmales(e.g:whoareunabletomake
testosterone)donotdevelopBPH.

14. CLINICAL PRESENTATIONS:
•Many men withBPH have no symptoms.
When symptoms (lower urinary tract symptoms) occur,
they may range from mild to serious and disruptive.
•The amount ofProstate enlargement is not always
related to the severity of the symptoms.
•Your symptoms may become worse during cold weather
or as a result of physical or emotional stress.

15. •BPH causes Lower Urinary Tract Symptoms (LUTS),
which are categorized into obstructiveand irritative
symptoms:
•Obstructive Symptoms:
•Hesitancy (difficulty starting urination)
•Weak or intermittent urine stream
•Straining to urinate
•Prolonged time to urinate
•Feeling of incomplete bladder emptying
•Dribbling at the end of urination

16. •Irritative Symptoms:
•Increased frequency of urination, particularly
at night (nocturia)
•Urgency (strong, sudden need to urinate)
•Dysuria (painful urination)
•Other symptoms may include acute urinary
retention and, rarely, hematuria (blood in
urine).

17. COMPLICATIONS
Urinary retention
Renal insufficiency
RecurrentUTI
Gross hematuria
Bladder calculi

18. IS BPH A TYPE OF
CANCER?

19. No!
BPH is completely benign. It
isnota precursor toprostate
cancer.
Butprostate cancermay cause
symptoms similar to those of
BPH.

20. Diagnosis
of BPH

21. Tests that are often done :
Digital rectal exam.The doctor inserts a finger into
the rectum to check your prostate for
enlargement.
Urine test and urine culture.Analyzing a sample of
your urine can help identifying an infection or
other conditions that can cause similar symptoms.

23. •Digital Rectal Examination (DRE): To assess
the size, shape, and consistency of the
prostate.
•Prostate-Specific Antigen (PSA): Elevated PSA
levels may indicate BPH or prostate cancer.
•Urinalysis: To rule out infection or hematuria.
•Uroflowmetry: Measures the rate of urine
flow to assess obstruction.

24. •Post-void Residual (PVR) Measurement:
Ultrasound to measure the amount of urine left in
the bladder after urination.
•Imaging:
•TransrectalUltrasound (TRUS): For detailed imaging
of the prostate.
•Cystoscopy: To directly visualize the bladder and
urethra in severe cases.
•Urodynamic studies: To evaluate bladder function
if voiding symptoms are severe or complicated.

25. MANAGEMENT:
•Lifestyle Modifications:
•Reduce fluid intake before
bedtime.
•Limit caffeine and alcohol.
•Avoid medications that worsen
symptoms (e.g., decongestants).

26. •Medications:
•Alpha-blockers(e.g., tamsulosin, alfuzosin): Relax the smooth
muscles in the prostate and bladder neck to improve urine flow.
•5-alpha-reductase inhibitors(e.g., finasteride, dutasteride):
Reduce the size of the prostate by blocking the conversion of
testosterone to DHT.
•Anticholinergics: May be used for irritativesymptoms like urgency.
•Phosphodiesterase-5 inhibitors(e.g., tadalafil): Used in
combination to relieve both urinary symptoms and erectile
dysfunction.

27. •Minimally Invasive Procedures:
•Transurethral Resection of the Prostate (TURP):
Surgical removal of part of the prostate via the
urethra.
•Laser Therapy: To ablate prostate tissue.
•Prostatic Urethral Lift (PUL): Implants used to
lift and hold the enlarged prostate tissue,
relieving compression on the urethra.

28. •Surgical Management(for severe
cases):
•Open Prostatectomy: Removal of part or
all of the prostate, generally for very
large prostates.
•Transurethral Incision of the Prostate
(TUIP): Small cuts made in the prostate
to relieve pressure on the urethra.

29. Drugs Used For BPH
α1-adrenoceptor-blocking agents
5α-reductase inhibitors

30. α1-adrenergic antagonist
Terazosin,Doxazosin,Tamsulosin,Alfuzosin,&
Silodosin
MechanismofAction
Theyblocktheα1(A)andα1(B)receptorsinthe
prostate,causingprostaticsmoothmuscle
relaxation,whichleadstoimprovedurineflow.

31. •Doxazosin,Terazosin,&Alfuzosinblockα1(A)
andα1(B)receptors,whichdecrease
peripheralvascularresistanceandlower
arterialBPbycausingrelaxationofboth
arterialandvenoussmoothmuscle.
•Tamsulosin&silodosin,aremoreselectivefor
theα1(A)receptorsandhavelesseffecton
BP.

32. PREVENTION:
•While BPH cannot be entirely prevented, certain measures may
reduce the risk or delay its onset:
•Healthy diet: A balanced diet rich in fruits, vegetables, and healthy
fats may help maintain prostate health.
•Regular exercise: Helps reduce the risk of BPH by maintaining
healthy hormone levels and body weight.
•Weight management: Obesity is linked to an increased risk of BPH.
•Avoid smoking and alcohol: These can exacerbate urinary
symptoms.
•Regular medical check-ups: Early detection of prostate
enlargement can help manage symptoms before they become
severe.

33. Summary:
•BPH is a common condition in older men,
characterized by the enlargement of the
prostate and lower urinary tract symptoms.
Early detection and a combination of lifestyle
changes, medications, or minimally invasive
treatments can effectively manage the
condition.

34. References
•Pharmacology text book/ Lippincott illustrated reviews.
•http://emedicine.medscape.com/
•http://www.webmd.com/
•https://www.andrologyaustralia.org

35. THANK
YOU