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

2. 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 .

3. 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.

4. 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.

5. 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.

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

8. 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.

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