Benign prostatic hyperplasia - symptomes and treatment

Benign prostatic hyperplasia - symptomes and treatment

1. BENIGN PROSTATIC HYPERPLASIA (BPH)

2. WHAT IS BPH? It is an enlarged  prostate gland. The   prostate gland surrounds the urethra. As the prostate gets bigger, it may squeeze or partly block the urethra, which causes problems with urinating.   It is also known as benign prostatic hypertrophy .

3. ANATOMY The prostate: is a gland that forms part of the male reproductive system. It is a conduit between the bladder and the urethra. It is composed of several zones. (Peripheral, central, anterior fibromuscular stroma, and transition zones). BPH originates in the transition zone, which surrounds the urethra.

4. BPH The main function of the prostate gland is to secrete an alkaline fluid that comprises 70% of the seminal volume. The secretions produce: lubrication and nutrition for the sperm. liquefaction of the seminal plug. neutralize the acidic vaginal environment.

5. CAUSES OF BPH BPH is probably a normal part of the aging process in men. Changes in hormone balance. Changes in cell-growth factors. Genetics (may also play a role).

6. PATHOPHYSIOLOGY Prostatic enlargement depends on the potent androgen dihydrotestosterone (DHT). In the prostate gland, type II 5-alpha-reductase metabolizes circulating testosterone into DHT, which works locally , not systemically . DHT binds to androgen receptors in the cell nuclei, potentially resulting in BPH.

7. PATHOPHYSIOLOGY vitro studies have shown that large numbers of alpha-1-adrenergic receptors are located in the smooth muscle of the stroma and capsule of the prostate. Stimulation of these receptors causes an increase in smooth-muscle tone, which can worsen LUTS. Microscopically , BPH is characterized as a hyperplastic process. The hyperplasia results in enlargement of the prostate that may restrict the flow of urine from the bladder, resulting in clinical manifestations of BPH. The prostate enlarges with age in a hormonally dependent manner. Notably , castrated males ( e.g : who are unable to make testosterone) do not develop BPH.

8. SIGN AND SYMPTOMS Many men with  BPH have no symptoms . When symptoms (lower urinary tract symptoms) occur , they may range from mild to serious and disruptive . The amount of  Prostate 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.

9. SIGNS AND SYMPTOMS The symptoms of BPH may involve problems emptying the bladder or problems with  bladder storage, they include: Urinary frequency Urinary urgency Incomplete bladder emptying Decreased force of stream Difficulty initiating the urinary stream; interrupted, weak stream Straining - The need strain or push to initiate and maintain urination in order to more fully evacuate the bladder Dribbling - The loss of small amounts of urine due to a poor urinary stream

10. PROGNISIS Chronic BOO secondary to BPH may lead to: Urinary retention Renal insufficiency Recurrent UTI Gross hematuria Bladder calculi

11. IS BPH A TYPE OF CANCER? No ! BPH is completely benign. It is  not  a precursor to   prostate cancer. But prostate cancer may cause symptoms similar to those of BPH.

12. Diagnosis of BPH

13. 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.

14. Tests that are often done : A prostate-specific antigen (PSA) test  helps check for prostate cancer, which can cause the same symptoms as BPH.

15. Tests that are used as needed A blood creatinine test checks how well your  kidneys are working . Post-void residual urine test (PVR) measures the amount of urine left in the bladder after urination using   ultrasound or a small tube ( catheter ) put into the bladder through the urethra.

16. Tests that are used as needed Pressure flow studies measure pressure in the bladder while urinating . Cystometrogram  measures the bladder's pressure, compliance, and capacity during urinary storage. Like a  uroflowmetry test , which measures how fast the urine flows out of the bladder.

17. Non pharmacological treatment of BPH

18. Non pharmacological treatment Limiting the amount of fluids you drink in situations where needing to go to the toilet may be inconvenient. Avoiding drinks that are diuretics because they increase the amount of urine released by the body.

19. Non pharmacological treatment Using double-voiding technique when you urinate : after urinating, you wait a moment and try again to see if more urine comes out. Doing exercises to train your bladder to hold more urine.

20. PHARMACOLOGICAL TREATMENT

21. Drugs Used For BPH α 1-adrenoceptor-blocking agents 5 α -reductase inhibitors

22. α 1-adrenergic antagonist Terazosin, Doxazosin, Tamsulosin , Alfuzosin , & Silodosin Mechanism of Action They block the α 1(A) and α 1(B) receptors in the prostate, causing prostatic smooth muscle relaxation, which leads to improved urine flow.

23. Doxazosin , Terazosin ,& Alfuzosin block α 1(A) and α 1(B) receptors, which decrease peripheral vascular resistance and lower arterial BP by causing relaxation of both arterial and venous smooth muscle. Tamsulosin & silodosin , are more selective for the α 1(A) receptors and have less effect on BP.

24. Adverse Effects Dizziness, a lack of energy, nasal congestion, headache, drowsiness and orthostatic hypotentsion . Tachycardia, vertigo, and sexual dysfunction. Inhibition of ejaculation and retrograde ejaculation. Tamsulosin has a caution about “ floppy iris syndrome”, a condition in which the iris billows in response to intraoperative surgery.

25. Doxazosin (CARDURA®, CARDURA XL®, CADEX®) S/E: (dizziness, headache, diarrhea, low blood pressure …). Preparations: TAB. (1,2,4&8 mg) TAB. SR (4&8 mg ).

26. Tamsulosin ( FLOMAX®) S/E: (anemia, nausea & vomiting, weakness, headache … ). Preparations: 0.4mg Cap. Dosing : The dose may be increased after 2-4 weeks if the response is not adequate.

27. 5- α reductase inhibitors Finasteride & Dutasteride Mechanism of Action They inhibit the enzyme 5- α rductase, which is responsible for converting testosterone to the more active dihydrotestosterone (DHT). DHT is an androgen that stimulates prostate growth. By reducing it, the prostate shrinks and urine flow improves.

28. Adverse Effects Sexual side effects ..( decreased ejaculate, decreased libido, ED, gynecomastia , & oligospermia ). They have teratogenic potential.. (Causing birth defects involving genitalia in a male fetus ).

29. Fenasteride ( PROSCAR®) S/E: ( impotence, decreased libido, confusion, …). Preparations: 1,5 mg TAB . . Dosing : F or 6-12 months to notice a benefit.

30. Dutasteride ( AVODART®) S/E: (impotence, ejaculation disorder ..). Preparation: 0.5mg liquid-filled capsule.

31. DRUGS FOR BPH TRADE NAME ACTIVE INGREDIENT COMPANY DISTRIBUTER XATRAL ALFUZOSIN SANOFI MSS ALFU-KAL XL ALFUZOSIN PERRIGO BD&M CADEX DOXAZOSIN DEXCEL مستودع الرام TAMSULOSIN teva TAMSULOSIN TEVA مستودع نابلس OMNIC TAMSULOSIN ASTELLAS ش. صيام للأدوية AVODART DUTASTERIDE GSK

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

33. THANK YOU DONE BY: ALA’ ABU TAIR BAYAN ABU SBEIH RINAD BAKRI