Benign prostatic hyperplasia

It affects the prostate
1. Anatomy of the prostate
  1. Blood supply
    1. Arterial
      1. Inferior vesical
      2. Middle rectal
      3. Internal pudendal
    2. Venous
      1. Prostatic plexus
      2. Vesical plexus
      3. Internal iliac
  2. Lobes
    1. Anatomical
      1. Median
      2. 2 Lateral
    2. Surgical
      1. Anterior
      2. Posterior
      3. Median Lobe
      4. 2 lateral
  3. Zones
    1. Central zone
    2. Peripheral zone
    3. Anterior lobe is fibromuscular
    4. Transition zone
Physiology of micturition
Increased number of cells of the prostate, to be specific, the transitional zone (median lobe) of the prostate.
Causes
1. Aging process (Androgen receptors)
2. Increased DHT
3. Changes in cell growth factors
Signs and symptoms
1. Intermittency
  1. Urgency
    1. Nictoria
      1. Emptying incomplete
        Urethral obstruction
        Mechanical: BPH and urethral stricture
        Functional: Shy bladder syndrome (Paruresis)
        Bladder: detrusor muscle areflexia or impaired centricity
        Neurological disease damaging the detrusor muscle.
        Sensory: Diabetic neuropathy
      2. Weak stream
    2. Straining
  2. Frequency
    1. UTI
      1. Diabetes
        Pregnancy
        Enlarged prostate
        Diuretic usa
Risk factors
1. Age
  1. Family history
    1. Lifestyle
Staging
1. Ti
  1. T2
    1. T3
      1. T4
        Invading other organs
      2. Local extraprostatic extension
    2. Palpable or visible cancer
  2. Clinically inapparent lesion (Impalpable and not by emaging)
Complications
1. UTI
2. Stones
3. Kidney damage
4. urinary retention
  1. Obstructive
    1. BPH
      1. Tumors and cancers
        Urethral stricture
  2. Non-obstructive
    1. Stroke
      1. Vaginal childbirth
        Nerve diseases
Investigations
1. Urodynamic tests
  1. Filling Cystometry
    1. Electromyography
  2. Uroflowmetry
    1. Pressure-flow urodynamic studies
Management
1. Alpha blockers
  1. 5-alpha reductase inhibitors
    1. Combination drug therapy.
      1. Tadalafil (Cialis)

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Benign prostatic hyperplasia

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	Created by fatima alkhateeb about 6 years ago