0:00

We're talking about BPH or benign

0:02

prostatic hypertrophy on MRI.

0:05

If you've watched other vignettes, you know

0:06

there is a low bar classification system

0:08

that breaks down BPH into anterior to the

0:13

urethra type 1, posterior to the urethra

0:16

above the verumontanum, which would be

0:18

right here, type 2, balanced or equally

0:22

hypertrophied type 3, and pedunculated

0:25

masses extending into the urethra type 4.

0:29

This one is balanced, but slightly

0:32

errs towards the side of anterior.

0:33

So anterior more than posterior

0:35

superior, so it's more of a type 1.

0:39

We see the urethra is now a bit angulated.

0:42

It makes kind of a kinked turn.

0:45

So this compression right here may

0:47

lead to difficulty in urination.

0:50

Now our surgical colleagues for years have

0:52

been using The sonographic classification

0:54

system, so let's just briefly review that.

0:57

If you've got very prominent bilateral,

1:00

lateral lobes, or TZ lobes, on either

1:03

side, that's a sonographic type 1.

1:07

If the enlargement is almost exclusively

1:10

retrourethral, above the verumontanum,

1:13

that would be a sono classification type 2.

1:17

If you've got both lateral TZ, or said

1:21

another way, anterolateral TZ hypertrophy

1:25

and posterosuperior hypertrophy, which

1:28

would be the equivalent of balanced lobar

1:30

type 3, is the same as sonographic 3.

1:36

Then type 4, which is analogous to the

1:40

type 4 on lobar classification, would

1:43

be A solitary or multifocal pedunculated

1:46

lesion that prolapses into the urethra.

1:50

Type 5, a pedunculated prolapsing

1:54

mass with retrourethral enlargement.

1:58

Type 6, subtrigonal or ectopic enlargement.

2:03

And type 7, anything else that doesn't fit into

2:07

the other criteria that we have already discussed.

2:10

So now you're able to compare what surgeons

2:13

use for their classification sonographically

2:16

with the low bar classification system,

2:19

which perhaps is a little bit more simple.

2:23

Now when you're looking at these, especially when

2:25

you have posterosuperior gland enlargement, this

2:29

tissue, if it's very polypoid, can stick up into

2:33

the bladder, the bladder can collapse on itself,

2:36

and these pedunculated masses can be entrapped

2:40

in the bladder, so you wanna see if there's a

2:42

narrow neck or stalk to the posterosuperior.

2:46

Variety for it too can sometimes be pedunculated.

2:50

The classic pedunculated lesion, however, is

2:53

gonna be found in the urethra, prolapsing into it.

2:57

The so-called low bar type four, or

2:59

sonographic rating system type four.

3:02

This is an example of a patient

3:04

with a relatively balanced.

3:07

Pattern of hypertrophy, although

3:09

the anterior component is slightly

3:11

bigger than the posterior component.