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Benign Prostatic Hypertrophy BPH PowerPoint Presentation

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Description : Benign hyperplasia of Prostate gland is very common and well known diseases in elderly male. this is nothing but the old age urinary outlet irritative and may be some time obstructive pathology which clinically manifested by increase frequency of urination along with dysuria and some time may be retention of urine.

Tags : dr. panchal vinayak, BPH, Hyperplasia of prostate

Published on : Dec 30, 2019 | Views : 4180 | Downloads : 21

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Dr. VINAYAK J. PANCHAL. PG Scholar Dept of Shalya Tantra N. K. J. Ayurvedic Medical College and PG centre MOB NO- 9405160287, E-MAIL- dr.vinayakpanchal@gmail.com BPH (Benign Prostatic Hypertrophy )
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SYNONYMS Senile enlargement of prostate Benign Adenoma of prostate Adenomyoma of prostate Benign prostatic Hyperplasia Nodular Hyperplasia HYPERPLASIA = Owergrowth in number of tissue cells
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Anatomy of Prostate Gland Acessory Gland Glandular tissue in a fibromuscular stroma It surrounds 1st part of urethra Site = lies in lesser pelvis below the neck of urinary bladder, behind the lower part of pubic symphysis and upper part of pubic arch, & in front of ampulla of thr rectum. Size= 3* 4* 2 Wt = normally approx. 18 - 20 gm .
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Anatomy of Prostate Gland Lobes = 5 ( ant, post, 2 lat. 1 median) Capsuls = 1) True capsul= formed by peripheral part, fibromuscular, continues with stroma, no venous plexus 2) False capsule = lies out side the true capsule, derived from endopelvic fascia Blood supply = Inf. Vesical Middle rectal Int. pudendal Atr. Venous return= Int. pudendal Int. Iliac
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Zones of prostate
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Hormonal changes on prostate (Normal) Hypothalamus LHRH (Leutinising hormone Relesing hor.) Ant. Pitutary Lobe LH (Leutinising Hormone) Leyding cell of testis Testesteron Prostate 80% Prostatic Fluid 20% By 5 Alpha reductase in high conc. 5 dihydrotestesteron ( DHT)= Normal growth of prostate 2% to 5%
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AETIOLOGY 1) IDIOPATHIC 2) AGE RELATED 3) 50 YRS « CAUSES 1) Hormonal Theory 2) Neoplastic Theory Hormonal Theory Androgenic activity Androgen = Oestrogen Predominance of Oestrogen Neoplastic Theory Growth of benign neoplasm i.e. Adenoma / Adenomyoma Fibroadenomyoma
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Mechanisms of enlarge prostate (Hormonal theory) Old age – Oestrogen & Adrogen Ant. Pitutary Lobe LH Total conversion by 5 Alpha reductase Hypothalamus LHRH Testesteron 5 dihydrotestesteron ( DHT) Directly responsible for of Prostate
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PATHOLOGY CHENGES = 2 TYPES OWERGROWTH OF GLANDULAR ELEMENT - Soft OWERGROWTH OF CONNECTIVE TISSUE ELEMENT- Firm Lobes Involved 1) Median – gland Project upword in bld. thru int.spi. 2) Lat. Lobe – gland Project from sides in bld. thru int.spi.
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DUE TO BPH IN URETER & KIDNEY IN BLADDER IN URETHRA ABNORMAL CHANGES
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Changes in Urethra Elongation of urethra twice to Normal. Posteriorly exuggeration of normal prostatic curve. Lateral compression of urethra .
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Hypertrophy of bld. Wall Hypertrophy of trigone Formation of diverticula Overflow incontinance Post prostatic pouch Residual urine Vesicle piles Changes in the Bladder
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Changes in Ureters & Kidney Hydroureter & Hydronephrosis due to Hypertrophy of trigone downward traction on the intramural segment of ureters obstruction to urine flow
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2) Vesicoureteric reflux. Residual urine Chr. Retention of urine Damage to the spincture of ureteric orifice Incomptance of ureto vesical valve 3) Acute or Chr. Pylonephritis 4) Uraemia
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SYMPTOMS
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Physical Signs General Examination Renal insufficiency Hypertension Cardiac assessment 2) Nervous Tebes dorsalis Multiple sclerosis Parkinson's disease 3) Peripheral nerve S3 & S4 nerve Exam.
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Local Examination P/A = Fullness of Bladder Loin = Renal enl. Hydronephrosis
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Rectal Examination Precaution : Evacuation of bladder Position : Left lat. Obeservation : prost. enla. – smooth, convex, firm swelling Rectal mucosa – easily sliding prostate Residual Urine may felt as a fluctuating swelling just above & behind the prostate
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Investigations Urine R/M = Pus cell, C/S, Oxalates, RBCs Urine flowmetry = N= 15ml/sec. CBP = Hb%, WBCs, ESR, RFT = Sr.Urea, Sr. Creatinine . PSA = Prostatic Specific Antigen Glucoprotine Function = facilitate liquification of semen Measure by Immunoassay tech. Normal Upper Limit = 4nmol/ml BEP Limit = 4-15 Prostatic Ca = 15 nmol/ml Metastasis = 30 nmol/ml
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X RAY (PLAIN)
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USG / TRANSRECTAL USG USG = Detection of size, wt, post void urine etc. T/r USG = Accurate size, early detection of Ca Useful when PSA high. surface of prostate is hard & irregular.
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IVP Renal Calculi Hydronephrosis Enlarge Bladder Hydroureter Metastasis spine
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Cystourethroscopy Indication To inspect urethra prostate lobe bladder spincter other bladder changes
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Quality of Life Acute urine retention
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Ex. Tamulosin Dose – 0.4/0.8 mg OD Ex. Dutasteride Dose – 0.5 mg OD
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BPH – Hormonal Therapy GnRH Analogs (Binds Pitutari recp. And LH release) Ex.- Leuprolide Acetate Route – IM /SC Dose – Anti androgens (Inhibits the androgen uptake) Ex- Flutamide Route – oral Dose – 125mg TID
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SURGICAL T/t
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INDICATIONS OF SURGERY 1) Acute Retation. 2) Chr. Retation 3) Frequency ( Day & Night) – discomfort 4) Haemorrage 5) Complications – Diverticulum Calculus etc. ( Residual Urine > 200 cc)
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PROSTATECTOMY A CC. APPROCH ( 2 ) 1) OPEN – SUPRAPUBIC (Freyer’s) RETROPUBIC (Millin’s) PERINEAL (Young’s ) 2) CLOSE- TRANSURETHRAL ( TURP) ACC. METHOD (2) 1) RADICAL 2) ENUCLEATION
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SUPRAPUBIC
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POST OP CARE I V fluides & Glycine irrigation. Antibiotics Analgesics Antiemetics Sedative ( if needed ) Liquid diet for 12 hrs after 8 hrs of O.T. Normal diet after 24 hrs Suprapubic drain remove after 48 hrs ( fluide should be bloodless) 9) Urethral catheter remove after 10 day ( urine should be clear )
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POST OP CARE = Same as pervious ADVANTAGE OVER SUPRAPUBIC 1)Bladder opening not needed = no bleeding in bladder Bleeding in retro. Space can remove with simple drain Short recovery period. DISADVANTAGE # Diverticula & stone can be missed
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Epididymitis Bladder neck stricture Rectrograde ejaculation & Impotancy Stricture of urethra
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INDICATION Small prostate Obstruction without enlag. of lat. Lobe median lobe enlar. Ca prostate ( Localised)
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1) PUCH TURP
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2) WIRE LOOP DITHERMY
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DIC = Disseminated intravascular coagulopathy
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BEFORE T/t AFTER T/t
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