Benign prostateic hyperplasia Dept. of urology.Shanghai Renji hospital Wang YiXin

Etiology 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 .

Pathology 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.

Clinical features Local symptoms General 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.

Diagnosis 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.

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.

Other investigations Electro—cardiography to assese myocardial state Chest x—ray Pulmonary function tests

Treatment of BPH Chronic retention of urine Acute retention Conservative methods by running water taps to induce to void ,sitting in a warm bath Catheterrisation Suprapubic cystostomy:temporary form of suprapubic cystostomy,catheter should be changed at monthly.

Operative treatment of BPH Transurethral prostatectomy Retropubic prostatectomy Transvesical prostatectomy Transperineal prostatectomy Cryogenic prostatectomy Microwave therapy