Table of Contents

INTRODUCTION

EMBRYOLOGY

ANATOMY

The Prostate “Capsule”

Neurovascular anatomy

HISTOLOGY

PHYSIOLOGY

ENDOCRINE CONTROL OF PROSTATIC GROWTH

Testosterone

Estrogen

Benign Prostatic Hyperplasia (BPH)

Risk Factors for BPH

Genetics

Diet

Other Risk Factors

PATHOPHYSIOLOGY OF BPH

Natural History

Aetiology

DISEASE MANIFESTATIONS OF BPH

Lower Urinary Tract Symptoms (LUTS)

COMPLICATIONS

Urinary Retention (Acute and Chronic)

Recurrent lower Urinary Tract Infection (UTI)

Bladder Calculi (stones)

Haematuria

Detrusor (Bladder) Instability

Renal insufficiency

Elevated Prostate Specific Antigen (PSA)

Quality of Life

HISTORY

International Prostate Symptom Score (IPSS)

EXAMINATION

DIFFERENTIAL DIAGNOSIS OF BPH

PROSTATITIS

Acute Prostatitis.

Chronic Prostatitis

Treatment of chronic prostatitis

INVESTIGATIONS of LUTS

Urinalysis

Post-void residual urine volume (PVRU)

Serum Creatinine

Upper Urinary Tract Imaging

Urodynamics

Urinary Flow Rate (Uroflowmetry)

Urodynamics- presssure-flow studies

Urethrocystoscopy

Transrectal ultrasound scanning (TRUS)

Serum Prostate Specific Antigen (PSA)

TREATMENT OF BPH- OVERVIEW

WATCH AND WAIT/LIFESTYLE CHANGE

PHYTOTHERAPY FOR BPH

Saw Palmetto Berry (Serenoa repens)

African plum tree (Pygeum africanum)

Pumpkin Seed (Cucurbita pepo)

Rye Pollen (Secale cereale)

Other extracts

MEDICAL THERAPY FOR BPH

α reductase inhibitors

Finasteride and Dutasteride

Prostate Cancer Prevention Trial (PCPT)

Summary of medical treatment

MAJOR STUDIES OF MEDICAL TREATMENT OF BPH

VETERANS AFFAIRS STUDY

PLESS STUDY

PREDICT TRIAL

OLMSTED COUNTY STUDY, USA

MTOPS STUDY AND PREDICTORS OF CLINICAL PROGRESSION

SMART-1

The TRIUMPH study

SURGICAL TREATMENT OF BPH

Transurethral resection of the prostate (TURP)

Open Prostatectomy

Minimally Invasive Surgical Therapies

MEASURING OUTCOMES AND EFFECTIVENESS OF TREATMENT