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prostate adenomatous hyperplasia

Saturday 21 January 2012

Prostatic Hyperplasia; Nodular prostatic hyperplasia (also termed benign prostatic hyperplasia, or BPH);

Nodular prostatic hyperplasia (also termed benign prostatic hyperplasia, or BPH) is a common condition as men age.

Perhaps a fourth of men have some degree of hyperplasia by the fifth decade of life.

By the eighth decade, over 90% of males will have prostatic hyperplasia. However, in only a minority of cases (about 10%) will this hyperplasia be symptomatic and severe enough to require surgical or medical therapy. (Bushman, 2009)

The mechanism for hyperplasia may be related to accumulation of dihydrotestosterone in the prostate, which then binds to nuclear hormone receptors which then trigger growth.

The effect of drugs which act to inhibit the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone within cells. This blocks the growth-promoting androgenic effect and diminishes prostatic enlargement. Such drugs include finasteride and episteride. Drug therapy must be continued to remain effective. (AndrĂ­ole et al, 2004)

Another class of drugs used to treat BPH are the alpha 1-adrenoreceptors, including prazosin, alfuzosin, indoramin, terazosin, doxazosin, and tamsulosin. These alpha adrenergic blockers lead to relaxation of smooth muscle in prostate and help to relieve obstruction. Drug therapy must be continued to remain effective. (Auffenberg et al, 2009)

The normal prostate weighs 20 to 30 gm, but most prostates with nodular hyperplasia can weigh from 50 to 100 gm.

Hyperplasia begins in the region of the veru-montanum, in the inner zone of the prostate, and extends to involve lateral lobes.

This enlargement impinges upon the prostatic urethra, leading to the difficulty on urination with hesitency that is typical for this condition.

Dysuria, dribbling, and nocturia are also frequent. The urinary tract obstruction leads to urinary retention and risk for infection. In severe, prolonged cases, hydroureter with hydronephrosis and renal failure can ensue. (Wasserman, 2006)

Microscopically, nodular prostatic hyperplasia consists of nodules of glands and intervening stroma.

Most of the hyperplasia is contributed by glandular proliferation, but the stroma is also increased, and in rare cases may predominate.

The glands may be more variably sized, with larger glands have more prominent papillary infoldings.

Nodular hyperplasia is NOT a precursor to carcinoma. (Homma et al, 1996)

See also

- prostatic hyperplasia