benign prostatic hyperthropy
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BENIGN PROSTATIC
HYPERTHROPY
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Clinical Presentation
HesitancyUrgencyFrequencyIncomplete bladderemptyingDrippling
Decreased stream flow
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Physical Examination
Suprapubic area for signof bladder distensionDRE:
Prostate glandsize , nodularity , masses,surface, tenderness, analtone
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Ultrasound The standard first line investigation Increase in volume of the prostate with a calculated volume exceeding30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic orof mixed echogenicity Calcification can be seen both within the hypertrophied gland as well asin the pseudocapsule (representing compressed peripheral zone)
Post micturition residual volume is typically elevated.
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IVU
The bladder floor can be elevated and the distal ureterslifiting medially (J-shaped ureters or Fishhook ureters) .Chronic bladder outlet obstruction can lead to detrusor
hypertrophy , trabecullation and formation of bladderdiverticula .
http://radiopaedia.org/articles/missing?article[title]=j-shaped-uretershttp://radiopaedia.org/articles/fishhook_uretershttp://radiopaedia.org/articles/missing?article[title]=detrusor-hypertrophyhttp://radiopaedia.org/articles/missing?article[title]=detrusor-hypertrophyhttp://radiopaedia.org/articles/missing?article[title]=bladder-diverticulahttp://radiopaedia.org/articles/missing?article[title]=bladder-diverticulahttp://radiopaedia.org/articles/missing?article[title]=bladder-diverticulahttp://radiopaedia.org/articles/missing?article[title]=bladder-diverticulahttp://radiopaedia.org/articles/missing?article[title]=detrusor-hypertrophyhttp://radiopaedia.org/articles/missing?article[title]=detrusor-hypertrophyhttp://radiopaedia.org/articles/fishhook_uretershttp://radiopaedia.org/articles/missing?article[title]=j-shaped-uretershttp://radiopaedia.org/articles/missing?article[title]=j-shaped-uretershttp://radiopaedia.org/articles/missing?article[title]=j-shaped-ureters -
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HYSTEROSALPINGOGRAPHY
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HYSTEROSALPINGOGRAPHYThe end of 1 st week after the menstrual period
Empty bladder before investigationTechnique :
Patient is placed in the lithotomy position on thescreening table
The external os is visualized through a vaginalspeculum and is swabbed with a mild antisepticsolutionThe anterior lip of the cervix is grasped by vulsellumforceps and a cannula is then inserted into the cervicalcanal
Contrast media : Water soluble non ionic(Iopamiro) 6-10 cc
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INDICATIONSInfertility
Congenital abnormalities of uterus and tubal obstructionAfter tubal surgery
Patency & configuration of the Fallopian tubes following surgeryfor tubal obstructionAfter tubal ligation 6 weeks after
After ectopic pregnancyRecurrent abortion
The width and configuration of the internal os and cervical canalDistortion of the uterine cavityUterine fibroids
Abnormal uterine bleedingFibroids, endometrial polyps, adenomyosis and intrauterineadhesions
Post-caesarean sectionThe integrity of the uterine scars following caesarian section
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CONTRA-INDICATIONS
PregnancyPelvic infection
Salpingitis 6 months before
Acute vaginitisCervicitis
Immediate pre- and postmenstrual phasesThickened/denuded endometrium venous intravasation
Water soluble media obscure adrenal detailSensitivity to contrast medium
AntihistamineCorticosteroid
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COMPLICATIONS
PainDistension of the uterus & Fallopian tubesPeritoneal spillage
Pelvic infectionAcute exacerbation of pre-existing chronic pelvic infection
HaemorrhageOrganic lesion Polyps ,carcinoma,endometrial damage
Allergic phenomenaUrticaria, asthma, laryngeal oedema
Vasovagal attackVenous intravasation
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Techniques
After an initial film, 3 to 5 mL of dye should beinjected slowly to allow adequate visualization of the uterine cavity. A second film is then taken.Cervical traction is often necessary to completelyevaluate the uterine cavity. A small acorn tip ispreferred over balloon-type catheters becausethe latter obstructs the visualization of thecavity. After this, another 5 mL is injected to
evaluate tubal patency, followed by a third film.A follow-up film is taken to evaluate peritubaladhesions and usually is performed in 10 minutes(using water-soluble media) or 24 hours (usingoil-based media).
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RADIOLOGICAL ANATOMY
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INFERTILITY / HABITUAL ABORTIONAnomalies varying between a completely double vagina, cervix,and uterus
FibroidsPolypsEndometrial hyperplasiaAdenomyosisIntrauterine synechiaTubal disease and defect
Hydrosalpinx, nodular salpingitis, tubal occlusion from infectionTubo-ovarian cavitiesKinking and adhesionsEndometriosis
Tubal amputation and closureCarcinoma of the uterusCervical lesion : stenosis, polyp, adenomyosisLesion to internal os : stenosis, polyposis, dilatation or widening,scarring, extreme spasm
Ovarian tumors
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UTERINE ABNORMALITY
Uterus didelphys
Unicornuate uterus
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Hydrosalpinx
HSG : tubal dilatation, especially of the ampullary portion, with loculation andabsent or limited peritoneal spillage of contrast medium
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Diverticulosis Isthmica Nodosa
Small diverticula of the Fallopian tubes. The diverticula are up to 2 mm in diameter and areusually situated on a 10-20 mm long segment of the proximal portion of the Fallopian tubes
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Tuberculous salpingitis
Calcification in the region of the Fallopian tubes and ovaries, tubal occlusion usuallybilateral in isthmic or ampullary portions. On HSG, there may be iiregular or raggedoutline of tubal contours due to multiple strictures, giving a beaded or rosaryappereance
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Fibroid Uterine
Multiple submucosal fibroids are associated with separated fillingdefects and sometimes gross distortion of the uterine cavity
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THANK YOU
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