This document discusses benign prostatic hyperplasia (BPH): 1. BPH is a non-cancerous enlargement of the prostate gland caused by testosterone-driven hyperplasia. It commonly affects men over 70 years old. 2. Microscopically, BPH shows nodular hyperplasia of prostate glands and stroma, with cystic glands and retained double epithelial layer. 3. Clinical complications can include urinary obstruction, retention, infections, and kidney damage if left untreated. Treatment may involve transurethral resection of the prostate (TURP).

1. “The weak can never forgive.
forgiveness is the attribute of
the strong.”
– MK Gandhi

2. CLINICAL PATHOLOGY
The foundation of clinical medicine.
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
BPH3: Urinary Tract Dis: Prostate, BPH

3. 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

4. Prostate: Zones
Trans. Zone
BPHBPH
Posterior Anterior

5. 5
Normal Prostate Histology: Fibromuscular gland.
2. Glands double layer epithelium.
1. Fibromuscular stroma
3. Secretions (corpora amylaceae)

6. 6
Prostate: Pathology
Disorders of Prostate:
1. Inflammations – infections - Prostatitis
2. Benign Prostatic Hyperplasia*
3. Neoplasms – Prostatic Carcinoma*
BPH
Cancer

7. 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.

8. One single grateful thought raised to
heaven is the most perfect prayer.
G. E. Lessing
German critic & dramatist (1729 - 1781)

9. 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!

10. 10
BPH: Morphology: Gross & Microscopy
Gross: Grey white, nodular Hyperplasia, Periurethral zone.
Microscopy: Hyperplastic cystic glands. Normal double layer epithelium

11. 11
BPH: Complications
 Enlarged prostate.
 Median lobe - ball valve**
1. Urinary Obstruction
2. Urine retention
3. Inflammation / infections
4. Hypertrophy of wall
5. Mucosal trabeculations
6. Urolithiasis – stones.
Stone

12. 12
BPH: TURP (Diagnosis + Treat )
Trans
Urethral
Resection of
Prostate
Complications:
Hemorrhage,
Infection,
Granulomatous prostatitis
Retrograde ejaculation.

13. 13
Normal – Prostatitis – BPH

14. “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