Only 14 pages are availabe for public view
benign Prostatic hyperplasia (BPH) will eventually occur in microscopic form in all men if they live long enough Only half develop the macroscopic form and only half of these develop symptoms which require treatment.
The cause of symptomatic BPH is not completely understood, but there are factors which contribute to the symptoms of BPH:
1- Mechanical obstruction by the enlarged prostate.
2- Dynamic obstruction caused by the tone of the prostatic smooth muscle.
3- The reaction of the bladder to the obstruction.
Medical treatment can be useful in: Patients with uncomplicated BPH, mild to moderate symptoms (IPSS <8-20), and unsuitable patients for surgery.
The dynamic component of prostatic obstruction can be treated with alpha blockers, while irritative or storage bladder symptoms can be treated with anti cholinergic drugs. Combination therapy can also be used.
Certain or absolute indications exist which include Refractory or repeated urinary retention, related azotemia, significant recurrent gross hematuria, recurrent or residual
infection, bladder calculi, bladder diverticulum and large residual urine volume.
Lines of treatment OF BPH include the following option: watchful waiting, medical treatment and surgical treatment.
The role of α receptor blocker is assumed from direct antagonism of α adrenergic induced tone in the stromal smooth muscle, resulting in decrease in outlet resistance
Anticholinergics increase the volume to the first spontaneous destructor contraction during filling and the bladder capacity, but decrease the amplitude of the first contraction.
These drugs are not used for obstruction due to BPH, but rather for bladder instability (frequency, urgency) which may mimic or coexist with BPH.
These drugs should only be considered after a urodynamic assessment which confirms bladder instability and excludes significant obstruction