Benign prostatic hyperplasia

Benign prostatic hyperplasia

1. Anatomy of prostate

2. Histology of prostate

3. Development of prostate

   • prostate arises from a budding collection of tissue in the urogenital sinus.
   • The prostate develops from epithelial outgrowths form the prostatic segment of the urethra that grows into the surrounding mesenchyme.
     • This outgrowth and branching start at week 10 during embryo growth; by week 12, there are 5 groups of tubules that form the lobes of the prostate.

4. Funtion of prostate

   • Production of seminal fluid

5. Risk factors of BPH

   • Age
     • Occurs in 20% of men over 40
     • Occurs in 90% of men over 70
   • Lifestyle
   • Family History
   • Race
   • Diabetes and heart disease
   • others

6. Signs and symptoms of BPH

   • Hesitancy
   • Frequency
   • Dribbling
   • bladder hypertrophy
   • my cause obstruction
   • Frequent UTI

7. Investigations of BPH

   • PSA
     • produced by the prostate gland.
     • is a 33-kd protein consisting of a single-chain glycoprotein of 237 amino acid residues, 4 carbohydrate side chains, and multiple disulfide bonds.
   • DRE
   • CBC
   • Urinary flow test
   • Postvoid Residual volume test
   • 24 hour voiding diary
   • Transrectal Ultrasound
   • Prostate Biopsy
   • Urodynamic and pressure flow studies
   • Cystoscopy

8. BPH histology

   • Nodular hyperplasia
   • Transitional zone
   • Urethra compressed into slit

9. BPH Pathophysiology

   • Proliferation of both epithelial and stromal elements
   • Both androgens and estrogens may play a role
   • Relative increase in estrogens in older men may increase DHT receptors in prostate

10. BPH Treatment

    • Pharmacology
    • Surgical management
      • Transurethral resection of the prostate
      • Open prostatectomy

11. prostate cancer

    • Malignant prolifration of prostatic glands
      • Spread to lumbar spine or pelvis is common
    • most common cancer in men
      • second most common cause of cancer death
    • Risk factors
      • Age
      • race
        • African american
      • diet high in saturated fat
    • arise in the posterior peripheral region
      • doesnt produce urinary symptoms early
    • screening beins at the agae of 50 with DRE and PSA
      • Decreased % free PSA suggest cancer
        • Biopsy is required to confirm
          • Shows small invasive glands with prominent nucleoli
    • Gleason grading system
    • Treatment
      • Prostatectomy
      • GnHR analogs
        • leuprolide
      • Flutamide

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