IV.

PATHOPHYSIOLOGY (BPH)

Exact cause is Idiopathic

Men-50 y/o & above Diet Obesity DM Smoking

Ethnicity Hormonal fx Race Family Hx Alcohol use

Estrogen

Androgen

RISK FACTORS
Testosterone Become sensitive to growthstimulating hormone
5-alpha reductase

Dihydrosterone

Hyperplasia
Binds to nuclear androgen receptors

Signals prostate cell to replicate

Signals growth factors Late activation of cell growth

Apoptosis

Hyperplasia
Symmetrically enlarged gland

Narrows the lumen of the segment of the prostate

Encroaches upon the bladder neck reducing the ability to funnel in response to micturation

Growth of the socalled median lobe of the prostate extends into the proximal urethra

Prostate capsule influence hyperplasia to expand outward

Accompanied by hypertrophy of the smooth muscle gland (Benign Prostatic Hypertrophy)

Size of prostate

Muscular tone at the bladder neck & proximal urethra

Mechanically adds to the tse. constricting the urethral lumen

UTI Hematuria

OBSTRUCTION

Amplify the strength of the detrusor contraction

Urethral resistance

Overwhelms the detrusor muscles ability to ensure effective bladder evacuation by micturation

LUTS

Decline in the force of the urinary stream

Feelings of incomplete bladder emptying

Daytime voiding frequency

Urgency

Nocturia

Lower Urinary Tract Symptoms

Associated w/ overactive detrusor contractions

Urge urinary incontinence

Detrusor decompensate

Acute Urinary Retention

Urinary residual volumes

Weakened muscle contraction

Uremia

Peritonitis

Increase risk of post-operative complications

The prostate is the genital organ most commonly affected by benign and malignantneoplasm.Benign enlargement of the prostate gland is an extremely common process thatoccurs in nearly all men with functioning testes.Hyperplasia is a general medical term referringto excess cell replication. Benign prostatic hyperplasia (BPH) is a noncancerous growth of theprostate gland. It is the most common noncancerous form of cell growth in men and usuallybegins with microscopic nodules in younger men. It should be noted that BPH is not aprecancerous condition. Some studies have suggested that African American men are at higher risk and Asian menat lower risk for BPH than Caucasians, a 2000 study found no greater risk for African Americansand only a slightly lower risk for Asians. Among Caucasians in the study, men of southernEuropean heritage were at greater risk while men of Scandinavian ancestry had a lower chanceof developing BPH. Histologic evidence of prostate enlargement begins about the third decade of life andincreases proportionally with aging.Specifically, about 43% of men in their 40s will haveevidence of BPH, as will 50% of men in their 50s, 75% to 88% in their 80s, and nearly 100% ofmen reaching the ninth decade of life. Some evidence has reported a higher incidence of benign prostatic hyperplasia --particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and type 2diabetes. Diabetes and hypertension, in any case, worsens urinary tract symptoms in men withBPH. In one study, flow rates were adversely affected by diabetes, although residual urinevolumes were not significantly greater. The exact cause of BPH is unknown.Potential risk factors include age, family history,race, ethnicity, and hormonal factors.Androgens (male hormones) most likely play a role inprostate growth. The most important androgen istestosterone, which is produced throughout aman's lifetime. The prostate converts testosterone to a more powerful androgen, dihydrotestosterone(DHT). DHT stimulates cell growth in the tissue that lines the prostate gland (the glandular epithelium) and is the major cause of the rapid prostate enlargement that occursbetween puberty and young adulthood. DHT is a prime suspect in prostate enlargement in lateradulthood.Additional factors also include a defective cell death in which cells naturally selfdestruct, goes awry and results in cell proliferation a process called asapoptosis. As BPH progresses, overgrowth occurs in the central area of theprostate called the transition zone, which wraps around the urethra (the tubethat carries urine through the penis). This pressure on the urethra can causelower urinary symptoms that have been the basis for diagnosing BPH. Itshould be noted that BPH is not always the cause of these symptoms. Anenlarged prostate may be accompanied by few symptoms, while severe LUTSmay be present with normal or even small prostates and are most likely dueto other conditions.Symptoms of BPH may include;Difficulty in starting to pass

urine (hesitancy), a weak stream of urine, dribbling after urinating, the need to strain to passurine, incomplete emptying of bladder, difficulty to control the urination urge, having to get upseveral times in the night to pass urine, feeling a burning sensation when passing urine. Sometimes a man is unaware of an obstruction until he suddenly cannot urinate at all.This condition is called acute urinary retention. It is a dangerous complication that can damagethe kidneys and may require emergency surgery. In general, BPH progresses very slowly andacute urinary retention is very uncommon. Men with BPH at highest risk for this complicationtend to be elderly and to have moderate to severe lower voiding symptoms. Taking anti-hypertensive drugs (except for diuretics) or antiarrhythmic drugs may also increase the risk.Bladder obstruction can also cause bladder stones, blood in the urine, urinary tract infection, andincontinence. Unfortunately, no current tests can accurately predict which men are at higher riskfor complications, although men with a weak urine stream and larger prostates are at higher riskfor urinary retention. Diagnostic tests used to confirm Benign Prostatic Hyperplasia include Digital Rectal Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy.

PATHOPHYSIOLOGY: Schematic Diagram: This is our case presentation for our midterms. First: Due to Aging I Low Testosterone Level I High Estradiol (Estrogen)Level I Obstruction of Urethra I Urinary retention (dysuria(difficulty of urination), oliguria, anuria)

->The cause of BPH is uncertain up to this point of time. However, lifestyle is a big factor in developing BPH. Based on our research, drinking too much alcohol causes BPH, because beers can increase the estradiol level and increased estradiol level is the only reason why men develops BPH. Furthermore, the testosterone level of the males when they reached 30 years old starts to con vert to estrogen by amylase.