Benign Prostatic Hyperplasia

Ren Ke
Department of Urology, The First Affiliated
Hospital of Chongqing Medical University
The local anatomy of lower urinary tract
 Definition

◆ LUTs: Lower urinary tract symptoms. Such

as frequency, urgency, odynuria, dysuria, etc.

◆ BPH: A series of LUTs caused by the enlarged

prostate.
 Etiology

◆ Functional testicle:
the prostate is an androgen
dependent organ, thus the
hyperplasia of prostate rely
on functional testicle.
The eunuch
◆ Ageing: Male elder than 50 are more liable to
BPH, and the incidence increases as the age
increases.
 Pathology & Pathophysiolog

◆ The prostate is divided

into three parts: central
zone, periphery zone
and transition zone, and
BPH always occur in the
transition zone.
◆ Mechanical obstruction:
the urethra is compessed by
the enlarged prostate, so
the resistance of urination
increase.

◆ Dynamic obstruction:
the contraction of the muscle fibers in the enlarged
prostate enhance the resistance.
◆ Secondary dysfunction of the bladder:

To overcome the increased urination

resistance, the detrusor muscle of the
bladder get thicker and overactive.

The decompensation of the bladder

will lead to urinary retention or even
overflow incontinence.
 Clinical Manifestation

◆ Irritation symptoms:
nocturia
frequency
urgency
urgent incontinence
The effective volume of the bladder decrease
 Clinical Manifestation

◆ Irritation symptoms:
nocturia
frequency
urgency
urgent incontinence
◆ Obstruction symptoms:
hesitancy
exertion
intermittency
urinary retention
overflow incontinence
◆ Complications:

Infection
Cystic calculus
Hematuria
Hydronephrosis
Chronic renal failure
Inguinal hernia & Anal prolapse
◆ Complications:

Infection
Cystic calculus
Hematuria
Hydronephrosis
Chronic renal failure
Inguinal hernia & Anal prolapse
 Diagnosis

◆ Typical clinical manifestation: dysuria

◆ Digital Rectal Examination（DRE）
 BPH: enlarged, central sulcus
become shallow, pliable

DRE

PCa: hard, unsmooth, with

nodules
◆ PSA: <4 ng/ml, distinguish BPH from
prostate carcinoma.

◆ Ultrasound: volume of the residual urine,

the size of the prostate, upper urinary tract
◆ Flow rate of the urination: Qmax<15ml/s.

◆ Dynamics of urination: distinguish BPH

from neurogenic bladder
 Differential diagnosis

◆ urethral stricture: after injury or infection,

urethroscope is needed to diagnose.

◆ bladder neck contracture: after inflammation

or operation, urethroscope is needed to diagnose.
◆ prostate cancer: same symtoms as BPH, DRE
and PSA abnomality are important signals.
Biopsy is necessary for diagnosis.

◆ neurogenic bladder: history of lumbar vertebra

injury or diabetes mellitus. Dynamics of
urination is needed. Operation is ineffective.
 Treatment
Medication:
◆ Alpha-receptor blocker:
to block the alpha-receptor on the muscle
fiber and target on the dynamic obstruction.
◆ 5-alpha reductases inhibitor:
to inhibit the activation of testosterone and
gradually inhibit the hyperplasia.
Operation:

◆ Indications:
Volume of residual urine ≥ 50 ml;
Qmax＜10 ml/s;
Repeated acute urinary retention;
Severe complications: cystic calculus, hematuria;
Severe symptoms frustrating the patients.
◆ Contraindications:

Complicated with acute prostatitis;

Severe urinary tract infection;
Dysfunction of blood clotting system;
Dysfunction of significant organs;
Debilitation of the detrusor muscle;
Relatively younger patient.
◆ Operation: transurethral resection of prostate
(TURP)