Benign Prostate Hypertrophy - W8 PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Klu...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins Benign Prostatic Hyperplasia(BPH)  Benign Prostatic Hyperplasia Pathophysiology Cause unknown: aging is largest risk factor more than 50% of men over age 60 as many as 90% of men over age 70 BPH is a condition of aging nearly all men over the age of 50 have some level of enlargement of the prostate At birth pea sized, growth continues until puberty Rapid growth until ~30s and reaches adult size Around 40-45 BHP starts and continues slowly until death Accessory sex organ Main role of prostate to secrete fluid Increase sperm motility Decrease vaginal acidity Strayer D, Rubin E. Rubin's Pathology: Clinicopathologic Foundations of Medicine. 7th ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins; 2014  Benign Prostatic Hyperplasia Pathophysiology Cause: unknown Hormonal changes with aging Reduced testosterone levels result in higher proportions of estrogen Estrogen promotes prostatic cell proliferation and growth In men testosterone converted into dihydrotestosterone (DHT) and estradiol in some tissues DHT also involved in prostate growth and may accumulate Promotes overproliferation of prostatic cells Hyperplasia occurs primarily periurethral (surrounding the urethra) part of prostate Not considered a prostate cancer precursor Strayer D, Rubin E. Rubin's Pathology: Clinicopathologic Foundations of Medicine. 7th ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins; 2014  Benign Prostatic Hyperplasia Clinical Manifestations Manifestations are related to urethral obstructions Urinary frequency Hesitancy, decreased force Urgency Compression progresses (several years) Long term urine retention Overflow incontinence Significantly reduced force of urinary stream More frequent complications: Hydroureter (dilation of ureter due to build up of urine) Hydronephrosis (swelling of renal calyces and pelvis due to build up of urine) Pyelonephritis (infection and inflammation of entire kidney) Renal insufficiency Severe pain, renal failure, death Strayer D, Rubin E. Rubin's Pathology: Clinicopathologic Foundations of Medicine. 7th ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins; 2014  Benign Prostatic Hyperplasia Diagnostic Criteria Patient history, physical examination Digital rectal examination to determine size, shape and consistency of prostate gland Benign: soft Malignant: hard, asymmetrical usually, cobblestone texture Elevated prostate-specific antigen (PSA) May indicate hyperplasia or dysplasia Elevation in PSA is followed by biopsy to confirm or rule out malignancy Urodynamic testing Volume and pressure of urine in bladder Evaluate urine flow Symptoms Index to summarize severity of symptoms  Benign Prostatic Hyperplasia Treatment Treatment reserved for those with significant symptoms Pharmacologic Smooth muscle relaxant to relive urinary obstruction Inhibiting testosterone conversion to DTH (dihydrotestosterone) Lack of hormonal stimulation leads to prostate atrophy Laser/heat-based treatments To destroy all or part of prostate gland Surgery TURP: transurethral resection of prostate Partial or full removal through urethra via penis Stent in urethra to keep it open and helps to drain Can cause irritation, frequent urination, pain, incontinence Difficult to remove