“The weak can never forgive. forgiveness is the attribute of the strong.”

– MK Gandhi

CLINICAL PATHOLOGYThe foundation of clinical medicine.

Shashidhar Venkatesh MurthyA/Prof & Head of Pathology

College of Medicine & Dentistry

BPH3: Urinary Tract Dis: Prostate, BPH

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Male Urogenital System: Prostate Periurethral, Fibromuscluar

gland. Function – Semen, acid

phosphatase. Sperm nutrition.

Hormone response – Androgens, Testosterone.

Prostatitis, BPH & Cancer. Central Zone - BPH Peripheral zone - Cancer

Prostate: Zones

Carcinoma

Trans. ZoneBPHBPH

Posterior Anterior

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Normal Prostate Histology: Fibromuscular gland.

2. Glands double layer epithelium.

1. Fibromuscular stroma

3. Secretions (corpora amylaceae)

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Prostate: Pathology

Disorders of Prostate:1. Inflammations – infections - Prostatitis2. Benign Prostatic Hyperplasia* 3. Neoplasms – Prostatic Carcinoma*

BPH

Cancer

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Prostatitis: Inflammation, edema, rectal pain, obstruction/dysuria. Acute suppurative prostatitis 5%

E.coli, rarely Staph or N. gonorrhoeae Chronic non bacterial / chronic pelvic pain sy.

90% Chronic Inflam, symptoms, no pathogens. Asymptomatic inflammatory prostatitis.

Only WBC, no symptoms no pathogens. Granulomatous prostatitis

BPH, infarction, post TURP, idiopathic, TB, or allergic(eosinophilic).

Diagnosis: Fluid examination after prostatic massage. Needle aspiration study of prostatic tissue.

One single grateful thought raised to heaven is the most perfect prayer.

G. E. LessingGerman critic & dramatist (1729 - 1781)

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BPH-Introduction Non-neoplastic, androgen hyperplasia.

Castration no BPH Testosterone DHT Hyperplasia. Common, 75% of men 70-80years.

Only few symptomatic. Involves periurethral transitional zone.

Morphology: Nodular hyperplasia of glands & stroma.

(like in breast, thyroid etc) Stromal & Gland hyperplasia. Cystic

glands, secretions, double layer maintained.

BPH is NOT a precursor to carcinoma!

Finasteride

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BPH: Morphology: Gross & Microscopy

Gross: Grey white, nodular Hyperplasia, Periurethral zone.

Microscopy: Hyperplastic cystic glands. Normal double layer epithelium

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BPH: Complications

Enlarged prostate. Median lobe - ball valve**1. Urinary Obstruction2. Urine retention3. Inflammation / infections4. Hypertrophy of wall5. Mucosal trabeculations6. Urolithiasis – stones.

Stone

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BPH: TURP (Diagnosis + Treat )

Trans Urethral Resection of Prostate

Complications: Hemorrhage,Infection, Granulomatous prostatitisRetrograde ejaculation.

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Normal – Prostatitis – BPH

“The only gracious way to accept an insult is to ignore it. If you can’t ignore it, top it. If you can’t top it, laugh at it.

If you can’t laugh at it, it’s probably deserved...!”

- - Joseph Russell Lynes