【医学课件】良性前列腺增生benign prostatic hyperplasia

1、Benign prostateic hyperplasiaDept. of urology.Shanghai Renji hospitalWang YiXinEtiology 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 and

2、rogen.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

3、wide variation between epithelial and fibrous elements. The hypertrophy originates in the periurethral glands Form a false capsule.Surgical capsule formationResidual urine.Possible formation of stonesHypertrophy of the detrusorPossible areas of involvement when infection occursClinical features Loca

4、l symptoms Increased frequencyNocturia ,hesitancy Feeling of incomplete Emptying .Dribbling, Dysuria.Haematuria, EpididymitisUrgency, Incontinence.Micturition easier on squattingGeneral symptomsLassitude due to nocturia.Renal pain.Prinephric abscess .Progressive renal failure.Anorexia ,Nausea, Vomit

5、ing Dyspnoea,Coma.Diagnosis of BPHClinical historyGeneral examinationRectal examination :size,consistency, irregularities or hard nodules.Becteriological tests:MSU (meadum stream urine)Haematological tests:anaemiaBiochemical tests:blood urea and creatinine, electrolytes, PSA.Diagnosis of BPH(Radiolo

6、gy)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 micturitionR

7、GP,when non-functioning kidney is present.Other investigationsElectrocardiography to assese myocardial state Chest xrayPulmonary function testsTreatment of BPH Chronic retention of urineAcute retention Conservative methods by running water taps to induce to void ,sitting in a warm bath CatheterrisationSuprapubic cystostomy:temporary form of suprapubic cystostomy,catheter should be changed at monthly.Operative treatment of BPHTransurethral prostatectomy