Genitourinary Radiology > Male Pelvis > Prostate & Seminal Vesicles > BPH

Benign Prostatic Hypertrophy

Benign prostatic hypertrophy (BPH) affects 50-75% of men over age 60 years. It is more common in blacks, diabetics, and hypertensives, presenting with symptoms of hesitancy, decreased force of urine stream, dribbling, incomplete emptying of the bladder. These symptoms are a result of uninhibited contractions of a hypertrophied detrusor muscle due to obstruction of the prostatic urethra by enlargement of glandular tissue of the prostate.

Imaging studies should be performed to evaluate the upper urinary tract for ureteral obstruction and obstructive nephropathy, to evaluate bladder size and estimate post-void residual urine volume, bladder wall thickness, presence of trabeculation, and formation of diverticula. The prostate gland should be evaluated for gross evidence of adenocarcinoma.

CT IVU shows an elevated trigone with a j-hook configuration of distal ureters. Common findings include benign renal cysts, bladder diverticula, renal stones, and some degree of obstruction. The enlarged prostate gland may cause a smooth, dome-like indentation along the floor of the bladder.

MRI demonstrates normal increased signal intensity on T2-weighted images and either low- or high-intensity on T1 with hypertrophic changes in the transitional zone.

Gray scale ultrasound images of the bladder in sagittal (1) and transverse (2) show an enlarged prostate gland creating a bulge in the bladder base (arrows) representing prostatic enlargement. There are no specific findings of carcinoma on ultrasound or CT. Biopsy or MR spectroscopy can be performed for evaluation of prostate carcinoma.

Unenhanced (1) and delayed images of pelvis following contrast administration (2) in the excretory phase shows an ill-defined bladder mass at the bladder base (arrows). Following excretion of contrast into the bladder, the mass is well seen because it is outlined by the excreted contrast (M). This mass is seen to arise from the prostate gland (P).

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