Definition of "Benign prostatic hyperplasia"

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Benign prostatic hyperplasia (BPH, benign enlargement of the prostate, adenofibromyomatous hyperplasia, benign prostatic hypertrophy) is an increase in the size of the prostate.

Patient information

What is benign prostatic hyperplasia?
It's where the prostate becomes bigger in size.

Cool beans. But what's the prostate?
It's the thing that makes a white basic fluid that makes up 30% of semen.

Pathophysiology
  • Hyperplasia (i.e. increase in the number of cells, cf hypertrophy i.e. a growth in the size of individual cells) of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the transition zone of the prostate
  • When sufficiently large, the nodules impinge on the urethra and increase resistance to flow of urine from the bladder
  • Although it is described as an "obstruction", the urethral lumen is no less patent, only compressed
  • Resistance to urine flow requires the bladder to work harder during voiding, possibly leading to progressive hypertrophy, instability, or weakness/atony of the bladder muscle

Patient information

What does it mean to have a big prostate exactly?
It's where there's more cells. This is as supposed to where the cells are bigger. So this creates nodules.

Why does it matter to have a big prostate?
The urethra passes through the prostate gland. So if there's a big prostate, it can compress this. That's a problem, because the urethra is the tube that drains the bladder from the body. This means that the bladder has to work harder.

Ix
  • PSA, may be elevated in these Pt's because of an increased organ volume and inflammation due to UTI's, BPH does NOT lead to cancer, or increase cancer risk

Patient information

How do you look further into whether someone has a big prostate?
You can check PSA. The only thing is it can be increased not only in PSA, but also in UTI's. And the biggest problem is it's also elevated in prostate cancer, so that's the biggie we're worried about.

Tx
  • Drugs, including:
    • Alpha blockers, which block the alpha adrenergic receptors. It includes tamsulosin
    • 5alpha-reductase inhibitors, which inhibit conversion of testosterone to dihydrotestosterone (DHT). It includes dutasteride (triple 5a-reductase inhibitor)
    • These drugs can be taken as combinations, such as dutasteride/tamsulosin hydrochloride (Jalyn, Combodart, Duodart)
  • TURP (transurethral resection of the prostate), which visualizes the prostate through the urethra and removes tissue by electrocautery or sharp dissection. It is done w/ spinal/GA. A triple lumen catheter is inserted thorugh the urethra to irrigate and drain the bladder after

Patient information

What can you do about a big prostate?
The obvious one is surgery. The way we do it is through the urethra, to remove tissue. Afterwards, we also stick a tube through the urethra and drain the baldder that way too. The thing though, is that you can also use drugs.

What drugs can you use?
There are 2 in particular. One acts against the adrenergic fight-and-flight response, relaxing the muscle of the bladder wall, letting it contract. And the other inhibits the creation of a super potent version of testosterone, that makes a big prostate worse. In fact, this super testosterone can also cause prostate cancer!

Epidemiology
  • Adenomatous prostatic growth is believed to begin around 30yo
  • 50% of men have histological evidence of BPH by 50yo, and 75% by 80yo. In 45% of these men, BPH becomes clinically significant
  • Is in the top 10 most prominent and costly diseases in men >50yo

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Definition of Benign prostatic hyperplasia | Autoprac


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