This document discusses the pathogenesis of benign prostatic hyperplasia (BPH). It covers several key points:
1) BPH results from an increase in epithelial and stromal cells in the prostate transition zone due to proliferation and impaired programmed cell death. While androgens are important for normal prostate development, they are not direct mitogens for BPH growth.
2) Other contributing factors include stem cell dysfunction, growth factors, inflammation, and genetic/familial components. The prostate and bladder both adapt in response to outflow obstruction through changes like smooth muscle hypertrophy, increased extracellular matrix, and altered neural control.
3) While BPH causes lower urinary tract symptoms, the symptoms are
Benign prostatic hyperplasia and prostate cancer are two conditions that affect the prostate gland. Benign prostatic hyperplasia involves noncancerous nodules in the prostate that can obstruct urinary flow, while prostate cancer involves irregular yellow tumors forming mostly in the posterior prostate. Transrectal ultrasound and prostate biopsies are used to evaluate abnormalities, and treatments include transurethral resection of the prostate or radical prostatectomy.
The document discusses carcinoma penis, including its epidemiology, risk factors, pathology, staging, investigations, and treatment options. Premalignant lesions like erythroplasia of Queyrat and balanitis xerotica obliterans are described. Treatment depends on the stage and includes circumcision for small tumors, local excision, glansectomy, Mohs micrographic surgery, and laser surgery to preserve the organ while wide local excision or penectomy may be needed for more advanced cases.
Benign Prostatic Hyperplasia BPH [Dr. Edmond Wong]Edmond Wong
Here are the key points about the natural history and progression of BPH on watchful waiting:
- Most men with BPH will experience gradual worsening of symptoms over time if left untreated. However, the rate of progression varies between individuals.
- In the Ball et al study of 100 men on watchful waiting for 5 years, about 25% got better, 30% stayed the same, and 45% got worse.
- Other studies have found annual progression rates of symptoms and complications to be around 10-15% per year. However, many men have stable disease for many years as well.
- Risk factors for faster progression include larger prostate size, more bothersome initial symptoms, and older age at presentation
This document discusses tumors of the penis, including pre-malignant lesions, cancer in situ, invasive carcinoma, etiology, natural history, examination, staging, differential diagnosis, and treatment options. It provides an overview of the different types of penile tumors and lesions, from non-cancerous growths to invasive squamous cell carcinoma. Evaluation involves examination, imaging, and biopsy to determine tumor extent and stage. Treatment depends on tumor stage but may include circumcision, partial or total penectomy, lymph node dissection, and radiation therapy.
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document provides an overview of renal cell carcinoma (RCC). It discusses the epidemiology, clinical presentation, management, and prognosis of RCC. RCC arises from renal tubular epithelium and accounts for 80-85% of kidney cancers. Risk factors include genetic predispositions, smoking, occupational exposures, and obesity. Clinical evaluation involves history, exam, lab tests, and imaging studies. Management depends on staging and may include surgery, targeted therapy, immunotherapy, or palliative care. Prognosis depends on stage, grade, size and histological type of the tumor.
This document summarizes the surgical management of urethral strictures. It discusses investigations like retrograde urethrography and various types of urethroplasty procedures including dilation, internal urethrotomy, lasers, stents, and open reconstruction. Specific procedures covered include anastomotic urethroplasty, substitution urethroplasty using grafts and flaps, and augmented anastomotic urethroplasty. Complications of different procedures like buccal mucosal graft urethroplasty, fasciocutaneous urethroplasty, and anterior and posterior urethroplasty are also summarized.
Benign prostatic hyperplasia and prostate cancer are two conditions that affect the prostate gland. Benign prostatic hyperplasia involves noncancerous nodules in the prostate that can obstruct urinary flow, while prostate cancer involves irregular yellow tumors forming mostly in the posterior prostate. Transrectal ultrasound and prostate biopsies are used to evaluate abnormalities, and treatments include transurethral resection of the prostate or radical prostatectomy.
The document discusses carcinoma penis, including its epidemiology, risk factors, pathology, staging, investigations, and treatment options. Premalignant lesions like erythroplasia of Queyrat and balanitis xerotica obliterans are described. Treatment depends on the stage and includes circumcision for small tumors, local excision, glansectomy, Mohs micrographic surgery, and laser surgery to preserve the organ while wide local excision or penectomy may be needed for more advanced cases.
Benign Prostatic Hyperplasia BPH [Dr. Edmond Wong]Edmond Wong
Here are the key points about the natural history and progression of BPH on watchful waiting:
- Most men with BPH will experience gradual worsening of symptoms over time if left untreated. However, the rate of progression varies between individuals.
- In the Ball et al study of 100 men on watchful waiting for 5 years, about 25% got better, 30% stayed the same, and 45% got worse.
- Other studies have found annual progression rates of symptoms and complications to be around 10-15% per year. However, many men have stable disease for many years as well.
- Risk factors for faster progression include larger prostate size, more bothersome initial symptoms, and older age at presentation
This document discusses tumors of the penis, including pre-malignant lesions, cancer in situ, invasive carcinoma, etiology, natural history, examination, staging, differential diagnosis, and treatment options. It provides an overview of the different types of penile tumors and lesions, from non-cancerous growths to invasive squamous cell carcinoma. Evaluation involves examination, imaging, and biopsy to determine tumor extent and stage. Treatment depends on tumor stage but may include circumcision, partial or total penectomy, lymph node dissection, and radiation therapy.
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document provides an overview of renal cell carcinoma (RCC). It discusses the epidemiology, clinical presentation, management, and prognosis of RCC. RCC arises from renal tubular epithelium and accounts for 80-85% of kidney cancers. Risk factors include genetic predispositions, smoking, occupational exposures, and obesity. Clinical evaluation involves history, exam, lab tests, and imaging studies. Management depends on staging and may include surgery, targeted therapy, immunotherapy, or palliative care. Prognosis depends on stage, grade, size and histological type of the tumor.
This document summarizes the surgical management of urethral strictures. It discusses investigations like retrograde urethrography and various types of urethroplasty procedures including dilation, internal urethrotomy, lasers, stents, and open reconstruction. Specific procedures covered include anastomotic urethroplasty, substitution urethroplasty using grafts and flaps, and augmented anastomotic urethroplasty. Complications of different procedures like buccal mucosal graft urethroplasty, fasciocutaneous urethroplasty, and anterior and posterior urethroplasty are also summarized.
The document discusses the anatomy and functions of the prostate gland. It is located below the bladder and in front of the rectum. The prostate secretes fluid that nourishes sperm. Common prostate problems include enlarged prostate (BPH), prostate cancer, and prostatitis. BPH causes urinary symptoms due to pressure on the urethra. Prostate cancer develops from gland cells and can spread to other organs if not detected early. Diagnosis involves exams, tests like PSA, and biopsies. Treatment depends on the condition but may include medications, surgery, radiation, or watchful waiting.
This document provides information on bladder cancer, including benign bladder tumors, risk factors, symptoms, diagnosis, staging, and treatment of non-muscle-invasive bladder cancer. It discusses various benign bladder tumors such as epithelial metaplasia, leukoplakia, inverted papilloma, and their characteristics. Major risk factors for bladder cancer mentioned are smoking, occupational exposures, infections, and certain genetic factors. Cystoscopy and biopsy are important for diagnosis and staging. Treatment of non-muscle-invasive bladder cancer involves transurethral resection of bladder tumors.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document discusses the clinical features, prognostic factors, investigations and guidelines for diagnosis of renal cell carcinoma (RCC). It covers the typical presentations of RCC including incidental discovery, localized symptoms like flank pain, and symptoms of advanced disease. Investigations discussed include blood tests, CT, MRI, renal angiography and PET. Guidelines from AUA, EAU, NCCN and ESMO are summarized, emphasizing use of CT for diagnosis and staging, and recommending biopsy for small lesions before treatment.
Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis due to injury or inflammation. It is most common in males and usually occurs around age 50. Symptoms include poor urine stream and retention. Diagnosis involves tests like cystoscopy and retrograde urethrogram. Treatment depends on location and severity but may include dilation, internal urethrotomy, or open urethroplasty surgery to repair or bypass the stricture. Effective drainage of the bladder is important to manage this condition.
This document discusses the etiology and pathophysiology of benign prostatic hyperplasia (BPH). It states that while androgens are required for normal prostate development, the precise causes of BPH are uncertain. Several factors may be involved, including androgens, estrogens, growth factors, inflammation and genetic factors. BPH causes prostate enlargement which obstructs the urethra. This obstruction induces changes in bladder function over time, leading to lower urinary tract symptoms. A variety of treatment options exist to relieve bladder outlet obstruction and manage symptoms.
This document discusses pelvic fracture urethral distraction defects (PFUDD). It provides classifications for pelvic fractures and urethral injuries. For urethral injuries, it describes the Colapinto-McCallum and Goldman classifications based on radiological findings. Clinical features, diagnostic evaluations including retrograde urethrography, and management approaches for immediate vs delayed treatment are covered. Goals of treatment include re-establishing urethral continuity while reducing risks of stenosis, incontinence and impotence.
The ureters are tubular structures that transport urine from the kidneys to the bladder. They have multiple layers including epithelium, smooth muscle, and adventitia. Sites of natural narrowing include the ureteropelvic junction (UPJ) and ureterovesical junction. UPJ obstruction is most common in boys and on the left side. It can be caused by intrinsic narrowing at the UPJ or extrinsic compression. Surgical intervention is considered if renal function declines or symptoms develop. Treatment options include open or laparoscopic pyeloplasty, endopyelotomy, or ureterocalycostomy depending on the specifics of each case.
Urinary diversion involves redirecting the urinary pathway from the bladder due to conditions like muscle invasive bladder cancer. There are various types including continent, incontinent, internal, and external diversions. The ileal conduit is the most common non-continent diversion and involves using a segment of ileum as a urinary conduit connected to an abdominal stoma. Continent diversions like the Indiana pouch create an internal pouch that allows intermittent self-catheterization. Complications of urinary diversion can include metabolic abnormalities, infections, stone formation, and nutritional deficiencies depending on the bowel segment used.
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
The document provides information on the surgical anatomy of the kidney and ureter. It discusses the embryology, gross anatomy including orientation and position of the kidneys. It describes the microscopic anatomy including the nephron. It details the coverings of the kidney including the fibrous capsule, perinephric fat, Gerota's fascia and paranephric fat. It outlines the relations of the kidney to surrounding structures like ribs, diaphragm and pleura. It also discusses the blood supply, lymphatic drainage and nerve supply of the kidneys.
Prostate carinoma- surgery- Open Radical Retropubic Prostatectomy(rrp)GovtRoyapettahHospit
This document describes the department of urology at a hospital in Chennai, India. It lists the professors and assistant professors in the department. It then provides details on radical retropubic prostatectomy surgery, including its history and the goals of the surgery. It describes the preoperative assessment and surgical procedure, including anatomy, incisions, and key steps like bladder neck reconstruction. It discusses complications, post-operative care, and management of issues like hemorrhage and bladder neck contracture.
This document discusses testicular tumors, including their etiology, classification, clinical presentation, diagnosis, staging, and treatment. Some key points:
- Testicular cancer is the most common cancer in men ages 15-35 and has a high cure rate with early detection and treatment.
- Risk factors include cryptorchidism, prior testicular cancer, infertility, and genetic factors. Carcinoma in situ is a precursor to most germ cell tumors.
- Tumors are classified as seminomas or non-seminomas. Staging involves tumor markers, imaging, and pathology to determine extent of disease.
- Treatment involves radical orchidectomy followed by radiotherapy for seminomas or chemotherapy for
This document provides an overview of the history and techniques for orthotopic neobladder urinary diversion. Some key points:
- Orthotopic diversion was pioneered in the 1950s as an alternative to ureterosigmoidostomy and ileal conduit diversion due to complications of those procedures.
- Patient selection considers oncologic factors like risk of urethral recurrence and tumor stage, as well as patient factors like age, renal function, manual dexterity, and prior treatments.
- Surgical techniques aim to optimize continence by preserving the rhabdosphincter and its innervation during cystectomy. For males the urethra is detached in a retrograde
Post-obstructive diuresis refers to high urine output that can occur after relief of urinary tract obstruction. It is caused by accumulation of water, sodium, and urea during the period of obstruction. There are two main types - physiological diuresis which is self-limiting as fluid balance returns to normal, and pathological diuresis where inappropriate water loss continues beyond normalization of volume status. Treatment involves careful fluid management to replace losses based on urine output and electrolyte monitoring, as most cases will resolve spontaneously once homeostasis is restored. However, those with risk factors like edema may require closer monitoring and intravenous fluids.
The document describes the process of renal transplantation recipient surgery. It discusses:
- The moderators and their roles
- Preparing the allograft kidney by inspecting and dissecting vessels and ligating branches
- Preparing the recipient with anesthesia and positioning
- Exposing the iliac vessels through an incision and developing the retroperitoneal space
- Performing the anastomoses of the renal vessels to the iliac vessels and reperfusion
- Constructing the ureteroneocystostomy
- Closing with catheters, drains, and stents
UPJ obstruction is a partial or complete blockage of urine flow from the renal pelvis to the ureter. It is often detected during prenatal ultrasound as hydronephrosis. Diagnosis is confirmed by diuretic renography showing delayed drainage. Conservative management involves monitoring with serial ultrasounds and antibiotics if VUR is present. Surgical intervention is considered if symptoms develop, renal function declines, or infections recur. Surgical options include open or laparoscopic pyeloplasty to reconnect the renal pelvis to ureter.
This document discusses human growth factors and their roles in various processes from the Department of Urology at GRH and KMC in Chennai. It lists the moderators and their roles. Growth factors are defined as signaling molecules that stimulate cellular growth, proliferation, and differentiation. Examples include cytokines and hormones. The document discusses the cell cycle and how growth factors interact with cell surface receptors to affect gene transcription and cell cycle progression. It provides examples of many growth factors including their functions and roles in various conditions.
The document discusses the anatomy and functions of the prostate gland. It is located below the bladder and in front of the rectum. The prostate secretes fluid that nourishes sperm. Common prostate problems include enlarged prostate (BPH), prostate cancer, and prostatitis. BPH causes urinary symptoms due to pressure on the urethra. Prostate cancer develops from gland cells and can spread to other organs if not detected early. Diagnosis involves exams, tests like PSA, and biopsies. Treatment depends on the condition but may include medications, surgery, radiation, or watchful waiting.
This document provides information on bladder cancer, including benign bladder tumors, risk factors, symptoms, diagnosis, staging, and treatment of non-muscle-invasive bladder cancer. It discusses various benign bladder tumors such as epithelial metaplasia, leukoplakia, inverted papilloma, and their characteristics. Major risk factors for bladder cancer mentioned are smoking, occupational exposures, infections, and certain genetic factors. Cystoscopy and biopsy are important for diagnosis and staging. Treatment of non-muscle-invasive bladder cancer involves transurethral resection of bladder tumors.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document discusses the clinical features, prognostic factors, investigations and guidelines for diagnosis of renal cell carcinoma (RCC). It covers the typical presentations of RCC including incidental discovery, localized symptoms like flank pain, and symptoms of advanced disease. Investigations discussed include blood tests, CT, MRI, renal angiography and PET. Guidelines from AUA, EAU, NCCN and ESMO are summarized, emphasizing use of CT for diagnosis and staging, and recommending biopsy for small lesions before treatment.
Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis due to injury or inflammation. It is most common in males and usually occurs around age 50. Symptoms include poor urine stream and retention. Diagnosis involves tests like cystoscopy and retrograde urethrogram. Treatment depends on location and severity but may include dilation, internal urethrotomy, or open urethroplasty surgery to repair or bypass the stricture. Effective drainage of the bladder is important to manage this condition.
This document discusses the etiology and pathophysiology of benign prostatic hyperplasia (BPH). It states that while androgens are required for normal prostate development, the precise causes of BPH are uncertain. Several factors may be involved, including androgens, estrogens, growth factors, inflammation and genetic factors. BPH causes prostate enlargement which obstructs the urethra. This obstruction induces changes in bladder function over time, leading to lower urinary tract symptoms. A variety of treatment options exist to relieve bladder outlet obstruction and manage symptoms.
This document discusses pelvic fracture urethral distraction defects (PFUDD). It provides classifications for pelvic fractures and urethral injuries. For urethral injuries, it describes the Colapinto-McCallum and Goldman classifications based on radiological findings. Clinical features, diagnostic evaluations including retrograde urethrography, and management approaches for immediate vs delayed treatment are covered. Goals of treatment include re-establishing urethral continuity while reducing risks of stenosis, incontinence and impotence.
The ureters are tubular structures that transport urine from the kidneys to the bladder. They have multiple layers including epithelium, smooth muscle, and adventitia. Sites of natural narrowing include the ureteropelvic junction (UPJ) and ureterovesical junction. UPJ obstruction is most common in boys and on the left side. It can be caused by intrinsic narrowing at the UPJ or extrinsic compression. Surgical intervention is considered if renal function declines or symptoms develop. Treatment options include open or laparoscopic pyeloplasty, endopyelotomy, or ureterocalycostomy depending on the specifics of each case.
Urinary diversion involves redirecting the urinary pathway from the bladder due to conditions like muscle invasive bladder cancer. There are various types including continent, incontinent, internal, and external diversions. The ileal conduit is the most common non-continent diversion and involves using a segment of ileum as a urinary conduit connected to an abdominal stoma. Continent diversions like the Indiana pouch create an internal pouch that allows intermittent self-catheterization. Complications of urinary diversion can include metabolic abnormalities, infections, stone formation, and nutritional deficiencies depending on the bowel segment used.
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
The document provides information on the surgical anatomy of the kidney and ureter. It discusses the embryology, gross anatomy including orientation and position of the kidneys. It describes the microscopic anatomy including the nephron. It details the coverings of the kidney including the fibrous capsule, perinephric fat, Gerota's fascia and paranephric fat. It outlines the relations of the kidney to surrounding structures like ribs, diaphragm and pleura. It also discusses the blood supply, lymphatic drainage and nerve supply of the kidneys.
Prostate carinoma- surgery- Open Radical Retropubic Prostatectomy(rrp)GovtRoyapettahHospit
This document describes the department of urology at a hospital in Chennai, India. It lists the professors and assistant professors in the department. It then provides details on radical retropubic prostatectomy surgery, including its history and the goals of the surgery. It describes the preoperative assessment and surgical procedure, including anatomy, incisions, and key steps like bladder neck reconstruction. It discusses complications, post-operative care, and management of issues like hemorrhage and bladder neck contracture.
This document discusses testicular tumors, including their etiology, classification, clinical presentation, diagnosis, staging, and treatment. Some key points:
- Testicular cancer is the most common cancer in men ages 15-35 and has a high cure rate with early detection and treatment.
- Risk factors include cryptorchidism, prior testicular cancer, infertility, and genetic factors. Carcinoma in situ is a precursor to most germ cell tumors.
- Tumors are classified as seminomas or non-seminomas. Staging involves tumor markers, imaging, and pathology to determine extent of disease.
- Treatment involves radical orchidectomy followed by radiotherapy for seminomas or chemotherapy for
This document provides an overview of the history and techniques for orthotopic neobladder urinary diversion. Some key points:
- Orthotopic diversion was pioneered in the 1950s as an alternative to ureterosigmoidostomy and ileal conduit diversion due to complications of those procedures.
- Patient selection considers oncologic factors like risk of urethral recurrence and tumor stage, as well as patient factors like age, renal function, manual dexterity, and prior treatments.
- Surgical techniques aim to optimize continence by preserving the rhabdosphincter and its innervation during cystectomy. For males the urethra is detached in a retrograde
Post-obstructive diuresis refers to high urine output that can occur after relief of urinary tract obstruction. It is caused by accumulation of water, sodium, and urea during the period of obstruction. There are two main types - physiological diuresis which is self-limiting as fluid balance returns to normal, and pathological diuresis where inappropriate water loss continues beyond normalization of volume status. Treatment involves careful fluid management to replace losses based on urine output and electrolyte monitoring, as most cases will resolve spontaneously once homeostasis is restored. However, those with risk factors like edema may require closer monitoring and intravenous fluids.
The document describes the process of renal transplantation recipient surgery. It discusses:
- The moderators and their roles
- Preparing the allograft kidney by inspecting and dissecting vessels and ligating branches
- Preparing the recipient with anesthesia and positioning
- Exposing the iliac vessels through an incision and developing the retroperitoneal space
- Performing the anastomoses of the renal vessels to the iliac vessels and reperfusion
- Constructing the ureteroneocystostomy
- Closing with catheters, drains, and stents
UPJ obstruction is a partial or complete blockage of urine flow from the renal pelvis to the ureter. It is often detected during prenatal ultrasound as hydronephrosis. Diagnosis is confirmed by diuretic renography showing delayed drainage. Conservative management involves monitoring with serial ultrasounds and antibiotics if VUR is present. Surgical intervention is considered if symptoms develop, renal function declines, or infections recur. Surgical options include open or laparoscopic pyeloplasty to reconnect the renal pelvis to ureter.
This document discusses human growth factors and their roles in various processes from the Department of Urology at GRH and KMC in Chennai. It lists the moderators and their roles. Growth factors are defined as signaling molecules that stimulate cellular growth, proliferation, and differentiation. Examples include cytokines and hormones. The document discusses the cell cycle and how growth factors interact with cell surface receptors to affect gene transcription and cell cycle progression. It provides examples of many growth factors including their functions and roles in various conditions.
It is not for practicing, only general description of prostate cancer.......of my presentation . for explanation study authentic books also .....and webs.
This document provides an overview of benign prostatic hyperplasia (BPH), including relevant anatomy, etiology, pathophysiology, symptoms, complications, diagnosis, and treatment options. It discusses the prostate gland anatomy and development. Etiology sections cover the roles of androgens, estrogen, growth factors, and other signaling pathways. Pathophysiology involves increased urethral resistance and compensatory bladder changes. Symptoms include both voiding and storage issues. Complications include urinary retention, incontinence, and infection. Diagnosis involves history, exam, testing such as DRE, ultrasound and PSA. Treatment ranges from medications to minimally invasive procedures like TUNA and TUMT to surgeries
Benign Prostate Hyperplasia (BPH) has an uncertain molecular etiology. Factors that may play a role include androgens, estrogens, stromal-epithelial interactions, growth factors, and neurotransmitters. The prostate maintains its ability to respond to androgens throughout life. Stromal cells play a central role in androgen-dependent prostate growth, and type 2 5-alpha reductase within stromal cells is key in amplifying androgenic effects. Programmed cell death is important in maintaining glandular homeostasis, and defects in apoptosis may contribute to BPH pathogenesis. Various growth factors, cytokines, and signaling pathways also influence prostate proliferation and growth. A familial
This study examined the anti-tumor effects of Jianpi Huayu decoction (JHD) on liver cancer dormancy and recurrence. A mouse model of liver cancer dormancy was used. Mice were administered different doses of JHD after tumor dormancy was disrupted. JHD increased liver cancer dormancy rates in a dose-dependent manner by inhibiting angiogenesis. It did so by decreasing levels of proteins and genes involved in angiogenesis, such as HIF-1α, VEGF, MMP-9, TIMP-1 and EMMPRIN. JHD also inhibited the proliferation of circulating endothelial cells, which are involved in tumor blood vessel formation. The results suggest JHD may enhance liver cancer dormancy by inhibiting angiogenesis
This document discusses various categories of male infertility treatment. It covers common causes of male infertility like varicocele, cryptorchidism, endocrinopathies, and ejaculatory dysfunction. For each category, it describes the etiology, pathophysiology, evaluation, and treatment options. The treatment options discussed include varicocele repair, orchiopexy for cryptorchidism, hormone therapy for endocrinopathies, and assisted reproductive techniques for conditions affecting sperm production or delivery.
This document discusses various categories of male infertility treatment. It covers common causes of male infertility like varicocele, cryptorchidism, endocrinopathies and outlines treatment approaches. For varicocele, it describes indications for treatment, outcomes of repair including improved semen parameters and pregnancy rates. For cryptorchidism, it discusses detrimental effects on fertility and benefits of early orchiopexy. Overall, the document provides an overview of etiologies of male infertility and management strategies.
This document discusses the etiology and evaluation of erectile dysfunction (ED). It begins with definitions of ED and classifications of organic vs psychogenic causes. It then covers the epidemiology, risk factors, and various etiologies of ED including vascular, neurological, hormonal, drug-induced, diabetes-related, and other causes. The document outlines the evaluation of ED, including sexual questionnaires, medical history, physical exam, lab tests, and specialized tests like vascular testing using duplex ultrasound, pharmacologic injection, and dynamic infusion cavernosometry and cavernosography. It provides details on techniques, indications, and interpretations for the various diagnostic tests used to evaluate patients with ED.
The document discusses the endocrinology of sex hormones and their effects on the periodontium. It covers the main sex steroid hormones - androgens like testosterone, estrogens like estradiol, and progestins like progesterone. It describes their mechanisms of action, roles in various physiological conditions like puberty, menstruation, pregnancy, and menopause. Fluctuations in sex hormone levels during these conditions can impact the periodontal tissues by altering the subgingival microbiota and increasing vascular permeability and inflammation. The periodontium is identified as a target tissue for sex hormones.
This study investigated the role of histone deacetylase 3 (HDAC3) in endometriosis. The researchers found that HDAC3 gene expression was highest in epithelial cell lines and endometriotic cell lines. HDAC3 expression was not regulated by ovarian steroid hormones in endometrial or endometriotic cell lines. HDAC3 gene expression was higher in endometriosis lesions than normal endometrial tissue. Preliminary results also showed that GDF11, a cell cycle regulator target of HDAC3, was not expressed in normal endometrium but its expression in endometriosis lesions requires further analysis. The results suggest HDAC3 may contribute to the growth of endometrial cells at ectopic sites
This document discusses prostate pathology, including the anatomy and histology of the normal prostate gland. It describes common benign conditions like benign prostatic hyperplasia (BPH) and its relationship to dihydrotestosterone (DHT). It also covers prostate cancer, including risk factors, screening recommendations, diagnosis, common histologic variants of adenocarcinoma, the Gleason grading system, and prognostic factors. Key points are that DHT plays a major role in BPH development, prostate cancer most commonly presents as acinar adenocarcinoma, and Gleason score is important for predicting cancer prognosis.
This document discusses hematopoietic growth factors (HGFs), which regulate blood cell production. It focuses on erythropoietin and myeloid growth factors, describing their clinical uses, dosages, and risks. Erythropoietin is used to treat chemotherapy-induced anemia but may increase thromboembolic risks and possibly promote tumor growth. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor are used to prevent or treat febrile neutropenia from chemotherapy.
This document provides an overview of the medical management of fibroids. It discusses the epidemiology, etiology, classification, and various treatment options for fibroids. The main treatment approaches include watchful waiting for asymptomatic cases, medical management to improve symptoms and reduce fibroid size, and surgical management for severe or unresponsive cases. Medical management involves hormonal agents like combined oral contraceptives, anti-progesterones, LNG-IUS, and antigonadotropins to treat heavy bleeding and reduce size. GnRH agonists are commonly used pre-operatively to shrink fibroids. Selective progesterone receptor modulators like ulipristal acetate are also discussed.
This document summarizes a study on the role of autocrine human growth hormone in calcium-dependent oligomerization of VDAC1 in breast cancer cells. The study aims to investigate how growth hormone and calcium may regulate VDAC1 expression in mitochondria and influence epithelial-mesenchymal transition and apoptosis in breast cancer cell lines. The study will analyze VDAC1 expression and cell proliferation in MCF-7 breast cancer cells transfected with wild-type or mutant growth hormone genes. Outcomes may improve understanding of cancer cell survival mechanisms and provide novel therapeutic strategies for breast cancer.
This document summarizes theories of carcinogenesis and hallmarks of cancer. It discusses the genetic theory, which states that cancer arises from DNA mutations that are transmitted to daughter cells. It also covers the epigenetic theory, immune surveillance theory, and monoclonal hypothesis. Major hallmarks of cancer include excessive growth from oncogenes, resistance to growth inhibition from tumor suppressor genes like RB and p53, evading apoptosis, angiogenesis, invasion and metastasis. Carcinogenesis is described as a multi-step process involving sequential acquisition of mutations. The roles of growth factors, receptors, signaling proteins, and cell cycle regulators in promoting uncontrolled growth are outlined.
RESEARCHERS MAP SIGNIFICANT OF FUNCTIONAL SEQUENCES OF MOUSE GENOME AND ACTIV...Alejandro Garzón
This document summarizes key findings from recent research on the human genome and cholangiocarcinoma. The research identified that activating the NOTCH and AKT genes can cause liver cells to transform into cholangiocarcinoma cancer cells. While it was previously believed that only stem cells could change cell types, this research showed that mature liver cells can be reprogrammed to become another cell type. Understanding the molecular origins of this disease may help develop new antibody therapies to treat cholangiocarcinoma. Overall, the study provides important insights into how cancers can develop and highlights the medical utility of genome research.
RESEARCHERS MAP SIGNIFICANT OF FUNCTIONAL SEQUENCES OF MOUSE GENOME AND ACTIV...Alejandro Garzón
This document summarizes several research studies on genetics and the human genome. It discusses how genome research allows for understanding of genetic backgrounds and disease susceptibility. One study identified that activating the NOTCH and AKT genes can trigger cholangiocarcinoma by reprogramming mature liver cells into bile duct cells. Researchers are exploring gene therapy and antibody treatments targeting these genes to treat cholangiocarcinoma. While much remains to be learned, these studies provide insights into cancer development and new therapeutic approaches.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
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- Factors that can affect the procedure such as hydration, medications, and kidney positioning
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This document provides information about a KUB (kidney, ureter, bladder) x-ray performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides details on the history, physics, techniques, anatomical landmarks, disorders, and interpretations of renal calculi, ureter, bladder, and other findings that can be seen on a KUB x-ray.
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The document provides information about urodynamics testing performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the professors and assistant professors who moderate the tests. It then describes the purpose and components of urodynamics testing, which involves a series of tests to evaluate urine storage and evacuation. The key components reviewed include uroflowmetry, measurement of post-void residual urine, cystometrogram, pressure flow studies, and videourodynamics. The document provides details on performing each test and interpreting the results.
This document provides an overview of MRI in urology, with a focus on MRI of the prostate. It discusses the moderators and professors of the department of urology. It then covers the basic principles of MRI, including magnetic field strength, radiofrequency pulses, T1/T2 weighting, and contrast agents. Applications of MRI for prostate imaging and prostate cancer detection are described, including T2-weighted imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy. The PIRADS scoring system and assessment of extracapsular extension on MRI are also summarized.
This document provides information about intravenous urography (IVU), including its definition, history, indications, contraindications, technique, phases, and what is evaluated. Some key points:
- IVU involves injecting iodine contrast intravenously and taking x-ray images as it passes through the kidneys, ureters, and bladder. It was introduced in 1929 by American urologist Moses Swick.
- Indications include evaluating for ureteral obstruction, trauma, congenital anomalies, hematuria, infection, or uncontrolled hypertension. Contraindications include contrast allergy and renal impairment.
- The technique involves injecting contrast as a rapid bolus,
This patient presented with anterior urethral stricture and multiple abnormal connections (fistulas) between the prostate gland/urethra and the skin, resulting in urine leakage to the skin. Treatment will require surgical repair of the strictures and closure of all abnormal connections to restore normal urinary flow and continence.
This document provides information about intravenous urography (IVU), including:
- IVU involves injecting contrast media intravenously and imaging the kidneys, ureters, and bladder.
- It has indications like evaluating suspected obstruction, assessing integrity after trauma, and investigating hematuria or infection.
- Contraindications include contrast allergy and renal failure. Advantages include clearly outlining the urinary system, while disadvantages include need for contrast and radiation exposure.
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This document discusses urinary extravasation, which is when urine leaks out of the urinary tract into other body cavities. It defines two types - superficial and deep extravasation. Superficial extravasation occurs above the perineal membrane and is usually caused by injuries to the penile urethra during instrumentation. Deep extravasation occurs below the perineal membrane due to injuries of the membranous urethra or extraperitoneal bladder from pelvic trauma. Management involves pain relief, antibiotics, suprapubic catheterization, and sometimes surgical exploration and drainage of collections.
This document provides information about urodynamic evaluation of voiding dysfunction. It discusses the history of urodynamics, aims, equipment used including catheters, flowmeters and EMG equipment. It describes how to conduct urodynamic evaluations including uroflowmetry, cystometrogram, and considerations for filling rate and medium. Key points covered are the indications for urodynamics, preparation of patients, types of equipment and how to interpret uroflow curves and cystometrogram measurements.
This document provides information about various tumor markers used in urology, including prostate-specific antigen (PSA) markers for prostate cancer screening and diagnosis, tumor markers for testicular cancer such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), and urine-based markers for bladder cancer screening like NMP22 and BTA. It also discusses guidelines for PSA screening and interpretation, as well as clinical applications of different tumor markers for diagnosis, prognosis, monitoring treatment response, and detecting recurrence of urological cancers.
This document discusses transitional urology, which involves the planned movement of adolescents and young adults with chronic urological conditions from pediatric to adult-centered care. It provides an overview of common urological conditions seen in transitional urology, including spina bifida, bladder exstrophy, hypospadias, posterior urethral valves, vesicoureteral reflux, and pediatric genitourinary cancers. It also discusses specific issues in transitional urology like urinary tract infections in neurogenic/reconstructed bladders, troubleshooting continent catheterizable channels, risks of malignancy with augmentation cystoplasty, and presentation of BPH and pelvic organ prolapse in patients with neurogenic
This document provides information about retroperitoneal fibrosis (RPF), including its pathogenesis, clinical presentations, investigations, and management. RPF is characterized by extensive fibrosis in the retroperitoneum that can encase the aorta, vena cava, and ureters. Patients typically present with nonspecific symptoms like back pain, but late presentations can include urinary obstruction and vascular complications. Diagnosis is often made using CT or MRI imaging showing soft tissue surrounding retroperitoneal structures. Treatment involves medications like corticosteroids to reduce inflammation or surgical procedures to decompress the urinary system if obstructed.
The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
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This document describes uroflowmetry - a noninvasive test used to evaluate urine flow. It discusses the normal and abnormal flow patterns seen in uroflowmetry and their clinical significance. Uroflowmetry provides parameters like maximum flow rate, average flow rate and voided volume. It can detect bladder outlet obstruction, detrusor underactivity or overactivity. However, pressure-flow studies are needed to precisely define lower urinary tract function. Uroflowmetry is useful for screening and monitoring treatment response, though invasive therapy should not be based on uroflowmetry alone per AUA guidelines.
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1. PATHOGENESIS OF BPH
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
1
2. Moderators:
Professors:
Prof. Dr. G. Sivasankar, M.S., M.Ch.,
Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
Dr. J. Sivabalan, M.S., M.Ch.,
Dr. R. Bhargavi, M.S., M.Ch.,
Dr. S. Raju, M.S., M.Ch.,
Dr. K. Muthurathinam, M.S., M.Ch.,
Dr. D.Tamilselvan, M.S., M.Ch.,
Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. Histologic BPH - microscopic evidence of prostatic
stromal and epithelial hyperplasia. ( transition zone
and periurethral glands.)
Macroscopic BPH- enlargement of the prostate
arising from the stromal and epithelial proliferation.
( no consensus establishing the degree of prostate
enlargement required to support the diagnosis of
macroscopic BPH).
Clinical BPH - clinical manifestations attributed to
the enlarged prostate. (lower urinary tract
symptoms (LUTS), bladder outlet obstruction,
incomplete bladder emptying, acute and chronic
urinary retention, urinary tract infection (UTI),
urosepsis, bladder stones, and hematuria)
3
Dept of Urology, GRH and KMC, Chennai.
4. clinical BPH ,diagnosis of exclusion
prostate cancer prostatitis,
bladder cancer bladder stones
overactive bladder interstitial cystitis,
radiation cystitis UTI, urethritis
primary bladder neck hypertrophy
diabetes,
Parkinson’s disease
lumbosacral disc disease
multiple sclerosis.
4
Dept of Urology, GRH and KMC, Chennai.
5. • Benign prostatic hyperplasia (BPH) is a
pathologic process that contributes to LUTS,
NOT THE SOLE CAUSE OF LUTS
• mass-related increase in urethral
resistance.
• age-related detrusor dysfunction.
• MAY OR MAY NOT produce clinically
significant LUTS / Urodynamically proven 5
Dept of Urology, GRH and KMC, Chennai.
6. Etiology of Benign Prostatic Hyperplasia
• BPH is characterized by an increased
number of epithelial and stromal cells in the
periurethral area of the prostate.
• increase in cell number –
1.epithelial and stromal proliferation
2.impaired programmed cell death
6
Dept of Urology, GRH and KMC, Chennai.
7. • No clear evidence proliferative process.
• early phases of BPH , associated with a rapid
proliferation of cells,
• established disease , maintained in the
presence of an equal or reduced rate of cell
replication.
• Increased expression of antiapoptotic pathway
genes (e.g., bcl-2)
• Androgens-actively inhibit the cell death
7
Dept of Urology, GRH and KMC, Chennai.
8. theories
Hormonal -Androgens, estrogens,
Stem cell theory
Stromal epithelial interaction,growth factor
Genetic,familial factors
8
Dept of Urology, GRH and KMC, Chennai.
9. • viewed as a stem cell disease .
• Dormant stem cells in the normal prostate
rarely divide, but when they do, they give rise to
a second type of transiently proliferating cell
capable of undergoing DNA synthesis and
proliferation - Maintains the number of cells in
the prostate.
9
Dept of Urology, GRH and KMC, Chennai.
10. The aging process
↓
block maturation
process
↓
↓ progression to
terminally
differentiated cells
↓
↓ rate of cell death.
proliferating cells
↓
mature
↓
process of terminal
differentiation
↓
finite life span –
↓
programmed cell death
10
Dept of Urology, GRH and KMC, Chennai.
11. • Hormones may exert their influence over the
stem cell population advancing age ,during
embryonic and neonatal development .
• The size of the prostate may be defined by the
absolute number of potential stem cells present in
the gland - Dictated at the time of embryonic
development.
• Early imprinting of prostatic tissue by
postnatal androgen surges is critical to
subsequent hormonally induced prostatic 11
Dept of Urology, GRH and KMC, Chennai.
12. The Role of Androgens
• Androgens do not cause BPH, the development
of BPH requires the presence of testicular
androgens during prostate development, puberty,
and aging
• castrated prior to puberty do not develop BPH.
• genetic diseases impair
androgen action or production
prostatic levels of DHT & AR remain high with aging
. (peripheral levels of testosterone are decreasing.)
• Androgen withdrawal - partial involution of
established BPH . 12
Dept of Urology, GRH and KMC, Chennai.
14. The Role ofAndrogens
• In the prostate, 5α-reductase converts the hormone
testosterone into DHT, the principal androgen .
• 90% of total prostatic androgen is in the form of DHT,
principally derived from testicular androgens.
• Adrenal androgens - 10% of total prostatic androgen,
• Both testosterone and DHT bind to the same high-affinity
androgen receptor protein.
• DHT is a more potent , higher affinity for the AR.
14
Dept of Urology, GRH and KMC, Chennai.
15. The Role ofAndrogens
• Despite the importance of androgens in
normal prostatic development and secretory
physiology, no evidence that either
testosterone or DHT serves as the direct
mitogen for growth of the prostate in older
men.
• Neither hormone is mitogenic to cultured
prostatic epithelial cells . 15
Dept of Urology, GRH and KMC, Chennai.
16. Androgen Receptors
• The prostate, maintains its ability to
respond to androgens throughout life.
• AR levels in the prostate remain high
throughout aging .
• Nuclear AR levels may be higher in
hyperplastic tissue than in normal controls .
• Age-related increases in estrogen,
increase AR expression
16
Dept of Urology, GRH and KMC, Chennai.
17. DHT and 5α-Reductase
• Intraprostatic DHT concentrations are
maintained same / elevated in BPH.
• the aging prostate - high level of DHT ,
high level of AR; the mechanism for
androgen-dependent cell growth is
maintained.
17
Dept of Urology, GRH and KMC, Chennai.
18. DHT and 5α-Reductase
• Two steroid 5α-reductase enzymes have
been discovered.
• Type 1 5α-reductase - extraprostatic tissues
,skin and liver
• Type 2 5α-reductase - predominant prostatic
enzyme.
• Type 2 enzyme is critical to normal 18
Dept of Urology, GRH and KMC, Chennai.
19. DHT and 5α-Reductase
• Type 2 5α-reductase - stromal cell
• Epithelial cells uniformly lack type 2 protein.
• Stromal cell plays a central role
• type 2 5α-reductase enzyme within the
stromal cell is the key androgenic
amplification step.
• circulating DHT produced in the skin and
19
Dept of Urology, GRH and KMC, Chennai.
20. DHT and 5α-Reductase
• androgen withdrawal – prostrate involution through vascular
effects.
• Castration - acute and drastic vasoconstriction of blood
vessels
20
Dept of Urology, GRH and KMC, Chennai.
21. The Role of Estrogens
• Serum estrogen levels increased in
aging men
• Intraprostatic levels of estrogen
• Larger volumes of BPH - higher levels of
estradiol
• induction of the AR .
• “sensitize” the aging prostate to the effects
of androgen.
21
Dept of Urology, GRH and KMC, Chennai.
22. The Role of progesterone
• high levels of progesterone receptor - normal and
hyperplastic prostate.
• the role of the progesterone , in BPH remains to be
defined.
22
Dept of Urology, GRH and KMC, Chennai.
23. Regulation of Programmed Cell Death
• Programmed cell death (apoptosis) is a
physiologic mechanism crucial to the
maintenance of normal glandular
homeostasis .
• Androgens - suppress programmed cell death
• Following castration, active cell death is
increased in the luminal epithelial population
as well as in the distal region of each duct. 23
Dept of Urology, GRH and KMC, Chennai.
24. Regulation of Programmed Cell Death
local growth factor or growth factor receptor
abnormalities
↓
increased proliferation or decreased levels of
programmed cell death.
24
Dept of Urology, GRH and KMC, Chennai.
25. Stromal-Epithelial Interaction
• Prostatic stromal and epithelial cells
maintain a sophisticated paracrine type of
communication.
• Stromal cell excretory protein (
extracellular matrix) partially regulates
epithelial cell differentiation.
• BPH , a defect in a stromal component
that normally inhibits cell proliferation,
25
Dept of Urology, GRH and KMC, Chennai.
26. Growth Factors
Growth factors are small peptide molecules
that stimulate, or inhibit cell division and
differentiation processes .
Variety of growth factors have been
characterized in normal, hyperplastic, and
neoplastic prostatic tissue.
bFGF (FGF-2),
acidic FGF (FGF-1),
Int-2 (FGF-3),
keratinocyte growth factor (KGF, FGF-7),
transforming growth factors (TGF-β), and
epidermal growth factor (EGF)
26
Dept of Urology, GRH and KMC, Chennai.
28. Growth Factors
• interdependence between growth
factors, growth factor receptors, and
the steroid hormone milieu of the
prostate
• DHT augmenting or modulating the
growth factor effects.
• TGF-β, inhibit epithelial cell
proliferation, may normally exert a
restraining influence over epithelial
28
Dept of Urology, GRH and KMC, Chennai.
29. Role of Inflammatory Pathways and Cytokines in BPH
additional source of growth factors in human BPH
tissue - inflammatory cell infiltrates
Infilteration by activated T – cells
↓
Secrete,produce – VEGF,bFGF,EGF
↓
Stromal & glandular hyperplasia.
29
Dept of Urology, GRH and KMC, Chennai.
30. Genetic and Familial Factors
• BPH - inheritable genetic component.
• Autosomal dominant inheritance pattern.
• Approximately 50% of men undergoing
prostatectomy for BPH at less than 60 years of
age could be attributable to inheritable form of
disease.
• In contrast, only about 9% of men undergoing
prostatectomy for BPH at more than 60 years of
age would be predicted to have a familial risk.
• monozygotic twins demonstrate a higher
concordance rate of BPH than dizygotic twins
30
Dept of Urology, GRH and KMC, Chennai.
31. Genetic and Familial Factors
• Familial BPH - large prostate size,
with hereditary BPH , mean prostate volume of
82.7 mL
with sporadic BPH , 55.5 mL
31
Dept of Urology, GRH and KMC, Chennai.
32. pathogenesis
Anatomic Features -
• McNeal (1978) - BPH first develops in
the periurethral transition zone of the
prostate.
• the transition zone – itself enlarges
with age (unrelated to the development of
nodules ).
32
Dept of Urology, GRH and KMC, Chennai.
33. • presence of the prostatic capsule -
development of LUTS .
• transmits the “pressure” of tissue
expansion to the urethra - increase in
urethral resistance.
• incision of the prostatic capsule -
significant improvement in outflow
obstruction, DESPITE THE VOLUME OF
THE PROSTATE REMAINS THE SAME. 33
Dept of Urology, GRH and KMC, Chennai.
34. Histologic Features.
• BPH - true hyperplastic process.- an
increase in the cell number .
• early periurethral nodules - stromal in
character
• . the earliest transition zone nodules -
proliferation of glandular tissue
34
Dept of Urology, GRH and KMC, Chennai.
35. Histologic Features.
glandular nodules - newly formed small
duct branches that bud off from existing ducts,
a totally new ductal system within the nodule.
• increase in transition zone volume with age
=increased number of nodules + an increase in
the overall size of the zone.
• During the first 20 years of BPH
development-
↑number of nodules, and growth of
each new nodule is generally slow.
35
Dept of Urology, GRH and KMC, Chennai.
36. Importance of Prostatic Smooth Muscle
• prostatic smooth muscle represents a
significant volume of the gland.
• both passive and active forces in
prostatic tissue play a major role in the
pathophysiology of BPH .
36
Dept of Urology, GRH and KMC, Chennai.
37. Passive component Active component
The elastic elements in the stromal
and epithelial cells and the ECM
contributes
prostatic smooth muscle -
regulated by the adrenergic
nervous system
α1A- most abundant
adrenoreceptor subtype
Resonds to androgen ablation- primarily
- epithelial cell population
Responds to α blockade.
37
Dept of Urology, GRH and KMC, Chennai.
38. The Bladder's Response to Obstruction
• the bladder's response to obstruction - an adaptive
one.
• lower tract symptoms - due to obstruction-induced
changes in bladder function, NOT ONLY DUE to
outflow obstruction .
• One third of men continue to have significant voiding
dysfunction after surgical relief of obstruction .
38
Dept of Urology, GRH and KMC, Chennai.
40. The Bladder's Response to Obstruction
Obstruction-induced changes in the bladder - two
basic types.
• detrusor instability or decreased compliance
symptoms of frequency and
urgency
• decreased detrusor contractility
deterioration in the force of the
urinary stream, hesitancy, intermittency, increased 40
Dept of Urology, GRH and KMC, Chennai.
41. The Bladder's Response to Obstruction
• initial response of the detrusor to obstruction -
development of smooth muscle hypertrophy.
• Increase in muscle mass,associated with significant
intra- and extracellular changes in the smooth muscle ,
↓
• detrusor instability and in some cases impaired
contractility.
41
Dept of Urology, GRH and KMC, Chennai.
42. The Bladder's Response to
Obstruction
• changes in smooth muscle cell contractile protein
expression,
• impaired energy production (mitochondrial
dysfunction)
• calcium signaling abnormalities,
• impaired cell-to-cell communication
42
Dept of Urology, GRH and KMC, Chennai.
43. The Bladder's Response to
Obstruction
• smooth muscle cells revert to a
secretory phenotype.
↓
• phenotypic switch - increased ECM
production
significant increase in detrusor ECM
43
Dept of Urology, GRH and KMC, Chennai.
44. • The major endoscopic detrusor change,
trabeculation, is due to an increase in
detrusor collagen . ↓
• significant residual urine , incomplete
emptying may be due to increased
collagen rather than impaired muscle
function.
• Severe trabeculation, however, is seen in 44
Dept of Urology, GRH and KMC, Chennai.
45. The Bladder's Response to Obstruction
• obstruction - modulate normal neural-detrusor
responses ↓
• Altered neural control of micturition
↓
• bladder contractility,
• impaired central processing,
• altered sensation .
45
Dept of Urology, GRH and KMC, Chennai.
46. Independent of obstruction, AGING
↓
Atherosclerosis , chronic bladder ischemia or
hypoxia
↓
changes in bladder function, histology, and
cellular function .
46
Dept of Urology, GRH and KMC, Chennai.
47. Summary
The exact etiology of BPH is yet to be
elucidated
Androgens do not cause BPH but the
presence of androgens during developmental
,puberty and aging is required for BPH
Androgens regulate the effects of growth
hormones
47
Dept of Urology, GRH and KMC, Chennai.