1. Benign Prostatic Hyperplasia Dr.Bandar Al Hubaishy Urology Department KAUH

2. Clinical Presentation Hesitancy Urgency Frequency Incomplete bladder emptying Drippling Decreased stream flow

3. Physical Examination Suprapubic area for sign of bladder distension DRE: Prostate gland size, nodularity, masses, surface, tenderness, anal tone

4. investigations Laboratory tests: CBC U&E PSA Urine analysis Urine culture and sensitivity Uroflow meter Kidney-bladder Ultrasound TRUS biopsy

5. Medical Treatment The prostate gland consists of : Glandular tissue Fibromuscular tissue

6. Medical Treatment The prostate is rich in alpha receptors especially type 1a which are responsible for LUTS in those patient. So, blocking these receptors can decrease the resistance along the bladder neck, urethra and prostate

7. Alpha blockers Selective agents short-acting: prazosin, alfuzosin, and indoramin. long-acting: terazosin, doxazosin and slow-release (SR) alfuzosin. Non selective agents Phenoxybenzamine Partial selective agents Tamsulosin and silodosin.

8. 5 alpha reductase inhibitors Finasteride (Proscar) Dutasteride (Avodart)

9. Surgical management Indications: AUR failed voiding trials recurrent gross hematuria urinary tract infection. renal insufficiency secondary to obstruction. failure of medical therapy, a desire to terminate medical therapy financial constraints associated with medical therapy.

10. Transurethral resection of prostate (TURP) Complications: Hemorrhage, urinary incontinence, impotance, retrograde ejaculation

11. Open prostatectomy Indications : very large prostates (>75 g), patients with concomitant bladder stones or bladder diverticula patients who cannot be positioned for transurethral surgery.