Interactive Transcript
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We're talking about BPH or benign
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prostatic hypertrophy on MRI.
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If you've watched other vignettes, you know
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there is a low bar classification system
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that breaks down BPH into anterior to the
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urethra type 1, posterior to the urethra
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above the verumontanum, which would be
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right here, type 2, balanced or equally
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hypertrophied type 3, and pedunculated
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masses extending into the urethra type 4.
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This one is balanced, but slightly
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errs towards the side of anterior.
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So anterior more than posterior
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superior, so it's more of a type 1.
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We see the urethra is now a bit angulated.
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It makes kind of a kinked turn.
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So this compression right here may
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lead to difficulty in urination.
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Now our surgical colleagues for years have
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been using The sonographic classification
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system, so let's just briefly review that.
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If you've got very prominent bilateral,
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lateral lobes, or TZ lobes, on either
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side, that's a sonographic type 1.
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If the enlargement is almost exclusively
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retrourethral, above the verumontanum,
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that would be a sono classification type 2.
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If you've got both lateral TZ, or said
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another way, anterolateral TZ hypertrophy
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and posterosuperior hypertrophy, which
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would be the equivalent of balanced lobar
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type 3, is the same as sonographic 3.
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Then type 4, which is analogous to the
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type 4 on lobar classification, would
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be A solitary or multifocal pedunculated
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lesion that prolapses into the urethra.
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Type 5, a pedunculated prolapsing
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mass with retrourethral enlargement.
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Type 6, subtrigonal or ectopic enlargement.
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And type 7, anything else that doesn't fit into
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the other criteria that we have already discussed.
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So now you're able to compare what surgeons
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use for their classification sonographically
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with the low bar classification system,
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which perhaps is a little bit more simple.
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Now when you're looking at these, especially when
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you have posterosuperior gland enlargement, this
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tissue, if it's very polypoid, can stick up into
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the bladder, the bladder can collapse on itself,
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and these pedunculated masses can be entrapped
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in the bladder, so you wanna see if there's a
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narrow neck or stalk to the posterosuperior.
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Variety for it too can sometimes be pedunculated.
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The classic pedunculated lesion, however, is
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gonna be found in the urethra, prolapsing into it.
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The so-called low bar type four, or
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sonographic rating system type four.
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This is an example of a patient
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with a relatively balanced.
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Pattern of hypertrophy, although
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the anterior component is slightly
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bigger than the posterior component.
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