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BPH is uncommon before age

40

70% men >60 yr have


symptoms arising from BPH,
increasing up to 90% men >80
yr

20-30% of men reaching 80


year old need surgical
management for BPH

Briganti A, et.al. Benign prostatic hyperplasia and its aetiologies. J.eursup.2009


IAUI. Panduan Penatalaksanaan Klinis Pembesaran Prostat Jinak. 2017
Androgens

neurotransm
estrogens
itters

stromal-
growth
epithelial
factors
interactions

Benign prostatic hyperplasia:etiology,pathophysiology, epidemiology, and natural


history.Campbell--‐Walsh Urology, 10th Ed. 2012
 History taking
 Physical examination
 DRE

 Laboratory and Radiologic examination


• Weak stream
Voiding • Hesitancy
• Intermittency
(obstructive) • Straining
• Residual volume

Storage • Frequency
• Nocturia
(irritative) • Urge

Post • Post micturition dribbling


micturition • Sensation of incomplete emptying
 Blood count
 Serum creatinine
 Serum electrolyte
 PSA
 Urinalysis
 Culture + Sensitivity test

Imaging
 Sonography
 Watchful Waiting
 IPSS 0-7

 Medical Therapy
 Alfa-blocker, 5-ARI, antimuscarinic, PDE5-i and
combination therapy
 Surgical Therapy
 Minimal Invasive: TURP, TUIP, TUVP, HoLEP
 Open surg.: simple prostatectomy (PV>80-100 gr)

Neoplasm of Prostate Gland; Smith General Urology, 18th Ed. 2013


 TURP:
 Intraoperative:
Transfusion (0-9%), TURP Syndrome (0-5%), AUR (0-13,3%), clot
retention (0-39%), UTI (0-22%)
 Long-term Complication:
Urinary Incontinence (2,2%), bladder neck stenosis (4,7%), urethral
stricture (3,8%), retrograde ejaculation (65,4%), erectile
dysfunction (6,5-14%).

IAUI. Panduan Penatalaksanaan Klinis Pembesaran Prostat Jinak. 2017


Neoplasm of Prostate Gland; Smith General Urology, 18th Ed. 2013
 Open Surgery
 Intraoperative:
Bleeding require transfusion
 Long-term:
Bladder neck contracture, urethral stricture, urinary incontinence