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Categorizing BPH

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Let's categorize BPH,

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or benign prostatic hypertrophy, on MRI.

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There are some relatively basic conventions.

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If you've watched the anatomy vignette,

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you now know that the lateral lobes of the central

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portion of the gland, mostly made up of TZ.

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The transitional zone.

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So I'm gonna, I'm gonna

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circle the transitional zones.

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We're at the midgland level.

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There's a lot of TZ tissue here on both sides.

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Right and left.

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And the TZ, as you know, is divided up

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into an anterior TZ, a TZA, and a TZP.

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But when the TZ really takes over,

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in BPH, this is also known as lateral lobar

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hypertrophy, or lateral lobe hypertrophy.

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Now does that matter?

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It does matter because if you've got

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marked hypertrophy of the central zone

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of the central gland, that'll be in the

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posterosuperior quadrant, back here.

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So, you might have these two

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factors weighing against each other.

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In other words, the anterior portion of the

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gland, or the preurethral portion, may push the

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urethra back if this is selectively hypertrophied.

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Whereas if this is selectively hypertrophied,

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it'll push the urethra down and forward,

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and this will also prolapse into the bladder.

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So this would be central zone hypertrophy,

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this would be TZ or lateral gland hypertrophy.

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Now if you've got the deep tissues

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around the urethra getting big, as they

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may often do, this is known as median

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lobe or median prostatic hypertrophy.

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And this may contribute to pushing the

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central zone further up into the bladder.

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When this gets very polyploid, it can

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even prolapse into the urethra and cause

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urethral obstruction, which is a phenomenon

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described by Aberin many years ago.

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So, we've got lateral lobe hypertrophy,

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central posterosuperior hypertrophy, and then periurethral

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or median lobe hypertrophy, as some very

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basic portions of the gland that may enlarge.

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Now, let's, let's talk about the

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histologic criteria for a moment of BPH.

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In a prior vignette, you've heard what the

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imaging and gross anatomy criteria is, which is

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a gland that is 25 cubic centimeters or bigger.

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But histologically, when the gland gets

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big, it can be from stromal to ventral

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or epithelial hyperplasia.

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And these will have slightly

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different appearances.

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But when you have this hyperplasia, you also get

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a dynamic effect on the urethra, constricting

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urethra from either the back or the front or both.

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When they both equally enlarge, in other words,

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the retrourethral portion of the prostate,

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and the preurethral, or anterior portion of

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the prostate, if they enlarge symmetrically,

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this is referred to as balanced hypertrophy.

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So it's no wonder that you might have

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imbalanced hypertrophy, where the back

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gland is bigger, but not the front,

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or the opposite.

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The front portion of the gland

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is bigger, but not the back.

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And that is one of the bases for low bar

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classification of benign prostatic hypertrophy.

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In another vignette, we'll take a look

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at the low bar classification of BPH.

Report

Editorial Note

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

John F. Feller, MD

Chief Medical Officer, HALO Diagnostics. Medical Director & Founder, Desert Medical Imaging. Chief of Radiology, American Medical Center, Shanghai, China.

HALO Diagnostics

Tags

Prostate/seminal vesicles

MRI

Genitourinary (GU)

Body

Acquired/Developmental

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