Benign prostatic hyperplasia

Benign prostatic hyperplasia is a disease affects men older than 40 years , it means increase in prostate to a level can obstruct urination or making icfections to urinary tract.
Main reference is Robbins basic pathology 9the ed and others

1. Benign Prostatic Hyperplasia Nodular Hyperplasia By : Khaled H. N. Alkhodari Supervisor : Dr. Belal Dabour

2. Prostate Anatomy

3. Prostate Anatomy

4. Prostate Anatomy

5. The prostate gland secretes a thin, milky fluid that contains calcium, citrate ion, phosphate ion, a clotting enzyme, and a profibrinolysin . During emission, the capsule of the prostate gland contracts simultaneously with the contractions of the vas deferens. 30% of semen volume. A slightly alkaline prostatic fluid  successful fertilization of the ovum. Prostate physiology

6. Extremely common abnormality. It is present in: 20% men >= 40 year. increases to 70% by age 60 and to 90% by age 80. Characterized by : Proliferation of both stromal and epithelial elements. With resultant enlargement of the gland may  urinary obstruction. Pathology Benign Prostatic Hyperplasia - BPH

7. The cause remains incompletely understood But excessive androgen-dependent growth of stromal and glandular elements has a central role .(DHT). DHT is 10 times more potent than testosterone. Does not occur in males: Castrated before the onset of puberty. In men with genetic diseases that block androgen activity. Pathology Benign Prostatic Hyperplasia - BPH

8. MORPHOLOGY Always occurs in the inner, transitional zone of the prostate. Affected prostate is enlarged 60 - 100 g Vs. normal 7 and 16  g . Contains many well-circumscribed nodules that bulge from the cut surface. Solid Contain cystic spaces = dilated glandular elements . The urethra is usually compressed.

9. MORPHOLOGY In some cases, hyperplastic glandular and stromal elements may project into the bladder lumen as a pedunculated mass  a ball-valve type of urethral obstruction .

10. Microscopically the hyperplastic nodules are composed of Variable proportions of proliferating glandular elements. Fibromuscular stroma. The hyperplastic glands are lined by Tall , columnar epithelial cells. Peripheral layer of flattened basal cells. The glandular lumina often contain inspissated , proteinaceous secretory material = corpora amylacea . MORPHOLOGY

11. Clinical Features Appears in only about 10% of men with pathologic evidence of BPH . There is no direct correlation between histologic changes and clinical symptoms. The most common manifestations are related to lower urinary tract obstruction: Difficulty in starting the stream of urine (hesitancy) I ntermittent interruption of the urinary stream while voiding . Later  urinary tract infections , hydronephrosis . These symptoms frequently are accompanied by: Urinary urgency , frequency, and nocturia .

12. treatment Initial pharmacological Inhibit DHT formation ( Finestride ). R elax smooth muscle by blocking alpha adrenergic blockers (Flomax). Various surgical techniques are reserved for severely symptomatic cases recalcitrant to medical therapy.