Aim of Rx Relieving LUTS Decreasing Boo Improving bladder emptying Reversing renal insufficiency Preventing feature episodes of hematuria ,UTI &urinary retention the treatment includes Medical therapy Minimally invasive Operative therapy
Medical therapy Alpha adrenergic blocker drugs Terazosin(longe acting) Duxazosin(longe acting) Tamsulosin(alpha 1a selective) The tension of prostate smooth muscle is mediated by alpha1 adrenorecepter 98%of alpha1AR located in prostate By blocking this receptors Decrease the resistance a longe bladder neck, prostate,& urethra( relaxing of smooth muscle) Relieve dynamic component of the obstruction
Medical therapy Advantage of alpha adrenergic blockers Well tolerated Reduce out flow resistance Are safe in the elderly & Boo Treatment of choice with pt.HPT Side effects Asthenia Headache dizziness
Medical therapy Androgen suppression (5alpha-reductase inhibitor) drugs -finasteride* -flutamide Is an enzyme responsible to the conversion of the testosterone to DHT which promotes growth of prostate tissue Finasteride is competitive inh. Of this enz Lower intraprostatic levels of DHT prostate size (By inh of its growth ,apoptosis &involution ) Max reduction of prostate vol.by 6/12 20% size reduction 1/3 of the pt has improvement of symptom score
Treatment…. Watchful waiting Rx For mild symptoms AUA symptom score<8 flow rate >10ml/s good bladder emptying(RU<100ml) -Needs base line evaluation (annually ) Advice for: Limit fluid intakes at evening ↓ alcohol & coffee containing products Maintain time voiding schedules
Minimally invasive Mx of BPH Intraprostatic stents Tubular device left in the urethra (absorbable or nonabsorbable) An alternative for indwelling catheter for pts.unfit for surgery Success rate is from 50 to 90% The insertion is endoscopicaly(us guided) Temporally or permanent( after radical prostatectomy with incontinence)
Minimally invasive Mx… Transurethra microwave therapy Deliver heat to the prostate via urethra catheter or transrectal route Damaging to sympatatic nerve ending & induction of apoptosis → ↓ prostate size Takes one hour as out pt with LA Less complication(like impotence) Does not cure BPH –reduce urinary frequency,urgency,sraing &intermittent flow
Minimally invasive….. Lasers delivered heat Causes destruction of the prostate tissue (coagulation necrosis or vaporization of prostate tissue) Destroyed tissue then contract→ ↓prostate size Increase flow rate=9to15ml/sec Symptoms score improve by 50% Decrease bleeding ,fluid absorption, length of hospital stay ↓the incidence of retrograde ejaculation& impotence compared with TURP
Minimally invasive…. Transurethral needle ablation of the prostate Radiofrequencey energy through twin needle to burn the enlarged prostate Thermal injury to lateral lobe induce necrosis of hyper plastic prostate &improve symptom score
Prostatectomies Types TURP RP TVP Success AUR & CUR=100% sever symptoms & urodynamically proven BOO =90% Mild symptoms =65 Unobstructed detrusor instability =do not respond well
You've reached the end of your free preview.
Want to read all 73 pages?
- Fall '19
- Urology, urinary retention, calculi, Urethral stricture, TURP