benign%20prostatic%20hyperplasia
BENIGN PROSTATIC HYPERPLASIA
Benign prostatic hyperplasia (BPH) is a histopathological diagnosis characterized by epithelial cell & smooth muscle cell proliferation in the transition zone of the prostate leading to a non-malignant enlargement of the gland, which may result in lower urinary tract symptoms, including voiding and storage symptoms.
It is commonly called enlarged prostate.
Etiology is unknown but due to its similarity to the embryonic morphogenesis of the prostate has led to the hypothesis that BPH may be the result of "reawakening" in adulthood of embryonic induction processes.

Surgical Intervention

  • Recommended when medications are not effective, as well as when there are symptoms that are bothersome & severe & when complication arises

Transurethral Resection of the Prostate (TURP)

  • Most common surgery for benign prostatic hyperplasia (BPH)
  • Gold standard in treating the blockage of the urethra due to benign prostatic hyperplasia (BPH)
  • Resectoscope is inserted into the urethra to reach the prostate gland then pieces of tissue is cut using a wire loop

Laser Surgery

  • Cystoscope is used to pass a laser fiber into the urethra to the prostate & a high-energy laser is used to destroy prostate tissue

Open Prostatectomy

  • Done when the prostate is greatly enlarged , complication arises, bladder is damaged & repair is needed
  • Incision is made and part or all of the prostate gland is removed
  • Procedure requires general anesthesia, longer hospital stay & rehabilitation period
  • Recovery period varies from 3-6 weeks

Transurethral Incision of the Prostate (TUIP)

  • Procedure that widens the urethra of patients w/ mildly enlarged prostate gland
  • Cystoscope is inserted & electric current or laser beam is used to reach the urethra going to the prostate
  • Foley catheter is inserted after the procedure to freely drain the urine out of the bladder

Holmium Laser Ablation of the Prostate (HoLAP)

  • Laser using a 550 micron side-firing laser fiber in a noncontact mode is used to treat prostatic tissue transurethrally
  • It is designed to have the same TURP effect where the prostatic lobes may be vaporized down to the surgical capsule

Holmium Enucleation of the Prostate (HoLEP)

  • Used to enucleate the prostate adenoma by using end firing pulsed solid state laser
  • Have the same result as TURP w/ fewer complications

Holmium Laser Prostatectomy (HoLRP)

  • Uses laser-generated heat to remove prostate tissue obstructing the urethra

Complications

  • Problems urinating
  • Urinary incontinence
  • Bleeding & blood clots
  • Infection
  • Scar tissue
  • Sexual dysfunction
  • Recurring problems such urinary retention & urinary tract infections (UTIs)
  • Retrograde ejaculation

Minimally Invasive Procedures

  • Transurethral method that uses catheter or cystoscope to reach the prostate
  • May require local, regional or general anesthesia
  • Procedures are decided based on the patient’s symptoms & overall health

Transurethral Needle Ablation (TUNA)

  • Heat generated by radiofrequency energy used to destroy prostate tissue
  • Cystoscope w/ a needle at the end is inserted to send the radiofrequency to heat & destroy the selected prostate tissue

Transurethral Microwave Therapy (TUMT)

  • Microwaves are used to destroy prostate tissue
  • Catheter w/ antenna is inserted to the urethra to reach the prostate & microwaves are sent to heat & destroy the selected portions of the gland

High-Intensity Focused Ultrasound

  • Ultrasound probe is inserted onto the rectum near the prostate
  • Waves are used to heat & destroy the enlarged prostate tissue

Transurethral Electrovaporization of the Prostate (TUEVP)

  • Resectoscope w/ electrode is inserted to the urethra & moved across the prostate to transmit electric current to vaporize prostate tissue

Water-Induced Thermotherapy (WIT)

  • Catheter w/ a treatment balloon is used to heat & destroy the tissue
  • Can target specific region of the prostate, while the tissues surrounding the urethra & bladder remain protected

Prostatic Stent Insertion

  • Prostatic stent is inserted to the narrowed area caused by the enlarged prostate
  • The stent expands like a spring in place & pushes back the prostate tissue to widen the urethra
  • May be used in men who are unable to tolerate other procedures

Complications

  • Urinary tract infections (UTIs)
  • Painful urination
  • Difficulty urinating
  • An urgent or a frequent need to urinate
  • Urinary incontinence
  • Blood in the urine for several days after the procedure
  • Sexual dysfunction
  • Chronic prostatitis
  • Recurring problems such as urinary retention & urinary tract infections (UTIs)
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