Complications of Benign Enlargement of Prostate

BEP complications

1. COMPLICATIONS of BPH

2. 1. Bladder stones Prevalence: 8 times higher in BPH N o increased incidence of ureteral or kidney stones However, In clinical practice, the risk for bladder stone development is small, and screening is only indicated if clinical circumstances warrant it (e.g., hematuria, stuttering of urination).

3. 2. Bladder Decompensation P rogression from normal mucosa to advancing trabeculation, development of cellules, and diverticula, with ultimate detrusor muscle failure in mind. Biopsies from trabeculated, obstructed bladders show dense Connective tissue deposition UB Fibrosis occurs in both sexes with advancing Age

4. 3. Upper Urinary Tract Deterioration and Azotemia Patients in renal failure have an increased risk for complications after TURP compared with those with normal renal function (25% vs. 17%) M ortality rate increases up to 6- fold. “ S ilent obstruction / Silent prostatism ”: C onstellation of asymptomatic patients who eventually develop renal failure resulting from BOO. Rare and Important “ R enal azotemia ”: Doubling of serum creatinine from baseline

5. 4. AUR I nability to urinate with increasing pain O ne of the most significant complications or long-term outcomes d/t BPH. Indication for TURP: Refractory AUR (after failure of TWOC once) Causes: Poorly understood Role of O bstructive, Myogenic and Neurogenic Risk factors: Prostate infection, UB O verdistension, Excessive fluid intake, Alcohol consumption, Sexual activity, Debility, and Bed rest Prostate infarction may be an underlying event causing AUR ( Graversen et al., 1989 ) (v/s other study --- s/o no role)

6. Spontaneous v/s Precipitated AUR P r ecipitated AUR: I nability to urinate after a triggering event such as --- Non–prostate-related surgery, Catheterization , Anesthesia, Ingestion of medications with α- sympathomimetic or anticholinergic effects or antihistamines; or others. Spontaneous AUR: All other AUR episodes besides above mentioned factors Clinical Importance: I mportance of differentiating the two types of AUR becomes clear when evaluating the ultimate outcomes of patients. After S pontaneous AUR: 15% of patients had another episode of spontaneous AUR, and a total of 75% underwent surgery (v/s) after P recipitated AUR, only 9% had an episode of spontaneous AUR, and 26% underwent spontaneous surgery

7. 5. Urinary Incontinence Causes: After TURP: Incontinence is one of the most feared complications from surgical intervention for BPH. BPH complicated with “Overdistension of the UB” (Overflow incontinence) BPH complicated with “ D etrusor instability”: affect up to >=1/2 of all obstructed patients (Urge incontinence) Also a/w Aging

8. 6. UTI Cause: Increase in PVRU predispose to UTI development, clear evidence is lacking

9. 7. Hematuria P ts with BPH might develop Gross hematuria and form Clots with no other cause being identifiable. I n patients predisposed to Hematuria, “ M icrovessel density ” is higher.