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Benign Prostatic Hyperplasia BPH: Pathology

BPH is a common non-cancerous enlargement of the prostate gland that affects most men as they age. It occurs when the prostate grows larger due to increased cell growth of both the gland tissue and muscles of the prostate. Common symptoms include difficulty starting or stopping urination, weak urine stream, frequent urination, and urinary retention. Treatment options include watchful waiting for mild cases, medications to shrink the prostate or relax muscles, and surgery for more severe cases.

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hussain Altaher
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41 views9 pages

Benign Prostatic Hyperplasia BPH: Pathology

BPH is a common non-cancerous enlargement of the prostate gland that affects most men as they age. It occurs when the prostate grows larger due to increased cell growth of both the gland tissue and muscles of the prostate. Common symptoms include difficulty starting or stopping urination, weak urine stream, frequent urination, and urinary retention. Treatment options include watchful waiting for mild cases, medications to shrink the prostate or relax muscles, and surgery for more severe cases.

Uploaded by

hussain Altaher
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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17/04/1443

Benign prostatic hyperplasia


BPH

*BPH is the most common benign tumor in men.


*Its age related disease.
For Pathololgy mean cellular proliferation of stromal
and epithelial elements of prostate
For Radiologist mean an enlarged prostate > 30cm
For Urologsit represent acollection of lower urinary tract
symptoms (LUTs) that develop in male population in
association with aging and prostatic enlargement
Pathology.
The prostate composed of
-stroma (smooth muscle & fibrous tissue) and
-epithelium.
BPH can arise from any one of them or in combination

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Etiology. BPH need both Age +Androgen to develop


Increase in cell number
• Epithelial and stromal proliferation.
•Impaired programmed cell death (apoptosis)
Proposed factors that play role in aetiology include
Androgens
Estrogens
Stromal-epithelial interactions
Growth factors
Neurotransmitters
Genetic(autosomal dominant) family history
usually effect younger age group

Anatomically the prostate had 3 zones


-peripheral (70%) commonest site for Ca,
-central (25%) around ejaculatory duct, &
-transitional (5%) periurethral.
BPH uniformly originate from the transitional zone
& as the nodule enlarge compress the outer zones of
the prostate resulting in surgical capsule.
Pathophysiology
Increase urethral pressure lead tobladder wall
hypertrophy so
First : the changes that lead to decrease compliance
causing frequency and urgency

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Second :changes associated with decreased


contractility causing decrease force of urinary
stream,hestancy,intermittency and increase resudial
volume
Clinical features
Either obstructive or irritative.
obstructive symptoms
-hesitancy,
-decrease force & caliber of stream,
-sensation of incomplete bladder emptying,
-double voiding
-straining to urinate, & post void dribbling.

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Irritative symptoms
urgency, frequency, & nocturia.

* The amount of post void residual urine is


extremely variable in sequential evaluation of same
patient.
DRE,
used to determine the size, consistency of the
prostate
-a smooth firm usually BPH while
-induration signify the possibility of Ca & need
further evaluation.

-retention may occur usually precipitated by prostatic


infection or infarction, ingestion of diuretic,
anticholenergic, antidepressant
Symptom not related to prostatic size
Investigation
GUE, infection & hematuria.
Renal function : b.urea & s.creatinine.
PSA : is optional .prostatic tumor marker
 Imaging : IVU &U/S is some time recommended.
Cystoscopy. Used to choose surgical approach
when surgery is indicated.

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D.Dx.
Obstructive condition of lower tract like
-urethral stricture,
-bladder neck contracture,
-bladder stone, &
-Ca prostate.
irritative
-UTI,
-CIS, &
-neurogenic bladder

Treatment Options
Watchful waiting
Medication
Surgical approaches
TURP
Invasive open procedures
Minimal invasive
A-Watchful waiting
Idea is only 5% of BPH patients will develop retention
• Mild symptoms with not very active life style
• Follow up every 3-6 months
• Offer suggestions that reduce symptoms
Like avoid caffeine , night time excessive fluid and

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B-Medical therapy.
1-Alpha blocker:
The human prostate & bladder neck contain alph-1a
receptors.
Alpha blocker lead to smooth muscle relaxation &
dilatation of bladder neck.
Alpha blocker either nonselective act on alpha like
phenoxybenzamine
Selective which either
short acting e.g prazosin or,
long acting e.g terazosin & doxazosin .
These need dose titration to decrease their side effect

side effect include


-orthostatic hypotension,
-dizziness,
-tiredness,
-retrograde ejaculation,
-rhinitis, &
-headach .

Highly selective act on alpha 1a receptors like


Tamsolusin and Silodosin in both no need for dose
titration because it had fewer side effect.mostly
causing retro grad ejaculation

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17/04/1443

2- 5-alpa reductase inhibitor


Finasteride and dutasteride are 5 alpha reductase
inhibitors that block the conversion of testosterone to
dihydrotestosteron. This drug act on epithelial
component (adenoma) of the prostate reduce the size
of the gland
(20% reduction of weight in 6 months).
side effect
-decrease libido &
-reduce PSA level to 50% complicating cancer
detection.

B-Surgical management.
Absolutetely Indicated in
1-refractory retention (after at least 1 trial of catheter
removal),
2-recurrent UTI due to PBH
3-recurrent gross hematuria, due to PBH
4-bladder stone,
5-renal insufficiency
6-bladder diverticulum
7- failure of medical treatment (medication not
improving the quality of life)
*provide these are from BPH.

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1-TURP (transurethral resection of the prostate)


-resection of the prostate endoscopically into small
pieces which removed by bladder wash.
-Used in 95% of BPH.
complications. Immediate
-Bleeding
-Capsular perforation with fluid extravasation
-Infaction
-TURP syndrom
resulting from hypervolemic hyponatremic state due
to absorption of hypotonic irrigating solution.
Manifested by nausea, vomiting, confusion,
hypertension, bradycardia,& visual disturbance

Late complication
• Urethral stricture
• Bladder neck contracture
• Retrograde ejaculation
• Impotence
• Incontinence

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2-open simple prostatectomy.

Indicated when TURP not performed due to


1- large prostate >100g.
2- concomitant bladder pathology like stone or
diverticulum, &
3- when dorsal lithotomy positioning is not possible.

Its either transvesical or retropubic.

3-minimal invasiae therapy.


1- laser therapy,
2- electrovaporization of the prostate,
3- transurethral needle ablation,
4- high intensity focused ultrasound,
5- intraurethral stent,
6- balloon dilation of the prostate.

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