Post on 20-Jan-2017
“The weak can never forgive. forgiveness is the attribute of the strong.”
– MK Gandhi
CLINICAL PATHOLOGYThe foundation of clinical medicine.
Shashidhar Venkatesh MurthyA/Prof & Head of Pathology
College of Medicine & Dentistry
BPH3: Urinary Tract Dis: Prostate, BPH
3
Male Urogenital System: Prostate Periurethral, Fibromuscluar
gland. Function – Semen, acid
phosphatase. Sperm nutrition.
Hormone response – Androgens, Testosterone.
Prostatitis, BPH & Cancer. Central Zone - BPH Peripheral zone - Cancer
Prostate: Zones
Carcinoma
Trans. ZoneBPHBPH
Posterior Anterior
5
Normal Prostate Histology: Fibromuscular gland.
2. Glands double layer epithelium.
1. Fibromuscular stroma
3. Secretions (corpora amylaceae)
6
Prostate: Pathology
Disorders of Prostate:1. Inflammations – infections - Prostatitis2. Benign Prostatic Hyperplasia* 3. Neoplasms – Prostatic Carcinoma*
BPH
Cancer
7
Prostatitis: Inflammation, edema, rectal pain, obstruction/dysuria. Acute suppurative prostatitis 5%
E.coli, rarely Staph or N. gonorrhoeae Chronic non bacterial / chronic pelvic pain sy.
90% Chronic Inflam, symptoms, no pathogens. Asymptomatic inflammatory prostatitis.
Only WBC, no symptoms no pathogens. Granulomatous prostatitis
BPH, infarction, post TURP, idiopathic, TB, or allergic(eosinophilic).
Diagnosis: Fluid examination after prostatic massage. Needle aspiration study of prostatic tissue.
One single grateful thought raised to heaven is the most perfect prayer.
G. E. LessingGerman critic & dramatist (1729 - 1781)
9
BPH-Introduction Non-neoplastic, androgen hyperplasia.
Castration no BPH Testosterone DHT Hyperplasia. Common, 75% of men 70-80years.
Only few symptomatic. Involves periurethral transitional zone.
Morphology: Nodular hyperplasia of glands & stroma.
(like in breast, thyroid etc) Stromal & Gland hyperplasia. Cystic
glands, secretions, double layer maintained.
BPH is NOT a precursor to carcinoma!
Finasteride
10
BPH: Morphology: Gross & Microscopy
Gross: Grey white, nodular Hyperplasia, Periurethral zone.
Microscopy: Hyperplastic cystic glands. Normal double layer epithelium
11
BPH: Complications
Enlarged prostate. Median lobe - ball valve**1. Urinary Obstruction2. Urine retention3. Inflammation / infections4. Hypertrophy of wall5. Mucosal trabeculations6. Urolithiasis – stones.
Stone
12
BPH: TURP (Diagnosis + Treat )
Trans Urethral Resection of Prostate
Complications: Hemorrhage,Infection, Granulomatous prostatitisRetrograde ejaculation.
13
Normal – Prostatitis – BPH
“The only gracious way to accept an insult is to ignore it. If you can’t ignore it, top it. If you can’t top it, laugh at it.
If you can’t laugh at it, it’s probably deserved...!”
- - Joseph Russell Lynes