Renal and urologyBenign prostatic hyperplasia
Section snippets
Prostate gland
Development: male and female embryos develop identically initially. Each have undifferentiated gonads and Wolffian ducts (which develop into most male genital structures) and Mullerian ducts (which develop into most female genital structures). The male phenotype develops under the influence of testicular androgens and Mullerian-inhibiting substance (‘anti-Mullerian-hormone’). Mullerian-inhibiting substance is a peptide hormone in the transforming growth factor-β family that acts via type I and
Pathophysiology of BPH
Population prevalence of BPH: several large population studies have shown that progressive enlargement of the prostate gland is extremely common, and is seen in most men aged >70 years. The most studied populations are those of Baltimore (Maryland, USA), the Forth valley (Stirling, Scotland) and Olmsted County (Minnesota, USA). They have provided much information about the complex interactions between BPH, lower urinary tract symptoms, serum concentration of prostate-specific antigen in serum,
Diagnosis and assessment of BPH/lower urinary tract symptoms
Men rarely come complaining of a big prostate, but usually present with LUTS or a complication from unrelieved bladder outflow obstruction (BOO). Many men are anxious that they may have prostate cancer or may be going into renal failure; they are often aware of the risks of painful and unexpected acute urinary retention. Rapid estimation of these risks can be achieved by assessment incorporating:
- •
a history of symptoms, comorbidity and age
- •
careful examination of the prostate and lower abdomen
- •
Lifestyle changes
Advice on lifestyle changes is useful for most men. Stopping smoking and altering the nature, volume and timing of fluid intake may help significantly. A trial of a non-invasive therapy is usually indicated initially (and usually preferred by the patient). A surgical option should be offered (see below) if there are very severe symptoms, rapid failure of medical treatment or if the patient prefers definitive surgical treatment.
Medical
Pharmacotherapy is used to relieve excessive smooth muscle tone
Summary
Men in western society or those who are increasingly exposed to western diets will develop BPH microscopically. About 50% will develop macroscopic BPH and measurable enlargement of the prostate. The response and the development of symptoms depends on an interplay of factors, in particular bladder function. Asymptomatic men rarely present and can usually be reassured; symptomatic men or those with an established complication may wish treatment. Lifestyle changes can reduce mild to moderate
References (0)
Cited by (2)
Homologous recombination induced by doxazosin mesylate and saw palmetto in the Drosophila wing-spot test
2013, Journal of Applied Toxicology3D-QSAR CoMFA and CoMSIA studies for design of potent human steroid 5α-reductase inhibitors
2013, Medicinal Chemistry Research