Prostatic nodular hyperplasia

Benign prostatic hyperplasia 

Updated: 01/29/2021

© Jun Wang, MD, PhD

General features
  • AKA benign prostatic hypertrophy (BPH)
  • Incidence increases with age
  • Considered a normal part of the aging process in men
  • Hormonally dependent on testosterone and dihydrotestosterone production
  • Periurethral (transitional zone) nodules likely compress urethra and cause obstructive symptoms
  • May cause urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi
Pathogenesis
  • Activation of androgen receptor
  • Stromal type II 5-alpha-reductase convert testosterone to dihydrotestosterone (DHT)
  • DHT promotes glandular and stromal hyperplasia
  • Estrogen may increase quantity of androgen receptor
  • Other growth factors
Clinical features
  • Due to chronic bladder outlet obstruction
  • Urinary frequency
  • Urinary urgency
  • Hesitancy: Difficulty initiating the urinary stream; interrupted, weak stream
  • Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination
  • Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder
  • Decreased force of stream - The subjective loss of force of the urinary stream over time
  • Dribbling - The loss of small amounts of urine due to a poor urinary stream
Pathological findings
Marker
  • Negative for racemase
Management
  • Surgery
Transurethral resection of prostate (TURP)
Suprapubic prostatectomy
  • Androgen antagonists, smooth muscle relaxers (5 alpha reductase inhibitors decrease DHT and in many cases, prostatic volume and symptoms), minimally invasive treatment (i.e. ethanol ablation in Europe)  



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Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas M
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Anemia

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Lymphoid neoplasms

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