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Published on : Mar 14, 2014
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Slide 1 - Benign Prostatic Hyperplasia DR.Gehan Mohamed
Slide 2 - Normal Prostate Anatomy Prostate weights ~20g Measures ~3 by 4 by 2 cm Apex = inferior portion of prostate, continuous with striated sphincter. Base = superior portion and continuous with bladder neck.
Slide 3 - PROSTATE histology Prostatic tissue is formed of two components : fibromuscular tissue (30%) glandular epithelial cells (70%)
Slide 4 - Normal histology of prostate: formed of glands and fibromuscular stroma
Slide 5 - Normal histology of the prostate formed of glands and stroma glands: lined by two layers of cells which are inner cuboidal cells and outer basal cells stroma :fibro muscular stroma
Slide 6 - Prostate zones Central zone (CZ) Cone shaped region that surround the ejaculatory ducts (extends from bladder base to the verumontanum) Only 1-5% of prostate cancer from this region . Peripheral zone (PZ) Posteriolateral prostate Majority of prostatic glandular tissue Origin of up to 70% of prostate adenocarcinoma Transitional zone (TZ) Surrounds the prostatic urethra Commonest site for benign prostatic hyperplasia.
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Slide 9 - What causes BPH? BPH is part of the natural aging process, like getting gray hair or wearing glasses BPH cannot be prevented BPH can be treated n n n
Slide 10 - Half of all men over the age of 60 will develop an enlarged prostate. By the time men reach their 70’s and 80’s, 80% will experience urinary symptoms But only 25% of men aged 80 will be receiving BPH treatment
Slide 11 - BPHProposed Etiologies 1-alterations in the testosterone/estrogen balance:enlarged prostate may be caused by lower levels of testosterone (male hormone) production in middle to old age. As men age, the levels of testosterone in their blood decreases, leaving a higher proportion of estrogen (female hormone), so a higher amount of estrogen within the prostate gland can increase activity that promotes cell growth. 2-Induction of prostatic growth factors. 3- Increased stem cells/decreased stromal cell death
Slide 12 - Benign Prostatic Hypertrophy (BPH)—Pathophysiology Common in older men; varies from mild to severe Change is actually hyperplasia of prostate Nodules form around urethra Not change to cancer prostate. Rectal exams reveals enlarged gland Incomplete emptying of bladder leads to infections Continued obstruction leads to distended bladder, dilated ureters, renal damage If significant, surgery required
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Slide 14 - What’s Lower Urinary Tract Symptoms secondary to prostatic urethra obstruction? Abnormal Voiding (obstructive) symptoms Hesitancy Weak stream Straining to pass urine Prolonged micturition Feeling of incompletebladder emptying Urinary retention Storage (irritative or filling) symptoms Urgency:an increasingly strong desire to void) Frequency Nocturia Urge incontinence LUTS is not specific to BPH – not everyone withLUTS has BPH and not everyone with BPH has LUTS
Slide 15 - BPH—Signs and Symptoms Initial signs Obstruction of urine flow Hesitancy : delay between trying to urinate and the flow actually beginning. dribbling decreased force of urine stream Incomplete bladder emptying Frequency, nocturia : need to urinate at night recurrent Urinary Tract Infections
Slide 16 - BPH complications hypertrophy of the prostatedetrussor muscle of the bladder undergo hypertrophy to overcome the obstruction in the prostatic urethra. Later on decompensation occur . Increase pressure inside bladderdiverticula formationincreasing urine retentionhydronephrosis renal failure.
Slide 17 - Diverticula in bladder
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Slide 19 - Diagnosis of BPH Symptom assessment Digital rectal examination(DRE) inaccurate for size but can detect shape and consistency Prostate Volume (PV) determination by ultrasonography Urodynamic analysis Measurement of prostate-specific antigen (PSA) high correlation between PSA and PV, men with larger prostates have higher PSA levels PSA is a predictor of disease progression and screening tool for Cancer Prostate. as PSA values tend to increase with increasing Prostatic Volume and increasing age, PSA may be used as a prognostic marker for BPH.
Slide 20 - BPH : show marked hyperplasia in the number of prostatic glands
Slide 21 - When should BPH be treated? BPH needs to be treated ONLy IF: Symptoms are severe enough to bother the patient and affect his quality of life Complications related to BPH n n
Slide 22 - Medication :α blockers - relax the smooth muscle of prostate and provide a larger urethral opening Surgical approaches 1- Transurethral resection of the prostate (TURP) 2- Open simple prostatectomy Treatment options n n n
Slide 23 - Indication of surgical intervention Acute urinary retention Gross hematuria Frequent urinary tract infection (UTI) Vesical stone BPH related hydronephrosis or renal function deterioration Obstruction
Slide 24 - Differential Diagnosisof BPH(i.e from other causes of urinary obstruction) Urethral stricture Bladder neck contracture Carcinoma of the prostate Carcinoma of the bladder Bladder calculi Urinary tract infection and prostatitis Neurogenic bladder
Slide 25 - Thanks for Your Attention!