Benign prostatic hyperplasia

Benign prostatic hyperplasia

Benign prostatic hyperplasia BPH

IS INCREASINGLY COMMON WITH AGE AND IS PRESENT IN AN ESTIMATED 50%OF MEN OVER THE AGE OF 60 YERAS AND IN NEARLY 88% BY THE AGE OF 88 YEARS

THIS IS A HISTOLOGICAL DIAGNOSIS AND IS DUE TO THE HYPERPLASIA OF THE PERIURETHRAL GLAND IN THE TRANSITIONAL ZONE OF THE PROSTATE . THIS ENLARGEMENT CAUSES VARYIBG DEGREE OF OBSTRUCTION TO THE FLOW OF URINE AND LEADS TO

 A GROUP OF SYMPTOMS CATEGORIZED

AS LOWER URINARY TRACT SYMPTOMS (LUTS) . THE EXTEND OF THE PROSTATIC ENLARGEMENT MAY NOT BE DIRECTLY PROPORTIONAL TO THE DEGREE OF BLADDER OUTFLOW NOR TO THE AMOUNT OF SYMPTOMS

 THE CLINICAL DEFINITION OF BPH IS THEREFOR A COMBINATION OF LUTS , PALPABLE BENIGN  PROSTATIC ENLARGEMENT AND URODYNAMIC EVIDENCE OF BLADDER OUTFLOW OBSTRUCTION

PRESENTATION

 Patients may have no symptoms and are found to have a palpable bladder due to chronic retention of urine and occasionally in post renal obstructive renal failure LUTS can be divided into two groups

Obstructive symptoms

Associated with voiding which are hesitancy poor stream , straining , prolonged micturition postmicturition dribbling and a feeling of incomplete emptying and

Irritative symptoms

associated with filling which are frequency nocturia and urgency . patients may also present with acute retention haematuria and urinary tract infection

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UNDESCENDED TESTIS

UNDESCENDED TESTIS

Introduction

Evidence suggests that the incidence of infertility in undescended testes is reduced by early placement of the testicle in its natural location within the scrotum .orchidopexy is usually performed between 1 and 3 years of age in an attempt to promote normal subsequent development

Definition

confusion arise in the classification of this condition an undescended testis is any testis that fails to descend into the scrotum , and it includes those which adhere to the normal path but fail to descend fully (incomplete or arrest descent )as well as those found in locations remote from the normal path (ectopic) .approximately 3%of male infants have undescended testicle at birth whereas this figure drops to 1%by the age of one year . ectopic testes account for 10%of extrascrotal testes . they usually lie in one of four positions 1- superficial inguinal  2- base of penis 3- perineal 4- femoral an incompletely descended testis can be intra abdominal intracanalicular emergent or 
highscrotal

Testicular Developement

The testis originate from the posterior abdominal wall mesoderm the urogenital (wolffian)ridge and migrate into the scrotum by the inguinal canal they are directed along this path by the gubernaculum . the accepted theory is that failure to follow the correct fibromuscular gubernaculum produces an incompletely descended testis

Incidence

 genuinely undescended testes (cryptorchism) occur in 1%of males however 4-5%of males undergo orchidpexy

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BLADDER OUTFLOW OBSTRCUTION

BLADDER OUTFLOW OBSTRCUTION

the pathology may be neuropathic due to the failure of the sphincters to relax in harmony with detrusor contraction or due to obstruction from bladder neck hypertrophy being prostate hyperplasia (BPH)urethral stricture urethral calculus meatal stenosis or a tight phimosis 1- urethral stricture once a urethral stricture always a urethral stricture this adage still holds good pharaohs even took dilators with them to their burial chambers for the after life the causes are numerous as 1- catheter urethral site penoscrotal mechanism by pressure necrosis and paraurethral gland sepsis 2- perineal injury urethral site bulbar mechanism by crush injury 3- pelvic fracture urethral site membranous mechanism by prostatic displacement shear injury 4- infection throughout urethra by gonorrhoea and chlamydia 5- BXO urethral site meatal mechanism by fibrosis 6- chemotherapy throughout the urethra by causing chemical urethritis 7- instruments throughout urethra either iatrogenic or masturbation 2- presentation depending on the degree and length of narrowing and

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