BPH & ED Pathophys I Fall 2012 STUDENT (1)

Dht responsible for growth of prostate affinity for

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DHT responsible for growth of prostate ↑ affinity for androgen receptors compared to testosterone within the prostate Estrogen sensitizes prostate tissue to testosterone Stimulates the stromal region of the prostate See BPH despite declining testicular output of testosterone True “hyperplasia” 5 α -reductase
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Clinical Presentation of BPH Static factors: Anatomic enlargement of the prostate Blocks bladder neck and results in urinary outflow obstruction Dynamic factors: Excessive α-adrenergic tone results in Contraction of the prostate around urethra Urethral lumen narrowing
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Clinical Presentation of BPH Both static and dynamic factors lead to partial or complete obstruction of the urethra Symptoms may vary over time Obstructive symptoms Urinary hesitancy Urinary straining Weak urinary stream Post-void dribbling Constant feeling of bladder fullness Overdistention of the bladder Overflow incontinence
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Clinical Presentation of BPH Irritative symptoms: result of prolonged obstruction Urinary frequency Urinary urgency Nocturia
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Complications of BPH Overflow incontinence Urinary tract infections Destruction of the bladder wall Hypertrophy of bladder wall Diverticula Hydroureter Hydronephrosis Renal failure
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Diagnosis of BPH Symptoms Most important factor Nocturia, incomplete emptying, weak stream American Urological Association (AUA)
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