Diagnostic Ultrasound - Abdomen and Pelvis

Prostatic Hyperplasia
Diagnoses: Urinary Tract
TERMINOLOGY
• Benign prostatic hyperplasia (BPH)
○ Term reserved for histopathological pattern of smooth
muscle and epithelial cell proliferation
○ Hyperplasia is correct term since BPH is characterized by
increased number of epithelial stromal cells in
periurethral area of prostate (not hypertrophy, which
means increase in size)
IMAGING
• Sonographic appearance of BPH is variable, depending on
histopathologic changes
• Ultrasound cannot reliably differentiate BPH from prostate
cancer
• Ultrasound may be used to measure prostate size and PVR
as well as evaluate for upper tract obstruction in men with
BPH and renal insufficiency
• Estimated prostate volume: Prolate ellipsoid formula:
Width x height x length x π/6 = W x H x L x 0.52
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Prostate carcinoma
• Bladder carcinoma
• Prostatitis
PATHOLOGY
• Bladder outlet obstruction from BPH may occur from
urethral constriction from increased smooth muscle tone
and resistance (dynamic component) &/or urethral
compression from gland enlargement (static component)
• Possible bladder sequelae: Trabeculation, diverticula,
calculi, detrusor muscle failure
• Possible upper tract changes: Ureterectasis, hydronephrosis
○ Can be from secondary vesicoureteral reflux, obstruction
from muscular hypertrophy or angulation at
ureterovesical junction, sustained high pressure bladder
storage
(Left) Graphic shows a normal
(left) and hyperplastic (right)
prostate gland with
enlargement of the transition
zone (blue st) surrounding the
urethra. Central zone is in
orange, peripheral zone is in
green, and anterior
fibromuscular stroma is in
yellow. (Right) Graphic shows
zonal anatomy in coronal
plane. The urethra from the
bladder neck to
verumontanum is surrounded
by the preprostatic sphincter
, which contains
periurethral glands. The TZ
and periurethral glands are
the sites of origin of BPH.
(Left) Coronal graphic shows
the normal prostate with
smooth contours and widely
patent prostatic urethra.
(Right) Nodular enlargement
of the periurethral glands and
TZ cause external compression
of the prostatic urethra
and elevation of the bladder
base . Nodular protrusion
into the bladder (a.k.a.
enlarged "median lobe") → can
ball-valve into the urethra and
cause severe obstructive
symptoms.
524