良性前列腺增生Benign-Prostatic-Hyperplasia课件.ppt

Benign prostateic hyperplasia,Dept.of urology.Shanghai Renji hospitalWang YiXin,Etiology 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 androgen.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 wide variation between epithelial and fibrous elements.The hypertrophy originates in the periurethral glands Form a false capsule.,Surgical capsule formation,Residual urine.Possible formation of stones,Hypertrophy of the detrusor,Possible areas of involvement when infection occurs,Clinical features,Local symptoms Increased frequencyNocturia,hesitancy Feeling of incomplete Emptying.Dribbling,Dysuria.Haematuria,EpididymitisUrgency,Incontinence.Micturition easier on squatting,General symptomsLassitude due to nocturia.Renal pain.Prinephric abscess.Progressive renal failure.Anorexia,Nausea,Vomiting Dyspnoea,Coma.,Diagnosis of BPH,Clinical 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(Radiology),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 micturitionRGP,when non-functioning kidney is present.,Other investigations,Electrocardiography to assese myocardial state Chest xrayPulmonary function tests,Treatment 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 BPH,Transurethral prostatectomy Retropubic prostatectomyTransvesical prostatectomyTransperineal prostatectomyCryogenic prostatectomyMicrowave therapy,