Benign Prostatic Hyperplasia Ggb

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Benign

Prostatic HyperplasiaDR.Gehan Mohamed


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Normal Prostate Anatomy

Prostate weights ~20g

Measures ~3 by 4 by 2 cm

Apex = inferior portion of prostate, continuous with striatedsphincter. Base = superior portion and continuous with bladderneck.


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PROSTATE histology

Prostatic tissue is formed of two

components :

fibromuscular tissue (30%)

glandular epithelial cells (70%)


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Normal histology of prostate:

formed of glands and

fibromuscular stroma


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Normal histology of the prostate formed ofglands and stroma

glands: lined by two layers of cells which are inner cuboidal cells

and outer basal cells

stroma :fibro muscular stroma


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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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http://www.marinurology.com/


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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

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Half of all men over the age of 60 willdevelop an enlarged prostate.

By the time men reach their 70s and 80s,80% will experience urinary symptoms

But only 25% of men aged 80 will bereceiving BPH treatment


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BPH

Proposed Etiologies

1-alterations in the testosterone/estrogenbalance:enlarged prostate may be caused by lower levels oftestosterone (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


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Whats Lower Urinary Tract Symptoms secondary to

prostatic urethra obstruction?

Abnormal Voiding

(obstructive)symptoms

Hesitancy

Weak stream

Straining to pass urine Prolonged micturition

Feeling of incomplete

bladder 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 with

LUTS has BPH and not everyone with BPH has LUTS


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BPHSigns 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


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BPH

complications hypertrophy of the prostatedetrussor muscle of the

bladder undergo hypertrophy to overcome the obstruction

in the prostatic urethra. Later on decompensation occur .

Increase pressure inside bladderdiverticula

formation

increasing urine retention

hydronephrosisrenal failure.


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Diverticula in bladder


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Di i f BPH


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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.


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BPH : show marked hyperplasia in the number of prostatic glands


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When should BPH be treated?

BPH needs to be treated ONLy IF:

Symptoms are severe enough to botherthe patient and affect his quality of life

Complications related to BPHn

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Medication : blockers - relax the smooth muscle of prostate

and provide a larger urethral opening

Surgical approaches

1- Transurethral resection of theprostate (TURP)

2- Open simple prostatectomy

Treatment options

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Differential Diagnosis

of 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


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Benign Prostatic Hyperplasia Ggb

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