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BHP
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BHP
Aetiopathogenesis_
there r 2 theories to explain BPH
1 Harmonal theory_as the age avances,the level of androges comes down.There is corresponding increase in the oestrogen which stimulates the prostate gland n produce BPH.
2 neoplastic theory_according to this theory there is proliferation of all the elements of prostate_fibrous,musculaq n glandular resulting in fibromyoadenoma.
Clinical features_
1 frequency
to start with,frequecy is present
duing the day time followed by day n night.-5 to 10 times during during the night.It is due ineffective emptyinp of the bladder.It result in residual urine in the bladder precipitating cystitis.
2 urgency_as the prostate enlarges there is visceral introversion of sensitive mucous membrane of prostatic urethra within the bladder.This causes the internal spincter to streth n prevents contraction.This result in urgency.
3 Hesitancy_pt hesitate to pass urine because micturation is not effective due to obstruction.
4 haematuria is rare.
5 BPH can b present with acute retention of urine
6 complications like stones,diverticuli,renal failure.
Diagnosis of BPH-per rectal examination-enlarge lat lobe can b easily felt.Rectal mucosa is free.
Investiagations_
1 blood urea n creatinine_ raised level indicate renal failure.
2 uroflowmetry_person is asked to void urine frm his full bladder into flowmeter.The flow rate is assesed.
Normal peak flow rate is 20 ml/sec.Doubtfull peak obstruction._10-15 ml/sec.
Definite peak obstruction_less than 10 ml/sec.
3 ultrasonogram-to asses the size n wt of prostate,to assess the residual urine n to look for hydrouretonephrosis
4 IVP to study the renal changes in selected cases.
5 cystoscopy as part of treatment.
Treatment_
1 medical treatment_
if the pt has mere frequency of micturation, n if the residual urine is not much,uroflowmetry shows more than 15 ml/sec of urine flow,the pt can b reassuared n advise to avoid heavy alcohol consumption which may lead to prostatic congestion n acute retention of urine.To avoid overdistension of bladder,he has to void the urine as n when he feel the urinary sensation of micturation.
Drugs_fibnasteride acetate
5 mg daily for 6 mönths.
Alpha adrenargic blocker relax the internal spincter for better drainage of the bladder.
2 surgical treatment_
indication_1 acute retention of urine
2 chronic retention of urine with posvoidal urine more than 200 ml
3 if the frequency of micturation is so much that it disturb the normal life style during day time.
4 complication like haematuria.
Surgical method-
1 transvesical suprapubic prostatectomy_this method is now restricted to gland more than 100 gm in wt.
Through an extraperitoneal approch the bladder is opened,prostate is enucleated with finger,bleeding is controlled by inflating foley bulb with about 30-50 ml of air n by ligature.
Bladder is drained by malecots catheter.
2 transurethral resection of prostate _most popular method today.
A rectoscope is passd to urethra n under vision with constant irrigation with water,prosate is resected into multiple piece n removed.Haemostasis is achieved with the help of cautery.
3 retropubic prostectomy.
4 perineal prostatectomy.
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