Benign Prostatic Hyperplasia in a 13-Year-Old Boy

Chrispine Onyango Oluoch1, James Ikol1, Gitobu Mburugu1, Maxwell Gachie2, Dennis Inyangala3  

1Department of Surgery, Kenyatta National Hospital, Nairobi, Kenya
2Department of Radiology, Kenyatta National Hospital, Nairobi, Kenya
3Department of Pathology, University of Nairobi, Nairobi, Kenya

Correspondences to: Chrispine Onyango Oluoch; email: chrolongreat@yahoo.com

Received: 12 Apr 2022; Revised: 30 Aug 2022; Accepted: 30 Aug 2022; Available online: 5 Sep 2022

Abstract

Benign prostatic hyperplasia (BPH) is most common in men 40 years and above. It rarely occurs in childhood. As a result of the scarcity of cases, the pathogenesis is not clear, and treatment of BPH in this age group is challenging. This report focuses on a 13-year-old patient diagnosed with a histologically confirmed BPH, having presented with a 2-year history of recurrent hematuria and acute urinary retention. Magnetic resonance imaging (MRI) revealed a 287 g prostatic mass, with no signs of malignancy nor metastasis detected. A decision for open suprapubic prostatectomy was made. Post-operative follow-up at 1 year was uneventful. The possible causes of juvenile BPH have been postulated as gonadotropin supplementation for cryptorchidism and human chorionic gonadotropin-containing agent use by the mother during pregnancy. Our case had a history of the right inguinal undescended testis with scrotal orchidopexy done at 11 years of age. However, the patient had no history of human chorionic gonadotropin use, endocrinologic abnormality, or other possible contributing factors. His antenatal history was normal, with no use of human chorionic gonadotropin by the mother. Due to the very few reported cases, there is insufficient data to help understand the pathogenesis of childhood BPH.

Key words: Benign Prostatic Hyperplasia, Pediatric, Childhood

Ann Afr Surg. 2023; 20(2): **-**

DOIhttp://dx.doi.org/10.4314/aas.v20i2.10

Conflicts of Interest: None

Funding: None

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Benign prostatic hyperplasia (BPH) is a recognized pathology in aging males. It is extremely uncommon in men below 50 years of age. Rare reports have come out in the pediatric population. The literature review reveals about nine reported cases (Table 1).  The rarity of the cases poses a significant challenge in understanding the pathogenesis and treatment in the pediatric population. Our patient was a 13-year-old male who had intermittent gross hematuria and recurrent acute urine retention for 2 years and was finally treated for BPH through open suprapubic prostatectomy.

Case presentation

A 13-year-old patient presented with a 2-year history of intermittent hematuria and recurrent acute urine retention. He was initially evaluated in our facility in December 2018 and discussed in a multidisciplinary meeting. He had no history of urethral instrumentation or pelvic or perineal trauma.

 

Table 1. Cases of BPH in young patients reported in the literature

Abbreviations: C/O, complains of; TURP, transurethral resection of the prostate.

 
He did not have any neurological abnormality, constipation, or kidney stones. There was no prior treatment with hormonal therapy, nor was there a history of prostate gland disease in his family. His antenatal period was normal, with no history of his mother using human chorionic gonadotropin-like hormone supplements. At 11 years, he underwent scrotal orchidopexy for the right undescended testis. He had bilaterally palpable scrotal testes with a well-developed circumcised penis. There were no palpable nodules in the prostate. The prostate-specific antigen (PSA) measurements were all below 0.3ng/mL. The contrast-enhanced computed tomography (CECT) scan performed at the initial presentation demonstrated a prostatic mass of 62 g with other abdominal viscera normal (Figure 1, A and B). A multidisciplinary meeting decided to offer him transurethral resection of the prostate (TURP) and tumor biopsy. However, a pediatric resectoscope was lacking. Eleven months later, the parents sought treatment from a different facility. 
 
Figure 1.

Initial abdominal–pelvic CECT scan (December 2018), shows an enlarged heterogeneous prostate mass of 60 g (black arrows) indenting the bladder base. Other abdominal viscera such as kidneys are normal. (A) Axial plane. (B) Coronal plane. Abbreviation: CECT, contrast-enhanced computed tomography.


Figure 2.

(A) Opened urinary bladder showing prostate median lobe (black arrow) protruding into the bladder lumen. (B) Incisional biopsies taken during the aborte