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Benign prostatic hyperplasia, BPH (mechanism of disease)

This is a flowchart on benign prostatic hyperplasia, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Hormonal factors: Irritative symptoms: Risk factors / SDOH Cell / tissue damage Structural factors Benign prostatic hyperplasia Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Neoplasm / hyperplasia Genetic / hereditary Flow physiology Pathophysiology Etiology Manifestations Slit-like prostatic urethral compression Glandular and stromal hyperplasia in the transition zone (middle) of the prostate Formation of smooth, elastic, firm hyperplastic nodule Bladder outlet obstruction In contrast, outer peripheral zone → prostate cancer Involuntary detrusor contractions during bladder filling → detrusor overactivity Bladder wall weakening Incomplete voiding Urinary stasis Urinary retention Urinary tract infections Bladder stones ↑ intracystic pressure while voiding Detrusor muscle hypertrophy Bladder trabeculation Bladder mucosa protrude through the layers of the bladder wall Pseudodiverticula formation Urinary frequency Urgency, urge incontinence Nocturia Occasional dysuria Hesitancy (delayed onset) Straining to urinate Prolonged terminal dribbling Poor and/or intermittent stream (not continuous) Obstructive symptoms: Incomplete voiding sensation Acute urinary retention Digital rectal examination: symmetrically enlarged, smooth (no nodules), firm, nontender prostate with rubbery or elastic texture In contrast, if DRE shows: Nodules, hard consistency → prostate cancer Tenderness on palpation → prostatitis Dihydrotestosterone is potent prostatic growth factor (converted from testosterone by 5-α-reductase) Estrogen (estradiol) stimulates prostatic hyperplasia (formed from aromatization of testosterone in fat, hence ↑ in obesity) Gene amplification of androgen receptors Genetic susceptibility: Growth factor genes Androgen-regulator genes Apoptosis genes Androgen-regulated genes Stem cells in prostatic stroma: ↓ apoptotic factors ↑ antiapoptotic factors Longer stem cell lifespan