Benign Prostatic Hyperplasia and Urethral Strictures - Epidiemiology, SIgns and Symptoms, Investigations and Managment

BPH and Urethral Strictures

1. BPHAND URETHRAL STRICTURE
SAADD NAEEM

2. BPH
•Definedasnoncancerousincreaseinthesizeofthe prostate gland,
involving hyperplasia of stromal and epithelial cells in the transitional zone,
creating discrete nodules that push the urethra and cause urine outflow
obstruction.
•Causative molecule is Dihydrotestosterone
•Mostcommon urologic problem in men, incidence increases dramatically
after 40, reaching 80-90% for men over 70. Overall projection is 27.3% for men
over 40 by 2025.

3. RISK FACTORS/CAUSES
•Aging
•FamilyHistory
•Ethnic Background (lesscommoninAsian ethnicities)
•Diabetes, IHD
•Obesity, Sedentary Lifestyle
•Alcoholconsumption
•Prostatitis, Prostatic Carcinoma

4. SIGNS/SYMPTOMS
Patients will present with:
•Hesitancy in starting urination
•Increasedfrequency of urination
•Nocturia
•Urgency
•Abdominal straining
•Decreased volume and force of urination
•Interruption in urinary stream
•Dribbling
•Urinary retention
Patients can have the following signs:
•Enlarged, smooth prostate on DRE

5. DIFFERENTIAL DIAGNOSES +
COMPLICATIONS
•Acute Urinary Retention
•UTI
•Cystolithiasis
•Vesicoureteral reflux
•Hydronephrosis
•Gross hematuria
•UTI
•Urethral Stricture
•Prostatitis
•Prostatic Carcinoma

6. INVESTIGATIONS
•URE
•Serum PSA
•Uroflowmetry
•Ultrasound Prostate
•MRI/CT scan
•CBC
•RFT’s

7. TREATMENT
Medical:
•Alpha Blockers: Relax the neck and muscle fibers in the prostate,
include tamsulosin, silodosin, work better with smaller prostates,
cause orthostatic hypotension
•5 Alpha Reductase Blockers: Reduce the production of DHT, reducing
size of prostate, include finasteride, dutasteride, cause loss of libido,
erectile dysfunction, gynecomastia, infertility
•Both can be used in combination as well
•Immediate catheterization if urinary retention in present

8. TREATMENT
Invasive:
• Transurethral Microwave Thermotherapy
•Transurethral Needle Ablation (radiowaves)
•Interstitial Laser Coagulation
•Photovaporization
•Laser prostatectomy
•All ablate the tissue, can cause urinary retention so patients are sent home with an indwelling
catheter
•Normal function achieved 24-48 hrs later
•Intraprostatic urethral stents (recurrent UTI, strictures)
•TURP, most common procedure, done under spinal or GA, resectoscope is inserted through the
urethra, excise and cauterize tissue, catheter placed and bladder irrigation done, can cause
bleeding, clot retention, dilutional hyponatremia
•Transurethral Incision of the Prostate makes several small incisions along the prostate wall,
expanding the urethra, only for small to moderate BPH

9. URETHRAL STRICTURES
• Defined as abnormal narrowing or loss of
distensibility of any part of the urethra.
•Urethra has multiple parts: Males (20.5cm,
prostatic, membranous and penile) Females
(4 cm, proximal, middle and distal urethra)
•It is not common by itself, but is common as
a complication of some other disease process

10. RISK FACTORS/CAUSES
•Idiopathic
•Trauma (stone, surgical procedure, catheter, trauma)
•Inflammatory (post gonococcal, post chlamydial, tuberculous urethritis, allergic
reaction to latex catheter)
•Forms when urethra heals using fibroblast proliferation, which then contract as
scar matures, blocking outflow
•Urethra will be dilated proximal to the stricture

11. SIGNS/SYMPTOMS
Patients will present with:
•Hesitancy in starting urination
•Increased frequency of urination
•Nocturia
•Terminal dribbling
•Feeling of incomplete urination
•Poor stream
•Straining while micturition
•Urinary retention

12. INVESTIGATIONS
•URE
•Ultrasound KUB
•Uroflowmetry
•Retrograde
urethrogram
•Cystourethroscopy
•Voiding
Cystourethrogram
•MRI/CT scan
•CBC
•RFT’s

13. TREATMENT
•Immediate catheterization if urinary retention is present
•Urethral Dilation: Uses bougies, stretches the scar out, needs to be done
multiple times to be permanent, can cause bleeding, urethral/prostate
rupture, UTI
•Endoscopic Direct Vision Internal Urethrotomy: Incise the scar using
endoscope, cannot be done for long or complete stricture, 50-70% success,
can cause recurrence, bleeding, UTI, erectile dysfunction
•Urethral Stenting: Done for short, incomplete strictures
•Urethroplasty: Can be done for all strictures, for previous failed procedures
•Can be: Excision and Primary Anastomosis (shorter strictures, can cause
ejaculatory/erectile dysfunction, penile shortening, recurrence) or
Substitution Urethroplasty (for longer strictures, use mucosal grafts or skin
flaps, can cause bleeding, infections, diverticulum or fistula formation)

14. THANK YOU!
Saadd Naeem 2024-070