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  1. Benign Prostatic Hyperplasia
  2. BPH Also known as Nodular hyperplasia of is most common non neoplastic disorder in men over 50 years is characterised by hyperplasia of prostatic stromal as well as epithelial cells resulting in formation of large discrete nodules in prostate.
  3. ⦿ Histologic Diagnosis is characterized by Proliferation of Epithelial and Stromal elements of Prostate. ⦿Incidence is Age Related. 20% among men aged 41-50 years 50% among men aged 51-60 years >90% in men aged more than 80 years. ⦿BPH develops in Transition zone of Prostate.
  4. ⦿Normal weight of prostate ranges from 20-25 grams ⦿According to Mc Neal, gland is divided into 3 zones.
  5. Peripheral Zone Central zone Transition Zone 70% of gland; 25% of gland; 5% of gland Situated Situated Periurethral posteriorly posteior to zone of prostate -More prone to urethral lumen carcinomatous and above the change ejaculatory ducts
  6. CAPSULES OF PROSTATE • True Capsule: formed by condensation of peripheral part of gland. Fibromuscular and is continous with stroma of gland. • False Capsule: lies outside the true capsule; derived from endopelvic fascia. Prostatic venous plexus is embeded in between two capsules.
  7. Gland enlargement occurs due to epithelial and stromal proliferation or impaired pre- programmed cell death i.e.., Apoptosis or both. Prostatic enlargement depends on potent androgen Dihydrotestosterone (DHT). In prostate, type 2 5α Reductase metabolises circulating TST to DHT , which acts locally. DHT binds to androgen receptors of cell nuclei.
  8. ⦿There observed a positive correlation between levels of free TST , estrogen and volume of Prostate which suggests that the association between aging and BPH might result from increased estrogen levels causing induction of androgen receptor, which there by sensitizes the prostate to free TST . ⦿In men younger than 60 years, may be a heritable form of disease. In such cases it is of autosomal dominant pattern of inheritance. ⦿In First degree male relatives, relative risk is of approximately fourfold.
  9. Pathology:  BPH virtually always occurs in the inner, transitional zone of the prostate. The affected prostate is enlarged, typically weighing between 60 and 100 g, and contains many well circumscribed nodules that bulge from the cut surface.  As BPH nodules in the transition zone enlarge, they compress the outer zones of the prostate, resulting in the formation of a so-called surgical capsule. This boundary separates the transition zone from the peripheral zone and serves as a cleavage plane for open enucleation of the prostate during open simple prostatectomies performed for BPH.
  10. Obstructive ⦿Hesitancy ⦿Decreased force and caliber of stream ⦿Sensation of incomplete bladder emptying ⦿Double voiding ⦿Straining to urinate ⦿Postvoid dribbling Irritative ⦿Urgency ⦿Frequency ⦿Nocturia The symptoms of BPH can be divided into obstructive and irritative complaints.
  11. GRADING: • The American Urological Association (AUA) developed a self administered questionnaire which is reliable in identifying the need to treat patients and in monitoring their response to therapy. • The AUA Symptom Score Questionnaire has been extensively validated and it is now more commonly called the International Prostate Symptom Score • This assessment focuses on seven items that will be asked to patients to quantify the severity of their obstructive or irritative complaints on a scale of 0–5. • The score can range from 0 to 35. IPSS Grade 0-7 Mild 8-19 Moderate 20-35 Severe
  12. The nodules may appear solid or contain cystic spaces. The urethra is usually compressed by the hyperplastic nodules, often to a narrow slit. In some cases, hyperplastic glandular and stromal elements lying just under the epithelium of the proximal prostatic urethra may project into the bladder lumen as a pedunculated mass, producing a ball-valve type of urethral obstruction. C/S shows nodular,circumscribed homogenous,gray white areas.these nodular areas may show Honeycomb appearance. Well-defined nodules compress the urethra into slit like lumen
  13.  Low-power photomicrograph demonstrates a well-demarcated nodule. Microscopically The hyperplastic nodules are composed of variable proportions of proliferating glandular elements and fibromuscular stroma. The hyperplastic glands are lined by tall, columnar epithelial cells and a peripheral layer of flattened Basal cells.Collection of homogenous,pink,acellular hyaline material in lumen seen which is called corpora amylacea.  Higher-power photomicrograph showing morphology of the hyperplastic glands, which are large, with papillary infolding.