Benign prostateic hyperplasia

1
Benign prostateic hyperplasia

• Dept. of urology.Shanghai Renji hospital
• Wang YiXin

2
Etiology of BPH

• The etiology of BPH IS undoubtedly
  multifactorial. However,it is well recognized
  that two prerequisites for its induction are the
  testes and aging .
• Because prostatic growth is regulated principally
  by androgen.
• It has been suspected for years that BPH is under
  endocrine control .In addition. There is
  compelling evidence for a major role of the
  stroma in the induction of the disease .

3
Pathology of BPH

• The basic change is that of epithelial
  hyperplasia of the prostatic glands and their
  fibrous stroma
• A wide variation between epithelial and fibrous
  elements.
• The hypertrophy originates in the periurethral
  glands
• Form a false capsule.

4
Clinical features

• Local symptoms
• Increased frequency
• Nocturia ,hesitancy
• Feeling of incomplete
• Emptying .
• Dribbling, Dysuria.
• Haematuria, Epididymitis
• Urgency, Incontinence.
• Micturition easier on squatting

• General symptoms
• Lassitude due to nocturia.
• Renal pain.
• Prinephric abscess .
• Progressive renal failure.
• Anorexia ,Nausea, Vomiting
• Dyspnoea,Coma.

5
Diagnosis of BPH

• Clinical history
• General examination
• Rectal examination size,consistency,
• irregularities or hard nodules.
• Becteriological testsMSU (meadum stream urine)
• Haematological testsanaemia
• Biochemical testsblood urea and creatinine,
  electrolytes, PSA.

6
Diagnosis of BPH(Radiology)

• Straight x-ray, KUB.
• IVP shows
• 1.suppression of renal function
• 2.hydronephrosis and hydroureter
• 3.fish-hooking of the lows ends of the
  ureter
• 4.trabeculation of the bladder
• 5.bladder diverticular formation
• 6.filling defects in the bladder
• 7.residual contrast left in the bladder
  after micturition
• RGP,when non-functioning kidney is present.

7
Other investigations

• Electrocardiography to assese myocardial state
• Chest xray
• Pulmonary function tests

8
Treatment of BPH

• Chronic retention of urine
• Acute retention
• Conservative methods by running water taps to
  induce to void ,sitting in a warm bath
• Catheterrisation
• Suprapubic cystostomytemporary form of
  suprapubic cystostomy,catheter should be changed
  at monthly.

9
Operative treatment of BPH

• Transurethral prostatectomy
• Retropubic prostatectomy
• Transvesical prostatectomy
• Transperineal prostatectomy
• Cryogenic prostatectomy
• Microwave therapy