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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