Benign Prostatic
Hyperplasia

BPH
Also known as Nodular hyperplasia of
prostate.it is most common non
neoplastic disorder in men over 50 years
age.it is characterised by hyperplasia of
prostatic stromal as well as epithelial
cells resulting in formation of large
discrete nodules in prostate.

⦿ 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.

⦿Normal weight of prostate ranges from 20-25
grams
⦿According to Mc Neal, gland is divided into 3
zones.

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

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.

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.

⦿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.

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.

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.

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

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


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.