♥BPH
In benign prostatic hyperplasia or bph prostatic refers to the prostate gland hyperplasia means an increase in the number of cells and benign means that these cells aren’t malignant so they don’t invade neighboring tissues basically benign prosthetic hyperplasia is the non-cancerous growth of the prostate gland this condition is common in men over 50 and it’s
Often considered a normal part of aging the prostate is a small gland about the size and shape of a walnut that sits under the bladder and in front of the rectum the urethra which is the tube through which the urine leaves the bladder goes through the prostate before reaching the penis and that part of the urethra is called the prostatic urethra the prostate
Is covered by a capsule of tough connective tissue and smooth muscle beneath this layer the prostate can be divided into a few zones the peripheral zone which is the outermost posterior section is the largest of the zones and contains about 70 percent of the prostate’s glandular tissue moving inward the next section is the central zone which contains about 25 of
The glandular tissue as well as the ejaculatory ducts that join with the prostatic urethra last is the transitional zone which contains around five percent of the glandular tissue as well as a portion of the prostatic urethra the transitional zone gets its name because it contains transitional cells which are also found in the bladder at the microscopic level each
Of the tiny glands that make up the prostate is surrounded by a basement membrane made largely of collagen sitting within that basement membrane is a ring of cube-shaped basal cells as well as a few neuroendocrine cells interspersed throughout finally there’s an inner ring of luminal columnar cells which are within the lumen or center of the gland luminal cells
Secrete substances into the prostatic fluid that make it slightly alkaline and give it nutrients which nourish the sperm and help it survive in the acidic environment of the vagina during an ejaculation sperm leave the testes travel through the vas deferens into the ejaculatory ducts and travel through the prostatic urethra smooth muscles in the prostate contract
And push the prostatic fluid into the urethra where it joins the sperm as well as the semen which is the fluid that comes from the seminal vesicles the luminal cells also produce prostate-specific antigen or psa which helps to liquefy the gel-like semen after ejaculation thereby freeing the sperm to swim the basal cells and luminal cells of the prostate rely on
Stimulation from the androgens or male sex hormones for survival the androgens include testosterone which is produced by the testicles and dihydrotestosterone which is produced in the prostate itself this androgen is produced by the prostatic enzyme 5-alpha reductase which converts testosterone into the more potent dihydrotestosterone since androgens are steroids
They can cross the cell membrane and bind to the androgen receptors within the cell’s nucleus this inhibits apoptosis or programmed cell death allowing luminal and basal cells in the prostate to keep growing and multiplying dihydrotestosterone is 10 times more potent than testosterone because it can bind to androgen receptors much longer now after the age of 30
Men produce about 1 percent less testosterone per year but for unclear reasons 5-alpha reductase activity increases with age so even with less testosterone there can be an increase in dihydrotestosterone normal prostate cells respond to the increase in dihydrotestosterone levels by living longer and multiplying and that’s the underlying cause of benign prostatic
Hypertrophy this is a normal process of aging and around 50 percent of men develop bph by the age of 60 and over 90 percent have it by the age of 85. fortunately in bph there’s no increased risk for developing cell mutations that lead to prostate cancer rather the entire prostate gland enlarges pretty uniformly and small hyperplastic nodules can form within it
These nodules are smooth elastic and firm and are sometimes mistaken for prostate cancer typically hyperplastic nodules will form in the inner portions of the gland specifically around the prostatic urethra called the periurethral zone when these nodules or the prostate tissue itself compresses the prostatic urethra it becomes more difficult for urine to pass
Through it so the urine builds up in the bladder causing it to dilate in response the smooth muscle walls of the bladder will contract harder and this leads to bladder hypertrophy where the walls thicken and become easily irritated finally the stagnation of urine in the bladder also promotes bacterial growth and can lead to urinary tract infections symptoms of
Bph start up when the prostatic urethra gets obstructed and that can lead to a weak and inconsistent stream of urine called dribbling the person might also have to strain when urinating to overcome the obstruction have pain during urination called dysuria or trouble initiating urination called hesitancy as urine builds up in the bladder it causes a constant sense
Of incomplete bladder emptying which increases the frequency of urination at night called nocturia benign prostatic hyperplasia can be identified with a digital rectal examination which is where a finger is inserted into the rectum to feel against the anterior wall of the rectum which lies along the posterior prostate an enlarged prostate could indicate benign
Prostatic hyperplasia while hard nodules could be a sign of prostate cancer levels of prostate-specific antigen or psa a substance produced by healthy prostate cells are also elevated in benign prostatic hyperplasia since there are more cells around making the psa treatment of bph focuses on relieving the obstruction and allowing the urine to flow normally this
Can be done through medications like finasteride a 5-alpha reductase inhibitor which shrinks the prostate gland by inhibiting the conversion of testosterone into dihydrotestosterone next alpha-1 antagonists like phenoxybenzamine can bind to a1 receptors on the smooth muscles in the neck of the bladder the prostate and urethra causing them to relax and allow urine
To pass in some cases surgical procedures like transurethral resection of the prostate or terp can be done to remove part or all of the prostate
Transcribed from video
Benign Prostatic Hyperplasia BPH By khyber Medical University
