Download - 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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