Comparing normal and enlarged prostate glands Open pop-up dialog box Close Comparing normal and enlarged prostate glands Comparing normal and enlarged prostate glands At normal size, the prostate gland is about the size and shape of a walnut or golf ball. When enlarged, the prostate may obstruct urine flow from the bladder and out the urethra. The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis urethra passes through the center of the prostate.
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BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in residual urine or urinary stasis, which can lead to an increased risk of urinary tract infection.
This means that androgens must be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by evidence suggesting that castrated boys do not develop BPH when they age. On the other hand, some studies suggest that administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms, so the role of testosterone in prostate cancer and BPH is still unclear.
Further randomized controlled trials with more participants are needed to quantify any risk of giving exogenous testosterone. 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 ten times more potent than testosterone because it dissociates from the androgen receptor more slowly. Diet[ edit ] Studies indicate that dietary patterns may affect development of BPH, but further research is needed to clarify any important relationship.
Men older than 60 in rural areas had very low rates of clinical BPH, while men living in cities and consuming more animal protein had a higher incidence. Misrepair-accumulation aging theory   suggests that development of benign prostatic hyperplasia is a consequence of fibrosis and weakening of the muscular tissue in the prostate. However, repeated contractions and dilations of myofibers will unavoidably cause injuries and broken myofibers.
Myofibers have a low potential for regeneration; therefore, collagen fibers need to be used to replace the broken myofibers. Such misrepairs make the muscular tissue weak in functioning, and the fluid secreted by glands cannot be excreted completely.
Then, the accumulation of fluid in glands increases the resistance of muscular tissue during the movements of contractions and dilations, and more and more myofibers will be broken and replaced by collagen fibers. Pathophysiology[ edit ] Benign prostate hyperplasia As men age, the enzymes aromatase and 5-alpha reductase increase in activity.
These enzymes are responsible for converting androgen hormones into estrogen and dihydrotestosterone , respectively. This metabolism of androgen hormones leads to a decrease in testosterone but increased levels of DHT and estrogen.
Both the glandular epithelial cells and the stromal cells including muscular fibers undergo hyperplasia in BPH. The anterior lobe has little in the way of glandular tissue and is seldom enlarged. Carcinoma of the prostate typically occurs in the posterior lobe — hence the ability to discern an irregular outline per rectal examination.
The earliest microscopic signs of BPH usually begin between the age of 30 and 50 years old in the PUG, which is posterior to the proximal urethra. The degree of LUTS does not necessarily correspond to the size of the prostate.
An enlarged prostate gland on rectal examination that is symmetric and smooth supports a diagnosis of BPH. This may occur as a result of uncoordinated contraction of the bladder muscle or impairment in the timing of bladder muscle contraction and urethral sphincter relaxation.
Normal non-neoplastic prostatic tissue NNT. Benign prostatic hyperplasia. High-grade prostatic intraepithelial neoplasia. Prostatic adenocarcinoma PCA. Management[ edit ] When treating and managing benign prostatic hyperplasia, the aim is to prevent complications related to the disease and improve or relieve symptoms.
Lifestyle[ edit ] Lifestyle alterations to address the symptoms of BPH include physical activity,  decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products and following a timed voiding schedule. Patients can also attempt to avoid products and medications with anticholinergic properties that may exacerbate urinary retention symptoms of BPH, including antihistamines , decongestants , opioids , and tricyclic antidepressants ; however, changes in medications should be done with input from a medical professional.
Prostate Enlargement (Benign Prostatic Hyperplasia)
Very rarely, loss of bladder control incontinence There are several types of minimally invasive or surgical therapies. Transurethral resection of the prostate TURP A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.
Benign prostatic hyperplasia
Men who are having trouble urinating are good candidates for minimally invasive surgery. These implants lift and hold the enlarged prostate so that it no longer blocks the urethra. PUL may be done with either local or general anesthesia. PUL uses no cutting or heat to destroy or remove prostate tissue.