FACTOID # 4: Just 1% of the houses in Nevada were built before 1939.
 
 Home   Encyclopedia   Statistics   States A-Z   Flags   Maps   FAQ   About 
 
WHAT'S NEW
 

SEARCH ALL

FACTS & STATISTICS    Advanced view

Search encyclopedia, statistics and forums:

 

 

(* = Graphable)

 

 


Encyclopedia > Benign prostatic hyperplasia
Benign Prostatic Hyperplasia (Nodular Hyperplasia)
Classification & external resources
ICD-10 N40
ICD-9 600

Benign prostatic hyperplasia (BPH) also known as Nodular hyperplasia, Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to the increase in size of the prostate in middle-aged and elderly men. To be accurate, the process is one of hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists. It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra which interferes the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary retention. Although prostate specific antigen levels may be elevated in these patients, because of increased organ volume and inflammation due to urinary tract infections, BPH is not considered to be a premalignant lesion. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... BPH is a three-letter abbreviation with multiple meanings, as described below: Bachelor of Philosophy - an undergraduate or postgraduate degree. ... The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. ... Hyperplasia (or hypergenesis) is a general term for an increase in the number of the cells of an organ or tissue causing it to increase in size. ... Bodybuilder Markus Rühl has marked hypertrophy of skeletal muscle. ... In cell biology, stromal cells are connective tissue cells of an organ found in the loose connective tissue. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... This article or section is in need of attention from an expert on the subject. ... Urination, formally called micturition, is the process of disposing urine from the urinary bladder through the urethra to the outside of the body. ... A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ... Urinary retention also known as ischuria is a lack of ability to urinate. ... Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ...

Contents

Symptoms

Benign prostatic hyperplasia symptoms are classified as obstructive or irritative. Obstructive symptoms include hesitancy, intermittency, incomplete voiding, weak urinary stream, and straining.


Irritative symptoms include frequency of urination, which is called nocturia when occurring at night time, and urgency (compelling need to void that can not be deferred). These obstructive and irritative symptoms are evaluated using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH.[1]


BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infections. Urinary bladder stones, are formed from the crystallisation of salts in the residual urine. Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients who suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy. Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... In anatomy, the urinary bladder is a hollow, muscular, and distensible (or elastic) organ that sits on the pelvic floor in mammals. ... A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ... Kidney stones, also known as nephrolithiasis, urolithiasis or renal calculi, are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Urinary retention also known as ischuria is a lack of ability to urinate. ... In conventional medicine, a uropathy is a disease of the urinary system. ...


Etiology

Androgens (testosterone and related hormones) are considered to play a permissive role in BPH by most experts. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age, unlike intact men. Additionally, administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms. Dihydrotestosterone (DHT), a metabolite of testosterone is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2. This enzyme is localized principally in the stromal cells; hence, these cells are the main site for the synthesis of DHT. Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Testosterone is a steroid hormone from the androgen group. ... Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... This does not adequately cite its references or sources. ... For other uses, see DHT (disambiguation). ... A metabolite is the product of metabolism. ...


DHT can act in an autocrine fashion on the stromal cells or in paracrine fashion by diffusing into nearby epithelial cells. In both of these cell types, DHT binds to nuclear androgen receptors and signals the transcription of growth factors that are mitogenic to the epithelial and stromal cells. DHT is 10 times more potent than testosterone because it dissociates from the androgen receptor more slowly. The importance of DHT in causing nodular hyperplasia is supported by clinical observations in which an inhibitor of 5α-reductase is given to men with this condition. Therapy with 5α-reductase inhibitor markedly reduces the DHT content of the prostate and in turn reduces prostate volume and, in many cases, BPH symptoms. Autocrine signalling is a form of signalling in which the target cell is the secretory cell itself. ... Paracrine signalling is a form of signalling in which the target cell is close to the signal releasing cell, and the signal chemical is broken down too quickly to be carried to other parts of the body. ... Types of epithelium This article discusses the epithelium as it relates to animal anatomy. ... The androgen receptor is an intracellular steroid receptor that specifically binds testosterone and dihydrotestosterone. ... A micrograph of ongoing gene transcription of ribosomal RNA illustrating the growing primary transcripts. ... Growth factor is a protein that acts as a signaling molecule between cells (like cytokines and hormones) that attaches to specific receptors on the surface of a target cell and promotes differentiation and maturation of these cells. ... In medicine, a nodule refers to a small aggregation of cells. ... Look up inhibition, inhibitor in Wiktionary, the free dictionary. ...


There is growing evidence that estrogens play a role in the etiology of BPH. This is based on the fact that BPH occurs when men generally have elevated estrogen levels and relatively reduced free testosterone levels, and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. Cells taken from the prostates of men who have BPH have been shown to grow in response to high estradiol levels with low androgens present. Estrogens may render cells more susceptible to the action of DHT. Estriol. ... Etiology (alternately aetiology, aitiology) is the study of causation. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ...


On a microscopic level, BPH can be seen in the vast majority of men as they age, particularly over the age of 70 years, around the world. However, rates of clinically significant, symptomatic BPH vary dramatically depending on lifestyle. Men who lead a western lifestyle have a much higher incidence of symptomatic BPH than men who lead a traditional or rural lifestyle. This is confirmed by research in China showing that men in rural areas have very low rates of clinical BPH, while men living in cities adopting a western lifestyle have a skyrocketing incidence of this condition, though it is still below rates seen in the West.


Much work remains to be done to completely clarify the causes of BPH.


Diagnosis

Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate. It is dependent on the skills of the doctor. A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ...


Often, blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography. These combined measures can provide early cancer detection. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ...


Ultrasound examination of the testicles, prostate and kidneys is often performed, again to rule out malignancy and hydronephrosis. Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ...


Epidemiology

More than half of the men in the United States between the ages of 60 and 70 and as many as 90% between the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.


Treatment

Lifestyle

Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules.


Medications

Alpha blockers1-adrenergic receptor antagonists) provide symptomatic relief of BPH symptoms. Available drugs include doxazosin, terazosin, alfuzosin and tamsulosin. Older drugs, phenoxybenzamine and prazosin are not recommended for treatment of BPH [2]. Alpha-blockers relax smooth muscle in the prostate and the bladder neck, and decrease the degree of blockage of urine flow. Alpha-blockers may cause ejaculation back into the bladder (retrograde ejaculation). Alpha blockers (also called alpha-adrenergic blocking agents) constitute a variety of drugs which block alpha-adrenergic receptors in arteries and smooth muscles. ... Epinephrine Norepinephrine The adrenergic receptors (or adrenoceptors) are a class of G protein-coupled receptors that are targets of the catecholamines. ... Antagonists In medicine and biology, a receptor antagonist is a ligand that inhibits the function of an agonist and inverse agonist for a specific receptor. ... Doxazosin mesylate, a quinazoline compound sold by Pfizer under the brand name Cardura, is used to treat high blood pressure and benign prostatic hyperplasia. ... Terazosin (Hytrin) is an alpha blocker used for treatment of symptoms of prostate enlargement (BPH). ... Alfuzosin ((R,S)-N-[3-[(4-amino-6,7-dimethoxy-2-quinazolinyl) methylamino] propyl] tetrahydro-2-furancarboxamide, provided as the hydrochloride salt) is an alpha-adrenergic blocker used to treat benign prostatic hyperplasia (BPH). ... Tamsulosin (rINN) (IPA: ) is an α1a-selective alpha blocker used in the symptomatic treatment of benign prostatic hyperplasia (BPH). ... Phenoxybenzamine is a non-specific, irreversible alpha blocker used in the treatment of hypertension, and specifically that caused by pheochromocytoma. ... Prazosin, brand name Minipress®, is a medication used to treat high blood pressure (hypertension). ... In males, retrograde ejaculation occurs when the fluid to be ejaculated, which would normally exit via the urethra, is redirected towards the urinary bladder. ...


The 5α-reductase inhibitors (finasteride and dutasteride) are another treatment option. When used together with alpha blockers a reduction of BPH progression to acute urinary retention and surgery has been noted in patients with larger prostates.[3] 5α-reductase inhibitors (or 5-alpha-reductase inhibitors) are a group of drugs with antiandrogenic activity, used in the treatment of benign prostatic hyperplasia and androgenic (or androgenetic) alopecia. ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ...



There is also extensive evidence of the efficacy of Serenoa repens (saw palmetto) fruit extracts in alleviating mild-to-moderate BPH symptoms; a systematic review of evidence found comparable efficacy to finasteride (Wilt et al., 2002). Other herbal medicines that have solid research support in systematic reviews include beta-sitosterol from Hypoxis rooperi (African star grass) and pygeum (extracted from the bark of Prunus africana), while there is less substantial support for the efficacy of Cucurbita pepo (pumpkin) seed and Urtica dioica (stinging nettle) root (Wilt et al., 2000). At least one double-blind trial has also supported the efficacy of rye flower pollen (Buck, et al., 1990). Binomial name Serenoa repens Hooker Saw Palmetto, Serenoa repens, is the sole species currently classified in the genus Serenoa. ... Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Binomial name Hypoxis hemerocallidea Fisch. ... Pygeum (or Prunus africanum, or Pygeum africanum, or African plum) is a plant used in the treatment of benign prostatic hyperplasia. ... Binomial name Prunus africana Prunus africana (formerly Pygeum africanum) is a plant used in the treatment of benign prostatic hyperplasia (BPH). ... Species - hubbard squash, buttercup squash - cushaw squash - butternut squash - most pumpkins, acorn squash, summer squash References: ITIS 22365 2002-11-06 Hortus Third Squashes are four species of the genus Cucurbita, also called pumpkins and marrows depending on variety or the nationality of the speaker. ... Binomial name Urtica dioica L. The stinging nettle (Urtica dioica) is a herbaceous flowering plant native to Europe, Asia, northern Africa, and North America, and is the best known member of the nettle genus Urtica. ... Binomial name Urtica dioica L. The stinging nettle (Urtica dioica) is a herbaceous flowering plant native to Europe, Asia, northern Africa, and North America, and is the best known member of the nettle genus Urtica. ...


Sildenafil shows some symptomatic relief, suggesting a possible common etiology with erectile disfunction[4]. Sildenafil citrate, sold under the names Viagra, Revatio and generically under various other names, is a drug used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH), developed by the pharmaceutical company Pfizer. ... Erectile dysfunction, also known as impotence, is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ...


Surgery

If medical treatment fails, transurethral resection of prostate (TURP) surgery may need to be performed. This involves removing (part of) the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, some of which have not been around long enough to fully establish their safety or side effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what's left. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), TransUrethral Microwave ThermoTherapy (TUMT), TransUrethral Needle Ablation (TUNA), ethanol injection, and others are studied as alternatives. Transurethral resection of prostate (TURP) is a urological operation. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... Transurethral needle ablation (TUNA) is a recently approved technique which can be done with a local anesthetic on an outpatient basis, and uses radio frequency energy delivered through needles to kill excess prostate tissue. ...


Newer techniques involving lasers in urology have emerged in the last 5-10 years. Starting with the VLAP technique involving the Nd:YAG laser with contact on the prostatic tissue. A similar technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged very recently. This procedure involves a high powered 80 Watt KTP laser with a 550 micrometre laser fiber inserted into the prostate. This fiber has an internal reflection with a 70 degree deflecting angle. It is used to vaporize the tissue to the prostatic capsule. KTP lasers target haemoglobin as the chromophore and have typically have a penetration depth of 2.0mm (four times deeper than holmium).


Another procedure termed Holmium Laser Ablation of the Prostate (HoLAP) has also been gaining acceptance around the world. Like KTP the delivery device for HoLAP procedures is a 550um disposable side-firing fiber that directs the beam from a high powered 100 Watt laser at a 70degree from the fiber axis. The holmium wavelength is 2,140nm, which falls within the infrared portion of the spectrum and is invisible to the naked eye. Where KTP relies on haemoglobin as a chromophore, water within the target tissue is the chromophore for Holmium lasers. The pentration depth of Holmium lasers is <0.5mm avoiding complications associated with tissue necrosis often found with the deeper penetration and lower peak powers of KTP.


Both wavelengths, KTP and Holmium, ablate approximately one to two grams of tissue per minute.


See also

The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. ... Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ... Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ... A Prostatectomy is the surgical removal of all or part of the prostate gland. ... Urinary retention also known as ischuria is a lack of ability to urinate. ... The mucous membrane immediately behind the internal urethral orifice presents a slight elevation, the uvula of urinary bladder, caused by the middle lobe of the prostate. ...

References

  • Buck AC, Cox R, Rees RWM, et al. (1990) Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, Cernilton. A double-blind placebo-controlled study Br J Urol 66:398-404 (Medline abstract)
  • Kirby R, McConnell J, et al. (eds) (1996) Textbook of Benign Prostatic Hyperplasia (Oxford: Isis Medical Media) ISBN 1-899066-24-1
  • Kumar V., Abbas K., Fausto N. (2005) Robbins and Cotran Pathologic Basis of Disease, 7th ed.: 1047 - 1058 (Elsevier Saunders) ISBN-13 978-0721601878
  • Wilt TJ, Ishani A, MacDonald R, (2002). Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002 (3), CD001423. (Medline abstract)
  • Wilt TJ, Ishani A, Rutks I, MacDonald R (2000) Phytotherapy for benign prostatic hyperplasia Public Health Nutr 3(4A):459-72 (Medline abstract)
  • Yarnell E (2001) Naturopathic Urology and Men's Health (Wenatchee, WA: Healing Mountain Publishing) ISBN 0-9741178-3-8 [1]

The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration. ...

Footnotes

  1. ^ Barry MJ, Fowler FJ Jr, O'Leary MP, et al (1992). The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148(5): 1549-57. PMID 1279218
  2. ^ AUA Practice Guidelines Committee.AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 170(2 Pt 1): 530-47. PMID 12853821
  3. ^ Kaplan SA, McConnell JD, Roehrborn CG, et al (2006). Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater. J Urol 175(1): 217-20. PMID 16406915.
  4. ^ McVary KT, Monnig W, Camps JL Jr, et al (2007). Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 177(3) :1071-7. PMID 17296414

  Results from FactBites:
 
Benign Prostatic Hyperplasia (685 words)
Benign prostatic hyperplasia (BPH) is a noncancerous growth of the prostate gland.
The prostate produces a fluid that nourishes sperm and is ejaculated during orgasm.
BPH is a common health problem in men over the age of 60.
benign prostatic hyperplasia: Definition and Much More from Answers.com (1910 words)
Benign prostatic hyperplasia is nonmalignant (noncancerous)enlargement of the prostate gland, a common occurrence in older men.
Benign prostatic hyperplasia (BPH) also known as Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to the increase in size of the prostate in middle-aged and elderly men.
The importance of DHT in causing nodular hyperplasia is supported by clinical observations in which an inhibitor of 5α-reductase is given to men with this condition.
  More results at FactBites »

 
 

COMMENTARY     


Share your thoughts, questions and commentary here
Your name
Your comments

Want to know more?
Search encyclopedia, statistics and forums:

 


Press Releases |  Feeds | Contact
The Wikipedia article included on this page is licensed under the GFDL.
Images may be subject to relevant owners' copyright.
All other elements are (c) copyright NationMaster.com 2003-5. All Rights Reserved.
Usage implies agreement with terms, 1022, m