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    Benign Prostatic Hyperplasia (BPH) Dr. Christopher Kusumajaya

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    Christopher Kusumajaya
    This document provides information about benign prostatic hyperplasia (BPH). It discusses the anatomy of the prostate gland and its blood supply. It describes the clinical manifestations of BPH as lower urinary tract symptoms measured by the IPSS questionnaire. Treatment options discussed include conservative approaches, pharmacological treatments like alpha-blockers and 5-alpha-reductase inhibitors, and surgical procedures including transurethral resection of the prostate. Overall, the document provides a overview of BPH including anatomy, symptoms, diagnostic tools, and treatment approaches.

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    Benign Prostatic Hyperplasia (BPH) Dr. Christopher Kusumajaya

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    Christopher Kusumajaya
    31 views19 pages
    This document provides information about benign prostatic hyperplasia (BPH). It discusses the anatomy of the prostate gland and its blood supply. It describes the clinical manifestations of BPH as lower urinary tract symptoms measured by the IPSS questionnaire. Treatment options discussed include conservative approaches, pharmacological treatments like alpha-blockers and 5-alpha-reductase inhibitors, and surgical procedures including transurethral resection of the prostate. Overall, the document provides a overview of BPH including anatomy, symptoms, diagnostic tools, and treatment approaches.

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    pembesaran prostat jinak, benign prostatic hyperplasia

    Original Title

    BPH

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    This document provides information about benign prostatic hyperplasia (BPH). It discusses the anatomy of the prostate gland and its blood supply. It describes the clinical manifestations of BPH as lower urinary tract symptoms measured by the IPSS questionnaire. Treatment options discussed include conservative approaches, pharmacological treatments like alpha-blockers and 5-alpha-reductase inhibitors, and surgical procedures including transurethral resection of the prostate. Overall, the document provides a overview of BPH including anatomy, symptoms, diagnostic tools, and treatment approaches.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views19 pages

    Benign Prostatic Hyperplasia (BPH) Dr. Christopher Kusumajaya

    Uploaded by

    Christopher Kusumajaya
    This document provides information about benign prostatic hyperplasia (BPH). It discusses the anatomy of the prostate gland and its blood supply. It describes the clinical manifestations of BPH as lower urinary tract symptoms measured by the IPSS questionnaire. Treatment options discussed include conservative approaches, pharmacological treatments like alpha-blockers and 5-alpha-reductase inhibitors, and surgical procedures including transurethral resection of the prostate. Overall, the document provides a overview of BPH including anatomy, symptoms, diagnostic tools, and treatment approaches.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    BENIGN PROSTATIC HYPERPLASIA

    (BPH)
    DR. CHRISTOPHER KUSUMAJAYA
    LUTS (LOWER URINARY TRACT SYMPTOMS)
    IPSS
    • Validated symptom
    score questionnaire

    • Can be used to
    monitor treatment

    • Questions:
    • 7 symptoms
    • 1 QoL

    • Score
    • 0 Asymptomatic
    • 1-7 Mild
    • 8-19 Moderate
    • 20-35 Severe
    ANATOMY
    Gross
    Fibromuscular and glandular organ
    Weight: 20 g contains 2.5 cm posterior urethra.
    Supports: anteriorly puboprostatic ligaments, inferiorly
    urogenital diaphragm.

    Mc Neal Zones:
    peripheral zone, central zone, transitional zone,
    periurethral and anterior fibromuscular zone

    Lowsley Lobes:
    anterior, posterior, median, right lateral, and left lateral.
    Blood Supply
    ANATOMY

     Arterial
     Inferior vesical, internal pudendal,
    middlle rectal (hemorrhoidal) arteries
     Venous
     Periprostatic plexus, connect with
    deep dorsal vein of the penis and the
    internal iliac (hypogastric) veins
     Nerve Supply
     Sympathetic and parasympathetic
    nerves of the inferior hypogastric plexus
     Lymphatics
     Internal iliac (hypogastric), sacral, vesical,
    and external iliac lymph nodes
    PHYSICAL EXAMINATION
     Flank
     presence of hydronephrosis
     Suprapubic
     acute state, distended bladder
     External Genitalia
     search for meatal stenosis, urethral stricture
     DRE:
     Sphincter tone and lower rectum
     Prostate gland: size, consistency, mobility, and presence of prostate cancer
     Bulbocavernous reflex
    CLINICAL MANIFESTATION
    Clinical manifestation: LUTS (Lower Urinary Tract Symptoms)
    Symptom score questionnaires
    TREATMENT

    Conservative
    Pharmacological
    Surgical
    CONSERVATIVE/
    WATCHFUL WAITING
    PHARMACOLOGICAL
    TREATMENT
    ALPHA 1- BLOCKERS
    Tamsulosin dan Silodosin
    Mechanism
     Inhibit
    effect of endogenously released noradrenaline on
    smooth muscle cells in the prostat  reduce tone
    Efficacy
     Reduce IPSS 30-40%, increase Qmax 20-25%
    Adverse event
     Asthenia, dizziness, orthostatic hypotension
    5 ALPHA REDUCTASE INHIBITOR
    Finasteride dan Dutasteride
    Mechanism
     androgen effects on the prostate are mediated by DHT,
    which is converted from testosterone by the enzyme 5
    alpha reductase
    Efficacy
     improveIPSS 15-30%, decrease volume 18-28%,
    increase Qmax 1,5-2 mL/s
    Adverse events
     sexual function, reduced libido, ED
    MUSCARINIC RECEPTOR ANTAGONISTS
    Mechanism of action
     Thedetrusor is innervated by parasympathetic nerves
    whose main neurotransmitter is acetylcholine, which
    stimulates muscarinic receptors (M-cholinoreceptors) on
    the smooth muscle cells.
    Efficacy
     Effective for OAB
    Adverse events
     Increase PVR
    PDE 5 INHIBITORS
    Sildenafil dan Tadalafil
    Mechanism
     Increaseintracellular cyclic guanosine monophosphate,
    thus reducing smooth muscle tone of the detrusor,
    prostate and urethra.
    Efficacy
     Reduce IPSS, storage and voiding LUTS, and improve QoL
    Adverse events
     Flushing,
    gastroesophageal reflux, headache, dyspepsia,
    back pain and nasal congestion
    SURGICAL
    TREATMENT
    Open prostatectomy
    TUMT
    TUNA
    HoLEP
    Stent
    Urethral lift
    SURGICAL INDICATION
    Acute Urinary Retention
    Failed TwoC (Trial without Catheter)
    Recurrent UTI
    Recurrent Gross hematuria
    Vesicolithiasis

    Loss of Kidney Function


    Pathological changes in vesica and upper
    urinary tract
    TUR-P VIDEO
    REFERENCES
     European Association of Urology Guidelines 2017 Edition.
     Panduan Penatalaksanaan Klinis Pembesaran Prostat Jinak
    2015 Ikatan Ahli Urologi Indonesia.
     Tanagho
    E.A, Mc Annich J.W.,Smith’s General Urology 18thed.,
    Mc Graw Hill 2013
     WalshP.C., Retik A.B.,Vaughan E.D., Wein A.J., Campbell’s
    Urology 11thed., WB Saunders,Philadephia 2016
    THANK YOU

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