benign prostatic hyperthropy

7/28/2019 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 .
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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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benign prostatic hyperthropy

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