Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is probably the most common neoplastic growth observed in men. It starts developing in the periurethral glands inside the prostate. Prostate growth begins at birth and continues at a very slow rate through puberty. The prostate grows more rapidly through the third decade. After 45 years of age, a benign hyperplasia may take place, which can evolve during the rest of the mans life, leading to hypertrophy. However, pathological changes may never occur.

SAGITTAL VIEW OF LOWER URINARY TRACT

LUTS (LOWER URINARY TRACT SYMPTOMS)

Decreased stream: a weak stream; little force behind the stream. A feeling of incomplete emptying. Hesitancy: having to wait for the urinary stream to get started. Nocturia: waking up from sleep to urinate. Terminal dribbling: prolonged dripping of urine after the main urinary stream has nished. Urgency: having to run to the bathroom because of a sudden urge to void.

POSTMICTIONAL DRIPPING

Bladder Prostatic growth

TREATMENT
Medications may be used to improve and/or prevent BPH. Surgery: There are various forms involving the removal of the central growing core of the prostate.
The illustration shows the bladder with hypertrophy of the detrusor muscle and the cells, columns, and diverticuli inside that compose the concordant bladder. The prostatic growth that causes the obstruction of the vesical neck can also be seen. With the increasing urethral compression as a result of the growing adenoma, the patient presents a series of symptoms called prostatism, consisting in alterations of the calibre and strength of urine flow, hesitancy (delayed start of urination), inability to stop urination, prolonged dribbling after urination, vesical tenesmus, nocturia, and even urinary retention.

Spermatic vas Iliac artery Iliac vein

Ureter

CONCENTRIC ENLARGEMENT OF THE PROSTATE GLAND

Bladder

SUBCERVICAL PROSTATIC GROWTH

Pyramidal muscle

Anterior rectus (stright) muscle of abdomen

Vesical trigone Concentric growing of the lateral prostatic lobes

Lateral prostatic lobes in subcervical growth

Bladder

Seminal vesicle

Seminal vesicle (longitudinal section) Prostate Prostatic urethra

EXCENTRIC ENLARGEMENT WITH MEDIAL LOBE

Vesical mucosa

Ischiopubic ramus

CONCENTRIC GROWTH OF LATERAL LOBES AND MEDIAN LOBE

Membranous urethra

Spongy urethra Vas deferens

Medial lobe enlargement Ureteral meatus Medial lobe

POSTERIOR VIEW OF URINARY SYSTEM, PROSTATE AND SEMINAL VESICLES

BPH is a chronic disease that spans decades. Histologically distinguishable BPH as a nding during autopsy is present in about 8% in the age group of men 31 to 40 years, increasing with age to about 90% by the ninth decade of life. (McVary 2006). One of the most serious complications of BPH is acute urinary retention (AUR) inability to urinate, with increasing pain (Roehrborn 2001).
References: Ronald J. Hicks, M.D., and Jacqueline B. Cook, M.S.W. Managing Patients with Benign Prostatic Hyperplasia. American Family Physician. 52(1): 135-142. July 1995. Frank H. Netter, M.D. Abdomen. In his Atlas of Human Anatomy. USA, Icon Learning System, 1989. pp 256-258. Frank H. Netter, M.D. Pelvis and Perineum. In his Atlas of Human Anatomy. USA, Icon Learning System, 1989. pp 348-349. Roehrborn CG. The Epidemiology of Acute Urinary Retention in Benign Prostatic Hyperplasia. Reviews In Urology Vol. 3, No. 4, 2002, pp. 187-192. McVary K. BPH: Epidemiology and Comorbidities. Am J Manag Care. 2006;12:S122-S128. Copyright 2010 Anejo Producciones S.A. Total or partial reproduction by any means prohibited unless written consent is given by the owner of the copyright. Disclaimer: All information included within this product is not intended as a substitute for professional care. : PROSCAR is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA

Medial lobe growth Medial lobe

Prostate Prostatic utricle

Concentric growth of the lateral prostatic lobes Lateral lobes

There are two specific areas in the prostate: an internal area stimuated by oestrogens, and an external area modulated by androgens. After 40 years of age, nodular hyperplasia begins, where the collagen tissue intercalates with glandular acini and progresses, reaching two possible forms: 1. Rigid, nodular and fibrous, without significant size changes 2. Large adenoma which compresses the prostatic urethra

The subcervical development of lateral lobes raises the muscular ring of the vesical neck, resulting in the so-called median lobe. When the lobes grow laterally, they do so eccentrically or concentrically. The adenoma compress the muscular fibers against residual glandular tissue, forming the surgical capsule.

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FD10099 First Issued 11/2010