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Dr. Ajit Saxena APOLLO HOSPITALS NEW DELHI

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Dr. Ajit Saxena APOLLO HOSPITALS NEW DELHI

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    2. What is BPH? Benign prostatic hyperplasia (BPH) is stromal and epithelial cell hyperplasia beginning in the periurethral zone of the prostate It is a chronic progressive urologic condition giving rise to LUTS Affects a significant number of aging males Enlarged prostate or benign prostatic hyperplasia (BPH) is a chronic progressive urologic condition which affects a significant number of the aging male population. The prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged 70 and older. An estimated 1 in 4 men will seek medical care for management of symptomatic BPH by age 80. Approximately 90% of men have histologic evidence of the disease by age 85.Enlarged prostate or benign prostatic hyperplasia (BPH) is a chronic progressive urologic condition which affects a significant number of the aging male population. The prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged 70 and older. An estimated 1 in 4 men will seek medical care for management of symptomatic BPH by age 80. Approximately 90% of men have histologic evidence of the disease by age 85.

    3. Prevalence of BPH Prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged 70 and older Prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged 70 and older

    7. Clinical Presentation of BPH Obstructive Symptoms Incomplete emptying Intermittency Weak stream Hesitancy Irritative Symptoms Nocturia Frequency Urgency

    8. Investigations S-PSA Test Ultrasound Scan - KUB - TRUS Uroflow Test

    9. Do I Need an Operation ? History (IPSS)ssssssss DRE U/S Scan - KUB - TRUS Uroflow Test

    10. IS It Cancer ? DRE SPSA Test U/s Scan – TRUS + Biopsy

    11. Management Options for BPH Pharmacological treatment Hormonal manipulation

    12. Drugs for Medical Management

    13. a-Blockers: How They Work Block alpha-adrenoreceptors Relax smooth muscle in prostate and bladder neck Relax smooth muscle in bladder neck Fast onset of action in large/small prostate Source: Rev Urol 2003;5(Suppl 5):S42–S48.

    14. 5a-Reductase Inhibitors: How They Work Testerosterone 5-alpha-reductase DHT Reduce prostate volume Reduce risk of progression to AUR Reduce risk of prostatic surgery

    15. Indications for Specific Drugs Tamsulosin: First line in management LUTS & increasing uroflow Alfuzosin: Improves urinary voiding symptoms by decreasing post void residual urine. Very useful in acute urinary retention Finasteride: Decreases long-term complications of BPH, reduces need for surgery in large prostates Dutasteride: Suitable for long term use in enlarged prostates

    16. Combination Therapy: A Unique Approach

    17. Indications: Combination Therapy Dutasteride+Tamsulosin/Finasteride+Tamsulosin Patients with prostates >30 g or with PSA>3.0 ng/mL, or both Patients with prominent lower urinary tract symptoms

    18. Benefits of Combination Therapy Superior to monotherapy over long term for treating symptoms and slowing progression Risk of acute urinary retention 79% less with combination therapy as compared to 31% with a-blocker and 67% with 5a-reductase inhibitor alone

    19. A Quick Recap Tailor medical therapy for each patient depending upon symptoms and prostate size Men with smaller prostates and PSA less than 2.0 ng/mL can be started on an a-blocker Those with a large prostate size can start with a 5-a-reductase inhibitor Combination therapy is for patients with a prostate weighing > 30 g and serum PSA > 3.0 ng/mL, with no suspicion of prostate cancer, and prominent LUTS

    20. Surgery in BPH Indicated in : Severe symptoms and advanced cases Acute retention of urine Refractory urinary retention Persistent hematuria Complications like hydronephrosis

    22. OTHER TECHNIQUES Balloon Dilatation Intra Prostatic Stents Tuna Lasers Electro Vaporization Vapour Resection

    23. TRANS URETHRAL NEEDLE ABLATION OF PROSTATE

    24. LASERS Holmium Green Light PVP Diode Laser

    25. ELECTRO VAPOURIZATION

    28. Dec 02,2010 Suresh Sikka Priveleged Communication

    29. Metabolic Syndrome Induces BPH By Chronic Inflammation Via Interleukin- 6 and C- Reactive Pathway Changing Hormonal Milieu Non Neoplastic Mitogenesis due to ? ed Insulin Like Growth Factor Selective Neurodegeneration

    31. Estrogen Analogues Androgen Receptor Blockade Genetic Manipulation

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