Benign

Prostatic
Hypertrophy Benign Prostatic Hypertrophy
Roll numbers : 23 - 33
 Our team
•230023 BANSODE SAHIL •230029 BHOYE TUSHAR
BHAGWAN CHANDRAKANT
•230024 BASAPURE SUSHANT •230030 BHUSARE VIVEK VILAS
BALAJI
•230031 BIRAMBOLE KRISHNA
•230025 BENDRE GAURI RAJESH UMESH
•230026 BHAGAT TANUSHRI •230032 BOHARA RIDDHI VIKAS
SANJAY
•230033 BORSE ANKUR RAMESH
•230027 BHATIA RIYANSH RITESH

•230028 BHAVI NILESH BHANDARI

Clinical Presentation - Case
A 65 year old male came to the OPD with complaints of
1. Increased frequency of urination ( Needs to pass urine every 2 hours)
2. Urgency to pass urine
3. Straining for urination
4. Weak stream of urine during urination
5. A sense of incomplete emptying of the urinary bladder after passing urine
6. Need to wake up at night 2 to 4 times to pass urine
The complaints first started two years ago and have increased over the time.
The patient was investigated including digital rectal examination, ultrasound scan, blood
and urine test. A diagnosis of benign prostatic hypertrophy was made and the patient was
treated accordingly.
To understand what is BPH, Let us first learn about the anatomy of prostate.
 Anatomy
Anatomy of Prostate of Prostate
 Location
• The prostate lies in the lesser
pelvis

• Below the neck of the urinary

bladder, behind the lower part of
the pubic symphysis and the
upper part of the pubic arch.

• It lies in front of the ampulla of

 Shape, size and weight
• It resembles an inverted cone

• Dimension
1) transversely at the base width=
4cm
2) vertically length= 3cm
3) anteroposteriorly thickness= 2cm

• It weighs about 8 gm.

Note:- It is one of the organ in which
width is more than length like
caecum, pons and pituitary
 Gross Features
Apex :- The apex is directed downwards
surrounds the junction of prostatic and
membranous parts of posterior urethra.
It is separated from the anal canal by the
perineal body

Base :- The base is directed

upwards, and is structurally
continuous with the neck of the
bladder. The junction is marked by a
circular groove
Surfaces:-
1) Anterior surface:-
•Narrow and convex from side by side
•2cm behind pubic symphysis with retropubic fat intervening
•At upper part is connected to puboprostatic ligament
2) Posterior surface:-
•triangular in shape.
•It is flattened from side
•convex from above to downward
•Separate from rectum by fascia of denovillier
•Near its upper border, it is pierced on each side
of the median plane by the ejaculatory ducts
3) Inferolateral surface:-
•related to the side wall of pelvis
•The anterior fibres of the levator ani enclose the gland in
Relations of Prostate Gland

1. Inferior relations (Apex) :

- directed downwards
- rests on superficial fascia of urogenital
diaphragm

2. Superior relations (Base):

- directed upwards
- surrounds neck of urinary bladder
- pierced by urethra (prostatic)
3. Anterior relations:
- Pubic symphysis
- Retropubic space filled with fat

4. Posterior relations:
- Ampulla of rectum
- Rectovesical pouch and fascia of
Denonvilliers

5. Inferolateral relations:
- Levator prostate forming the pelvic
diaphragm
 Lobes of the Prostate
•The Prostate gland was described earlier as having Five
Lobes.
These were:-
1. One Anterior Lobe.
2. One Posterior Lobe.
3. One Median Lobe.
4. Two Lateral Lobes.

•But as of now, the glandular tissue is divided into

Three Lobes:-
1. Two Lateral lobes.
1. Anterior Lobe:-
The Anterior Lobe lies in front of the urethra and
connects the two lateral Lobes.
It is devoid of the Glandular Tissue.
Often called as Isthmus.

2. Posterior Lobe:-
The Posterior Lobe Lies behind the upper part of the
urethra and connects the two lateral Lobes.
The Primary Carinom of the prostate begins in this
lobe.
3. Median Lobe(Middle Lobe):-
The median lobe is wedge-shaped.
Lies behind the upper part of the urethra and in front of
ejaculatory ducts.
At contain much of the glandular tissue and is a common site
is adenoma.

4. Lateral Lobes:-

The lateral Lobes lie one on each side of the urethra.
The lateral lobes contain some glandular Tissue and therefore
may arises here in old age.
 Capsules and Ligaments of prostate
1.True capsule
Formed by condensation of peripheral part of gland.
Fibromuscular in structure.
Continuous with stroma of gland.

2.False capsule
Lies outside true capsule.
Derived from endopelvic fascia.
Anteriorly it is continuous with puboprostatic ligamnet.
Posteriorly It is avascular and formed by rectovesical fascia of Deno
Venous plexus lies between true and false capsule .
 Structures within prostate
1.Prostatic urethra
~Transverse gland vertically at junction of anterior 1/3 rd &
post.2/3rd .

2.Prostatic utricle
~Blind sac ,directed upward and backward.
~Opens at middle of urethral crest

3.Ejaculatory duct

~Opens into prostatic urethra

~ on each side prostatic utricle.
 Microanatomy Of Prostate
o IT IS A FIBROMUSCULAR GLANDULAR TISSUE.
o The glandular tissue is in form of follicles lined by
columnar to pseudostratified columnar epithelium
with numerous folds.
o The follicles are surrounded by plenty of smooth muscle
and fibrous tissue forming the fibromuscular stroma.
o The lumen of acini sometimes (mainly in old age) show
prostatic concretions called as corpora amylacea or
amyloid bodies.
o Prostatic urethra is also seen in the section lined by
urothelium if present above the ejaculatory duct or
stratified columnar epithelium if the cross section is
taken below the level of ejaculatory duct.
 What is
BPH ?
Enlargement in median lobe of prostate
gland due to it's hypertrophy
• Generally occurs in males above 50
yrs
• Enlargement of uvula vesicae
• Compresses urethra and obstructs
urine flow
As age increases, testosterone decreases and leads
to growth of prostate cells .
• In older men : high DHT levels may be responsible
( dihydrosterone = potent form )
Changes in Prostate with Age :

1) Childhood- Small , fibromuscular stroma ,

rudiments of ducts

2) At Puberty - Sudden increase in size ( due to

testosterone) , doubles in size- rapid proliferation
of prostatic follicles

3) During 3rd Decade - irregular epithelial foldings

in lumen
• 4) During 4th Decade - size remains constant ,
foldings disappear - formation of amyloid bodies
• 5) During 5th Decade - ( > 50 yrs ) : some degree of
hypertrophy present (as a sign of ageing )

• In some cases , may reduce in size called SENILE

ATROPHY
Symptoms & their Causes
 Symptoms Suggestive of Benign Prostatic hyperplasia
include
• Urinary :
frequency

• Urinary urgency

• Trouble with urine voiding

• Nocturia

• Urinary retention

• Urinary incontinence

• Pain after ejaculation or during urination

Causes
• Blocked Urethra
• Overworked, weakened bladder

 Size of prostate does not always

determine the severity of blockage or
symptoms
 Investigations
• Medical History of Patient
• Transrectal Ultrasound Scanning (TRVS): Used for accurate
estimation of prostatic size
• Blood test : serum, Creatinine, electrolytes & Hemoglobin
• Urine examination :
• examined for glucose & blood
• midstream specimen should be sent for bacteriological
examination
•Rectal examination: To detect enlargement of
prostate

•Serum Prostate Specific Antigen (PSA): This test

measures the level of PSA in the blood & is helpful
to detect a prostate cancer
 TREATMENT OPTIONS
• Medications:
• Alpha-blockers to relax prostate muscles.
• 5-alpha reductase inhibitors to shrink the
prostate.
• Minimally Invasive Procedures:
• Transurethral Microwave Thermotherapy (TUMT)
to reduce prostate size.
• Laser Therapy for tissue ablation.
•Surgical Options:
• Transurethral Resection of the Prostate (TURP) for
tissue removal.
• Open Prostatectomy for larger prostate glands.

In prostatectomy both the capsules are left

in place because the prostatic venous
plexus lies between the 2 capsules
SUMMARY
REFERENCES
• B.D. Chaurasia’s Human Anatomy, Vol 2, 9th Edition
• Textbook of Anatomy: Abdomen and Lower Limb; Vol
2, Vishram Singh
• Bailey and Love, Short Practice Of Surgery, 25th
Edition
ACKNOWLEDGEMENT
• Dr. Kishor Khushale sir, Head Of Department,
Anatomy, GSMC
• All Faculty, Anatomy Department, GSMC
• Dr. Dhaval Patil sir, Mentor and Guide