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)
 Intermittent 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).
 Relax smooth muscle by blocking alpha adrenergic
blockers (Flomax).
 Various surgical techniques are reserved for severely
symptomatic cases recalcitrant to medical therapy.