Download POSTERIOR VIEW OF URINARY SYSTEM, PROSTATE AND

Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is probably the most common
neoplastic growth observed in men. It starts developing in the
periurethral glands inside the prostate. Prostate growth begins at
birth and continues at a very slow rate through puberty.
SAGITTAL VIEW OF
LOWER URINARY TRACT
Bladder
Prostatic
growth
The prostate grows more rapidly through the third decade. After
45 years of age, a benign hyperplasia may take place, which can
evolve during the rest of the man’s life, leading to hypertrophy.
However, pathological changes may never occur.
POSTMICTIONAL DRIPPING
LUTS (LOWER URINARY TRACT SYMPTOMS)
•
•
•
•
•
Decreased stream: a weak stream; little force behind the stream.
A feeling of incomplete emptying.
Hesitancy: having to wait for the urinary stream to get started.
Nocturia: waking up from sleep to urinate.
Terminal dribbling: prolonged dripping of urine after the main
urinary stream has finished.
• Urgency: having to run to the bathroom because of a sudden
urge to void.
TREATMENT
• Medications may be used to improve and/or prevent BPH.
• Surgery: There are various forms involving the removal
of the central growing core of the prostate.
The illustration shows the bladder with hypertrophy of
the detrusor muscle and the cells, columns, and diverticuli
inside that compose the concordant bladder. The prostatic
growth that causes the obstruction of the vesical neck
can also be seen.
Ureter
Spermatic
vas
Iliac artery
CONCENTRIC
ENLARGEMENT OF THE
PROSTATE GLAND
With the increasing urethral compression as a result of the
growing adenoma, the patient presents a series of
symptoms called “prostatism”, consisting in alterations
of the calibre and strength of urine flow, hesitancy
(delayed start of urination), inability to stop urination,
prolonged dribbling after urination, vesical tenesmus,
nocturia, and even urinary retention.
SUBCERVICAL
PROSTATIC GROWTH
Iliac vein
Bladder
Pyramidal muscle
Anterior rectus (stright)
muscle of abdomen
Lateral prostatic
lobes in subcervical
growth
Vesical trigone
Concentric growing of the
lateral prostatic lobes
Bladder
Seminal vesicle
EXCENTRIC ENLARGEMENT
WITH MEDIAL LOBE
Seminal vesicle
(longitudinal section)
Prostate
Prostatic urethra
Ischiopubic ramus
CONCENTRIC GROWTH
OF LATERAL LOBES
AND MEDIAN LOBE
Vesical mucosa
Membranous
urethra
Spongy urethra
Vas deferens
Medial lobe
enlargement
Ureteral
meatus
Medial lobe
Prostate
Prostatic
utricle
There are two specific areas in the prostate: an internal area
stimuated by oestrogens, and an external area modulated by
androgens. After 40 years of age, nodular hyperplasia begins,
where the collagen tissue intercalates with glandular acini
and progresses, reaching two possible forms:
1. Rigid, nodular and fibrous, without significant size changes
2. Large adenoma which compresses the prostatic urethra
POSTERIOR VIEW OF URINARY SYSTEM,
PROSTATE AND SEMINAL VESICLES
BPH is a chronic disease that spans decades. Histologically distinguishable
BPH as a finding during autopsy is present in about 8% in the age
group of men 31 to 40 years, increasing with age to about 90% by
the ninth decade of life. (McVary 2006). One of the most serious
complications of BPH is acute urinary retention (AUR) – inability
to urinate, with increasing pain (Roehrborn 2001).
References: Ronald J. Hicks, M.D., and Jacqueline B. Cook, M.S.W. Managing Patients with Benign Prostatic
Hyperplasia. American Family Physician. 52(1): 135-142. July 1995. • Frank H. Netter, M.D. Abdomen. In his
Atlas of Human Anatomy. USA, Icon Learning System, 1989. pp 256-258. • Frank H. Netter, M.D. Pelvis and Perineum.
In his Atlas of Human Anatomy. USA, Icon Learning System, 1989. pp 348-349. • Roehrborn CG. The Epidemiology
of Acute Urinary Retention in Benign Prostatic Hyperplasia. Reviews In Urology Vol. 3, No. 4, 2002, pp. 187-192.
McVary K. BPH: Epidemiology and Comorbidities. Am J Manag Care. 2006;12:S122-S128.
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means prohibited unless written consent is given by the owner of the copyright.
Medial lobe
growth
Medial lobe
Concentric growth of the
lateral prostatic lobes
Lateral lobes
The subcervical development of lateral lobes raises the
muscular ring of the vesical neck, resulting in the so-called
median lobe. When the lobes grow laterally, they do so
eccentrically or concentrically. The adenoma compress the
muscular fibers against residual glandular tissue, forming
the surgical capsule.
Disclaimer: All information included within this product is not intended as a substitute for professional care.
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FD10099 First Issued 11/2010
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