Pathophysiology of Benign Prostate Hyperplasia (BPH)

This report discusses the pathophysiology of benign prostate hyperplasia (BPH), its clinical manifestations, the procedure of transurethral resection of the prostate (TURP), and whether BPH is considered a normal process with aging. It also includes references for further reading.

Urinary System

Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
1. Describe the pathophysiology of benign prostate hyperplasia (BPH)................................1
2. Describe clinical manifestations of benign prostate hyperplasia (BPH)............................2
3. Emilio has made the decision to have a transurethral resection of the prostate (TURP).
What is this procedure?..........................................................................................................2
4. Is benign prostate hyperplasia (BPH) considered a normal process that occurs with ageing?
Why/Why not?........................................................................................................................3
CONCLUSION................................................................................................................................3
REFERENCES................................................................................................................................4

INTRODUCTION
Benign prostatic hyperplasia is the condition in which the prostate is enlarge and occurs
when prostate gland cells begin to multiply (de Assis, and et. al., (2019). This report is based on
case study of Emilio who is 79-year-old man who has symptoms of BPH. This project covers
pathophysiology of condition along with its clinical manifestations. It also covers the procedure
of transurethral resection of the prostate.
MAIN BODY
1. Describe the pathophysiology of benign prostate hyperplasia (BPH)
Benign prostatic hyperplasia is a disease which is most frequent in ageing men. As the age
increases, the enzymes like 5 alpha reductase and aromatase increase in activity. They are
responsible for transforming androgen hormones into dihydrotestosterone and estrogen. The
androgen hormones metabolism leads to increase the level of dihydrotestosterone and estrogen
and decline in testosterone. In benign prostatic hyperplasia, the stromal cells and granular
epithelial cells undergo hyperplasia. Among both these tissues, stromal hyperplasia
predominates, but there is unclear exact ratio of the two. Anatomically, the lateral and median
lobes are enlarged because of highly glandular composition (Noor & Fischman, (2016). In the
way of granular tissue, anterior lobe has little and is seldom enlarged. The earliest microscopic
signs of Benign prosthetic hyperplasia initiate between 30 and 50 years of age in PUG, that is
posterior to proximal urethra. In the disease, majority of growth happens in transition zone of
prostate. Apart from these two areas, peripheral zone is also included to less extent. In peripheral
zone, prostatic cancer occurs. However, benign prostatic hyperplasia nodules from transition
zone are biopsied anyway to rule cancer in transition zone. Benign prostatic hyperplasia can lead
to exceptional enlargement in rare instances. In some males, this enlargement exceeds from 200
to 500 grams which called giant prostatic hyperplasia. The enlargement of prostatic rely on
potent androgen dihydrotestosterone. Type II 5 Alpha reductase in prostate gland metabolizes
circulating testosterone into dihydrotestosterone which not work systematically, but locally.
Dihydrotestosterone bind the receptors of androgen in cell nuclei, which potentially resulting in
Benign prostatic hyperplasia (Benign Prostatic Hyperplasia (BPH), 2019).
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2. Describe clinical manifestations of benign prostate hyperplasia (BPH)
The clinical manifestations of benign prostate hyperplasia are caused through external
compression of prostatic urethra which leads to impaired voiding. The long developing inability
to fully empty the bladder might cause distension in bladder with hypertrophy as well as
instability of detrusor muscle. The patients with benign prostate hyperplasia present with
hematuria. Due to severity, the causes and symptoms doesn't correlate with extent of hyperplasia
as well as other symptoms can leads to similar symptoms (Siemińska, and et. al., (2018). Its
prevalence increases with age. It is considered as normal condition and the men who above 80
years have symptoms of benign prostate hyperplasia. Though, the exact cause of disease is
unknown, alterations in male sex hormones which come with aging might be a factor. Any
abnormalities with testicles and family history of prostate may raise BHP risk. Initially, the
symptoms of benign prostate hyperplasia are very mild, but if they are not treated on time, they
become more serious. The signs and symptoms of benign prostate hyperplasia includes weak
urinary stream, painful urination, incomplete bladder emptying, dribbling at the end of urinary
stream, nocturia, blood in urine, sudden urge to urinate, delayed or slowed urinary stream and
leakage of urine or incontinence. It gets worse with the age and lead to bladder infection and
damage in more severe cases. All the causes of disease are not clear, but hormones from testis
might be a key factor (Silva‐Ramos, Silva, Oliveira, & Correia‐de‐Sá, (2016).
3. Emilio has made the decision to have a transurethral resection of the prostate (TURP). What
is this procedure?
Transurethral resection of prostate is a kind of surgery which is performed to treat urinary
issues which are caused through an enlarged prostate. Resectoscope is an instrument which is
inserted by tip of penis into tube which carries urine from bladder. This instrument assist doctor
to see and trim away enlarged or excess prostate tissue which is blocking the flow of urine. The
individual who have moderate to severe urinary issues and have not responded to medicines are
undergo transurethral resection of prostate surgery. After the trim of tissue, irrigating fluids
carries them in bladder. They are removed in the end of surgery (Transurethral resection of the
prostate (TURP), 2020). After the procedure takes place, a urinary catheter is inserted in place
due to swelling which block the flow of urine. It is left in place for around 24 to 48 hours or until
the swelling decreases. It makes Emilio able to urinate on his own.
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4. Is benign prostate hyperplasia (BPH) considered a normal process that occurs with ageing?
Why/Why not?
Yes, benign prostate hyperplasia is considered as a normal process that occurs with ageing.
As prostate expand, the urethra can block and make it difficult to urinate. It can initiate to press
up in opposition to the bladder which makes an individual feel that he or she have to urinate. It
can cause uncomfortable symptoms associated with urinary system like ok blocking flow of
urine. It can also cause urinary tract, bladder or kidney issues. The enlargement of prostate may
weaken the bladder due to which individual may unable to empty fully which cause leaving
some urine in urethra (Zabaiou, Mabed, Lobaccaro, & Lahouel, (2016). Narrowing of bladder
and urinary retention - unable to empty the urethra fully - causes issues associated with benign
prostate hyperplasia. In case of Emilio, he is a 79-year-old man and in ageing people BPH is
considered as normal process. So, the symptoms of frequent urination and delayed or slowed
urinary stream clearly depicts that he has benign prostate hyperplasia and is very common
according to his age.
CONCLUSION
As per the above mentioned report, it has been concluded that benign prostatic hyperplasia is
a condition which is very common with ageing. Family history and alterations in male sex
hormones may be the key factor due to which it causes.
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REFERENCES
Books and Journals
de Assis, A. M., and et. al., (2019). Effects of prostatic artery embolization on the dynamic
component of benign prostate hyperplasia as assessed by ultrasound elastography: a pilot
series. Cardiovascular and interventional radiology, 42(7), 1001-1007.
Noor, A., & Fischman, A. M. (2016). Prostate artery embolization as a new treatment for benign
prostate hyperplasia: contemporary status in 2016. Current urology reports, 17(7), 51.
Siemińska, L., and et. al., (2018). Serum concentrations of adipokines in men with prostate
cancer and benign prostate hyperplasia. Endokrynologia Polska, 69(2), 120-127.
Silva‐Ramos, M., Silva, I., Oliveira, J. C., & Correia‐de‐Sá, P. (2016). Increased urinary
adenosine triphosphate in patients with bladder outlet obstruction due to benign prostate
hyperplasia. The Prostate, 76(15), 1353-1363.
Zabaiou, N., Mabed, D., Lobaccaro, J. M., & Lahouel, M. (2016). Oxidative stress in benign
prostate hyperplasia. Andrologia, 48(1), 69-73.
Online
Benign Prostatic Hyperplasia (BPH), 2019. [Online]. Available through:
<https://emedicine.medscape.com/article/437359-overview>
Transurethral resection of the prostate (TURP), 2020. [Online]. Available through:
<https://www.mayoclinic.org/tests-procedures/turp/about/pac-20384880>
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