Benign Prostatic HyperplasiaDr.Bandar Al HubaishyUrology DepartmentKAUH

Clinical PresentationHesitancyUrgencyFrequencyIncomplete bladder emptyingDripplingDecreased stream flow

Physical ExaminationSuprapubic area for sign of bladder distension DRE: Prostate gland size , nodularity , masses, surface, tenderness, anal tone

investigationsLaboratory tests:CBCU&E PSAUrine analysis Urine culture and sensitivity

Uroflow meter

Kidney-bladder Ultrasound

TRUS biopsy

Medical TreatmentThe prostate gland consists of :

Glandular tissueFibromuscular tissue

Medical TreatmentThe prostate is rich in alpha receptors especially type 1a which are responsible for LUTS in those patient. So, blocking these receptors can decrease the resistance along the bladder neck, urethra and prostate

Alpha blockersSelective agents short-acting: prazosin, alfuzosin, and indoramin. long-acting: terazosin, doxazosin and slow-release (SR) alfuzosin.

Non selective agents Phenoxybenzamine

Partial selective agents Tamsulosin and silodosin.

5 alpha reductase inhibitors

Finasteride (Proscar)

Dutasteride (Avodart)

Surgical management Indications:AUR failed voiding trialsrecurrent gross hematuria urinary tract infection.renal insufficiency secondary to obstruction.

failure of medical therapy, a desire to terminate medical therapy financial constraints associated with medical therapy.

Transurethral resection of prostate (TURP)

Complications: Hemorrhage, urinary incontinence, impotance, retrograde ejaculation

Open prostatectomy

Indications :very large prostates (>75 g), patients with concomitant bladder stones or bladder diverticulapatients who cannot be positioned for transurethral surgery.