2. Anatomy of the prostate
•
The prostate surrounds the bladder outlet & the
beginning of male urethra.
•
Its shape is like a chestnut or inverted cone.
•
It measures 3 × 4 × 2 cm & weighs about 18 gm.
•
Relations:
3. Zonal anatomy:
•
TZ (the commonest site for BPH)
•
CZ
•
PZ (the commonest site for
prostatic carcinoma)
•
Anterior fibro-muscular stroma
Clinically :
The prostate has 2 lat. Lobes separated by a
central sulcus and a median lobe which may
project into the cavity of the U.B.
4. Benign prostatic hyperplasia
“Senile enlargement of the prostate”
•
The commonest tumor of the prostate
•
Affects about ⅔ of men over 50 y.
Etiology:
1- Unknown
2- Aging
3- Normal testosterone
Pathology:
•
From TZ or peri-urethral region
•
As adenoma enlarges, it compresses the normal
prostatic tissue forming a false capsule with a line
of cleavage.
5. Histology:
•
Hyperplasic acini
•
Variable in size
•
Lined with one or more layers of cells
•
some acini contain corpora amylacea
•
The fibro-muscular stroma shows hypertrophy
BPH Normal prostate
9. Clinical picture: (LUTS obstructive or irritative)
•
Obstructive : hesitancy, weak stream, interrupted
stream & urine retention
•
Irritative : ↑ frequency, urgency & urge
incontinence
-
Obstructive symptoms occur first but with infection
& stone formation irritative symptoms
become manifest
10.
11. Physical examination:
•
Abdominal mass (hydronephrosis)
•
Pelvic mass (retained bladder)
•
DRE:
1. Symmetrical or asymmetrical enlargement
2. Preserved sulcus
3. Smooth surface
4. Sliding rectal mucosa over the gland
5. Consistency like that of contracted thenar
eminence
12. Investigations:
A. Basic investigations:
1. Urinalysis
2. Serum creatinine
3. PSA:
•
Normal level → 0-4 ngml
•
BPH → 4-10 ngml
•
> 10 ngml may indicate cancer
4. U/S:
•
Abdominal
•
TRUS
15. Treatment:
1. Watchful waiting: ( in mild symptoms)
•
↓ fluid intake
•
Timed voiding
•
Avoidance of constipation
•
Avoid exposure to cold
•
Avoid diuretics & anti-cholinergic
•
Avoid sexual excitement
16. 2. Medical treatment:
-
Indications: Bothersome symptoms with no complications
-
Drugs:
•
α – adrenergic blockers (Doxazocin – Terazocin)
They act by ↓ the tension of the smooth
muscle of prostatic capsule
•
5 – α reductase inhibitors (Finasteride):
It inhibits the 5 – α reductase enzyme
responsible for conversion of
testosterone to DHT
17. 3. Surgical treatment:
•
Indications:
1. Recurrent attacks of acute retention
2. Hematuria
3. Recurrent urinary tract infection
4. Bladder stone or diverticula
5. Renal insufficiency
•
Routes of intervention:
-
Open surgery: Transvesical or retropubic
-
TUR-P
4. Minimally invasive techniques:
•
LASER prostatectomy
•
Prostatic balloon ablation
•
Prostatic stents
•
Thermotherapy
18. Prostate cancer
Etiology: Unknown
Risk factors: Family history, high fat diet & racial
factors
Pathology:
-
Gross: Hard nodular prostate, may invade the
capsule or adjacent structures
-
Microscopic: Adenocarcinoma of varying degrees
Spread:
1. Direct spread
2. Lymphatic spread
3. Blood spread
