Prostate Prepared by Dr Panchajani R Anatomy Accessary
Prostate Prepared by, Dr. Panchajani. R
Anatomy • • • Accessary Gland of Male Reproductive System Situated just below the urinary bladder. Walnut sized – 25 cubic cms size. Composed of Glandular Tissue It surrounds the first 3 cm of the urethra. 5 lobes - Anterior 2 lateral Posterior – Site of Primary Ca 1 middle - Site of Adenoma
Three zones • Peripheral zone – Prone for Ca • Periurethral transition zone – Site of BPH • Central zone
ENZYMES • Acid phosphatase - secreted by Prostate Raised in Ca with metastases. Not increase in BPH Slight increase in acute prostatitis • PSA - 2 forms, major bound & minor free form Secreted by the prostatic epithelium. More elevated in Ca - major form Less increase in BPH, Prostatitis. - minor form PSA is sensitive for Ca but not specific. Used to detect metastasis and recurrence after treatment. • Men aged > 50 yrs with PSA > 3 ng /ml should undergo biopsy.
BPH • He was very often, both in the Day and the Night , forced to make Water, seldom in any Quantity, because he could not retain it long enough. Edward Hyde, 1759
BPH • Commonly occurs after 50 yrs. usually between 60 - 70 yrs. • Affects the glandular epithelium and connective tissue stroma. • Benign neoplasm also called fibromyoadenoma
Aetiology • Disturbance of the ratio and quantity of circulating androgens& estrogens. • With age TS level drops slowly in relation to the estrogen level. • Arises from transitional zone it compresses the peripheral zone and enlarges lateral lobe. • Arises from central zone enlarges the middle lobe projecting up in to the bladder.
PATHOLOGICAL CHANGES Involves median and lateral lobes or one of them. Involves adenomatous zone. Median lobe enlarges in to bladder. Lateral lobes narrow the urethra causing obstruction. • Urethra - elongated and narrowed. • Bladder - trabeculations, sacculations, and diverticula formation. • Pressure on prostatic venous plexus causing vesical piles - Haematuria. • •
• Kidney & ureter – Hydroureter and Hydronephrosis • Ascending infection - chronic pyelonephritis. • Severe obstruction-uropathy with renal failure • Impotence
CLINICAL PRESENTATIONS Frequency , Urgency & hesitancy Nocturia, nocturnal incontinence Overflow and terminal dribbling. Intermittent stream- stops& starts Retention of urine - acute & chronic Haematuria Pain in supra pubic region - in cystitis& hydronephrosis. • Features of urinary tract infection. • Per rectal examination – enlarged prostate • •
IPSS( International prostrate symptom score) • • • Incomplete emptying Frequency Intermittency Urgency Weak stream Straining Nocturia Quality of life due to urinary symptoms Mild – less than or equal to 7 Moderate – 8 -19 Severe – 20 - 35
Diagnosis • History & physical examinations
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