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Benign prostateic hyperplasia

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  • 1. Benign prostateicBenign prostateic hyperplasiahyperplasia Dept. of urology.Shanghai Renji hospital Wang YiXin
  • 2. Etiology of BPHEtiology of BPH  The etiology of BPH IS undoubtedly multifactorial. However,it is well recognized that two prerequisites for its induction are the testes and aging .  Because prostatic growth is regulated principally by androgen.  It has been suspected for years that BPH is under endocrine control .In addition. There is compelling evidence for a major role of the stroma in the induction of the disease .
  • 3. Pathology of BPHPathology of BPH The basic change is that of epithelial hyperplasia of the prostatic glands and their fibrous stroma A wide variation between epithelial and fibrous elements. The hypertrophy originates in the periurethral glands Form a false capsule.
  • 4. Clinical featuresClinical features Local symptoms  Increased frequency  Nocturia ,hesitancy  Feeling of incomplete Emptying .  Dribbling, Dysuria.  Haematuria, Epididymitis  Urgency, Incontinence.  Micturition easier on squatting General symptoms  Lassitude due to nocturia.  Renal pain.  Prinephric abscess .  Progressive renal failure.  Anorexia ,Nausea, Vomiting  Dyspnoea,Coma.
  • 5. Diagnosis of BPHDiagnosis of BPH  Clinical history  General examination  Rectal examination :size,consistency, irregularities or hard nodules.  Becteriological tests:MSU (meadum stream urine)  Haematological tests:anaemia  Biochemical tests:blood urea and creatinine, electrolytes, PSA.
  • 6. Diagnosis of BPH(Radiology)Diagnosis of BPH(Radiology)  Straight x-ray, KUB.  IVP shows: 1.suppression of renal function 2.hydronephrosis and hydroureter 3.fish-hooking of the lows ends of the ureter 4.trabeculation of the bladder 5.bladder diverticular formation 6.filling defects in the bladder 7.residual contrast left in the bladder after micturition  RGP,when non-functioning kidney is present.
  • 7. Other investigationsOther investigations Electro—cardiography to assese myocardial state Chest x—ray Pulmonary function tests
  • 8. Treatment of BPHTreatment of BPH  Chronic retention of urine  Acute retention 1. Conservative methods by running water taps to induce to void ,sitting in a warm bath 2. Catheterrisation 3. Suprapubic cystostomy:temporary form of suprapubic cystostomy,catheter should be changed at monthly.
  • 9. Operative treatment of BPHOperative treatment of BPH Transurethral prostatectomy Retropubic prostatectomy Transvesical prostatectomy Transperineal prostatectomy Cryogenic prostatectomy Microwave therapy
  • 10. Operative treatment of BPHOperative treatment of BPH Transurethral prostatectomy Retropubic prostatectomy Transvesical prostatectomy Transperineal prostatectomy Cryogenic prostatectomy Microwave therapy