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

1、Dept.of urology.Shanghai Renji hospitalWang YiXinlThe etiology of BPH IS undoubtedly multifactorial.However,it is well recognized that two prerequisites for its induction are the testes and aging.lBecause prostatic growth is regulated principally by androgen.lIt has been suspected for years that BPH

2、 is under endocrine control.In addition.There is compelling evidence for a major role of the stroma in the induction of the disease.lThe basic change is that of epithelial hyperplasia of the prostatic glands and their fibrous stroma lA wide variation between epithelial and fibrous elements.lThe hype

3、rtrophy originates in the periurethral glands lForm a false capsule.Local symptoms lIncreased frequencylNocturia,hesitancy lFeeling of incomplete Emptying.lDribbling,Dysuria.lHaematuria,EpididymitislUrgency,Incontinence.lMicturition easier on squattingGeneral symptomslLassitude due to nocturia.lRena

4、l pain.lPrinephric abscess.lProgressive renal failure.lAnorexia,Nausea,Vomiting lDyspnoea,Coma.lClinical historylGeneral examinationlRectal examination:size,consistency,irregularities or hard nodules.lBecteriological tests:MSU(meadum stream urine)lHaematological tests:anaemialBiochemical tests:blood

5、 urea and creatinine,electrolytes,PSA.lStraight x-ray,KUB.lIVP 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 lef

6、t in the bladder after micturitionlRGP,when non-functioning kidney is present.lElectrocardiography to assese myocardial state lChest xraylPulmonary function testslChronic retention of urinelAcute retention 1.Conservative methods by running water taps to induce to void,sitting in a warm bath 2.Catheterrisation3.Suprapubic cystostomy:temporary form of suprapubic cystostomy,catheter should be changed at monthly.lTransurethral prostatectomy lRetropubic prostatectomylTransvesical prostatectomylTransperineal prostatectomylCryogenic prostatectomylMicrowave therapy