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Benign prostatic hyperplasia
Benign prostatic hyperplasia is a common disease of older men. Many men from the age of 30 to 40 students that have benign prostatic histological disease, but most of the gradual emergence from 50 years before the symptoms of benign prostatic hyperplasia. Cause of benign prostatic hyperplasia is not yet clear, the "doctrine of DHT", "Wake embryonic theory" and "dry cytology" and many other theories. BPH originated in the prostate transition zone and periurethral glands, a stromal hyperplasia, muscle hyperplasia, fibromuscular hyperplasia, fibroadenoma hyperplasia, adenomatous hyperplasia of muscle fibers in five different types. The disease belongs to Chinese medicine, "Dysuria", "urine", "pouring license" category.
Pathogenesis pathology
Also known as benign prostatic hyperplasia, prostatic hyperplasia, occurred in the 50 years of age or older, according to statistics in some countries in Europe and America, in the older men in the incidence rate of up to 80%. China reports lower. Human prostate growth after birth is very slow, growth accelerated after puberty to middle age the volume remains constant, B-bile gland about the report in the forefront 4cm 3cm 2cm in size. After the show two trends: some people tend to shrink, the gland decreased, while others tend to hyperplasia, the gland is gradually increasing. When a certain degree of prostatic hyperplasia, urethral pressure, causing difficulty in urination and a series of sym


ptoms, the medical condition known as benign prostatic hyperplasia.
First performance of BPH within the prostate gland adenomatous hyperplasia, usually more than 50 years of age or older will happen, but not necessarily caused by urinary symptoms. Because prostate bladder outlet just around the special position of the urethra, and if adenomatous hyperplasia of the prostate increases, proliferation to a certain extent, it will all aspects of oppression from around the urethra, the urine within the bladder obstruction, causing urinary system, a series of lesions. The most common symptoms of nighttime urinary frequency, dysuria. Near the bladder and prostate are affected first. Blocked the urine, bladder must be greater beam strength can be recalled through the narrowed urethra Fen, but patients have begun to frequent urination, urgency, especially the nocturnal increase in symptoms. With the continued proliferation of the prostate, the urethra is more narrow, the strength of the bladder wall has been completely excreted in urine can not be, not only will the bladder residual urine, but also weaknesses in the bladder wall protruding to form a medicine called "diverticulitis" in lesions. Further development of benign prostatic hyperplasia, bladder wall, more expansion, thinning, weakness, enuresis occurs in patients with symptoms at this time, medically known as filling urinary incontinence.
Some people think that the incidence of benign prostatic hyperplasia with the environment and diet and other factors. High degree of industrialization, high standard of living, animal protein intake and more countries or regions have high incidence of the green. In addition, from the professional point of , the incidence of mental higher than manual workers. However, the etiology of benign prostatic hyperplasia are not understood yet, there are several theories that deserves attention: As we all know, the male hormone is benign prostatic hyperplasia indispensable condition, eunuchs and castration dog prostatic hyperplasia does not occur. Leydig cells secrete testosterone does not play a direct role of testosterone into the prostate under normal circumstances, cells after the two metabolic pathways, "First, the role of 5 -reductase, irreversibly transformed into 5 -dihydrotestosterone, then the formation of 3 -androstane diol; followed by the role of the enzyme aromatase into 1 -**** 5 -dihydrotestosterone which (DHT) activity 2-3 times stronger than testosterone, the male is the most important hormones, with special receptor, form complexes into the nucleus, and then connected with the nuclear receptors, and chromatin binding of RNA and DNA synthesis, the formation of prostate hyperplasia positive role in promoting. With increasing age , men's estrogen levels stable or increased slightly compared with the young men, older men female and male hormone levels increase in proportion. Some scholars believe that this change in estrogen and androgen balance may be induced by activity of prostate stromal To the causes of prostate hyperplasia. Studies have shown that benign prostatic hyperplasia combined with state of estrogen to activate cell synthesis and secretion of extracellular matrix proteins in the cells surrounding the formation of a layer of dense fibrous connective tissue, the role of estrogen is a major ; in the process of benign prostatic hyperplasia, male and female hormones have a synergistic effect, which have claimed the growth of prostate stromal estrogen is a stimulant. male and female hormones change the balance of the causes of prostate hyperplasia. Since the release of estrogen stimulation of pituitary prolactin factors, prolactin can also stimulate the prostate cells to absorb and use of male hormones, studies have found that prostate growth and plasma prolactin levels in male and prostate cells are not stimulated to the receptor was positively correlated, it can be speculated that this both in benign prostatic hyperplasia the process can also have synergistic effect. but with the inhibition of prolactin failed to cross the Yao thing to reduce prostate hyperplasia, so the mechanism still needs further study. exist in the cytoplasm of prostate microsomes 5 -reductase, can be I type and type II are divided into two isozymes. people with type II enzyme-based, dog-type enzyme to I jade. studies have proven that other animals are declining, and in fact some people and dogs will naturally occurring prostatic hyperplasia. If the enzyme is defective 5 -BPH does not occur. 1972, Willson first measured by radioimmunoassay in vivo proliferation of prostate DHT (dihydrotestosterone) were 2-3 times higher than normal glands, the first in the same glands around the urethra gland hyperplasia DHT levels higher than in other regions, and made the doctrine of DHT. This doctrine, the incidence of benign prostatic hyperplasia and DHT accumulation in the gland on. features The existence of testicular benign prostatic hyperplasia of the necessary conditions for its incidence increased with age and higher. testosterone into the prostate cells after, and can not play a direct role, but by microsomes in the 5 -reductase into 5 -dihydrotestosterone testosterone (DHT) 5 -DHT activity than testosterone and strength combined with chromatin connection and thereby affecting the synthesis of RNA and DNA.
2) embryos and then wake-up theory: the initial pathological changes of prostate hyperplasia or hyperplastic nodule formation, occurs only in the prostate accounted for 5% -10% of body area, which is close to the prostate and the sphincter of the transitional zone is located inside the sphincter around the urethra area. BPH nodules is the first change in the proliferation of glandular tissue, that is to form a new branch of the original duct, long into the nearby interstitial, after further branching to form a complex framework of the new structure (ie nodules), McNeal under Wake-up theory of embryonic development that BPH is a prostate nodule formation during the growth of mesenchymal cells into embryonic development in the state of spontaneous results.
3) cells percentage change: Some people think that the prostate structure there is a strict hierarchical manner: Stem Cell - enlarged cells - the transitional cells, in which stem cells in the basal cell layer of prostate normal cell growth factor of stability, the stem cells in part may be developed into the enlarged cells, the growth of prostate cells have a positive effect, if their number is too much can cause the overall increase in the number of prostate cells, but cells in part through the action of androgen derived cells into the transition to achieve, that androgen stimulated the proliferation of all the transitional cell cloning that led to the formation of prostate hyperplasia.
4) The polypeptide growth factors: transforming growth factor is a kind of regulation of cell differentiation, growth of the peptide material, studies have shown that polypeptide growth factors can directly regulate the growth of prostate cells, but only an indirect role of sex hormones. Currently found in the prostate cell growth, but only an indirect role of sex hormones. Currently found in benign prostatic hyperplasia plays an important role during in the polypeptide growth factors, including: epidermal growth factor (EGF), transforming growth factor and (TGF -and TGF- ), fibroblast growth factor (FGF) and insulin-like growth factor-I (IGF-I), etc., of which basic fibroblast growth factor (bFGF) has been proven to promote human prostate homogenate in almost all cells in mitosis role in the pathogenesis of benign prostatic hyperplasia by increasing the status of attention. As a class of polypeptide growth factors regulates cell (including prostate cells) growth and differentiation of polypeptide growth factors to regulate cell in the pathogenesis of a class of position are more and more attention. As a class of polypeptide growth factors regulates cell (including prostate cells) growth and differentiation of the peptide substance produced by a variety of cells and has important role in the pathophysiology and treatment, currently found in benign prostatic hyperplasia peptides play a role during in growth factors are:
(1) epidermal growth factor (EGF) and Transforming Growth Factor- (TGF- ): EGF by Cohen H, Xi gland in mice was found, and its receptors are present in the prostatic epithelial cells of its bottom. EGF may act directly on prostate epithelial cells, or by adjusting the combination of testosterone and testosterone receptor binding and biological activity of the process and play a role. Prostatic hyperplasia, EGF receptor expression was significantly higher than the normal prostate, benign prostatic hyperplasia and epithelial hyperplasia mainly for basal cell hyperplasia, indicating that EGF and its receptor in benign prostatic hyperplasia have an important role in the process occurs. TGF- EGF family members, yes this one, but the genes from different s may be prostate-specific epithelial cells of the EGF receptor binding, and Bibi cultured prostate epithelial cells have significant role in promoting mitosis.
(2), fibroblast growth factor (FGF): also known as heparin-binding growth factors, including acidic fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) in which the biological activity of bFGF is aFGFR 10 -100 times, and the ability to bind to the receptor was significantly higher than the former. Lawson and other findings, bFGF promote human prostate homogenate with almost all cells in the mitotic role. Many studies have shown, bFGF and its mRNA in BPH tissue was significantly higher than normal prostate tissue. Qin prostate fibroblasts can be divided into bFGF, while bFGF can paracrine stimulation of prostate epithelial cells, many scholars believe that its role in prostate cell proliferation is direct, and dihydrotestosterone (DHT) may be through increased production and (or) secretion of growth factors play a role indirectly.
(3) transforming growth factor- (TGF- ): transforming growth factor- is a two-way regulating cell growth factor, which has growth promoting and growth inhibitory re-weight properties, may constitute growth on the growth of body cells fine adjustment. In vitro experiments show that: TGF- can inhibit prostate epithelial cells and interstitial cells, while FGF and EGF can inhibit the proliferation-promoting role, it was felt EGF / TGF- FGF / TGF- regulates the balance of prostate cells proliferation and apoptosis, the loss of balance may be the main reason for occurrence of benign prostatic hyperplasia.
(4) insulin-like growth factor-I (IGF-I): also known as growth factors C, mainly synthesized in the liver and its regulation by androgen secretion. DHT in the growth factor and bFGF synergistically together to promote prostatic epithelial cells such as proliferation, the main ways through autocrine role in prostate epithelial cells, experiments also confirmed benign prostatic hyperplasia in insulin-like growth factor-I excess in the occurrence and development of BPH may play an important role.
2 Pathology
Inside and outside the normal prostate is divided into two layers: the inner layer is around the urethra urethral gland and submucosal gland mucous membrane, outer peripheral zone, fibrous membrane between two layers separated. BPH occurs, the first in the prostate gland area under the urethral mucosa, muscle fibers have multiple centers of nodules, that matrix proliferation, and then only on a straight gland hyperplasia. Gland pathology can be divided into two kinds of nodules and matrix nodules, nodule If there is such a zone in the absence of glands, only the quality of the formation of the nodule, and then stimulate the proliferation of neighboring epithelial cells and invasive nodular hyperplasia , the formation of matrix adenoma. Hyperplasia of the prostate will be a real pressure out weeks, extruded tissue degeneration into fibrous tissue, forming hard gray pseudomembrane - surgical capsule.
(1) pathological type: Some people will be the proliferation of the composition is divided into five different types: muscle fiber hyperplasia, muscle hyperplasia, adenomatous hyperplasia of fibers, fiber muscle tumor-like hyperplasia and matrix proliferation. Stromal hyperplasia is one of the important features of benign prostatic hyperplasia.
(2) changes in structure and composition: When benign prostatic hyperplasia, interstitial proportion (about 60%) than in normal prostate (45%) was significantly increased, interstitial composition also changed the structure of smooth muscle the percentage of total area of interstitial significantly higher than normal prostate, and epithelial hyperplasia of the basal cell hypertrophy is characterized by normal basal cells into flat or low columnar cubic. Smooth muscle cells thick, dense, diffuse distributed in the stroma, abnormal nuclear morphology showed significant changes, but DNA and RNA glandular epithelial cells were increased vitality, and benign hyperplasia of prostate tissue showing the main features of the vascular component of the decline in .
(3) pathological changes associated with the symptoms: The symptoms of benign prostatic hyperplasia related to changes in the following three aspects.
1 detrusor lesions: Animal experiments show that stems Yin Fasheng after a significant change in bladder detrusor, detrusor reduce the nerve endings, that is part of the phenomenon of denervation, bladder volume increased, but the relative intensity of muscle contraction weakened, acetylcholinesterase activity was significantly reduced.
2 Prostate dynamic factors: the human prostate contains more a1-A receptor, 98% were present in the gland stroma, human prostate muscle cells stimulated by this receptor, smooth muscle contraction, tension increases, causing bladder outlet obstruction.
3 Prostate static factors: the prostate volume increases pressure on the bladder neck caused by the emergence of obstructive symptoms.
(4) pathological lesions: benign prostatic hyperplasia disease management is the root cause physiological changes channels bladder outflow obstruction, in this based on the occurrence of bladder dysfunction, urinary kht expansion on renal function damage.
Obstruction bladder outflow channel 1: benign prostatic hyperplasia induced bladder outlet obstruction first. Causes of bladder outlet obstruction caused by benign prostatic hyperplasia, including the urethra and urethral cross sectional area extending down due to mechanical obstruction; prostatic urethra, prostate and prostatic capsule tension caused by increased pumping power of the obstruction. The proliferation of prostatic tissue, hyperplasia of smooth muscle tissue significantly, a receptor is the main factor of this tension.
2 bladder dysfunction: the performance of the unstable bladder, bladder weakness and low in, and compliance bladder. About 52% -82% of the BPH bladder instability occurs. Bladder instability is caused by frequent urination, urgency, urgency urinary incontinence the main reason. Bladder detrusor muscle weakness, decreased systolic function, but also can cause difficulty urinating, poor postoperative recovery.
3 upper urinary tract dilatation, impaired renal function: a large residual urine, bladder pressure is greater than 40cm of water continued to lead to expansion of benign prostatic hyperplasia on the urinary tract are two basic reasons, according to the main pathological features of bladder divided into: hypertension chronic urinary retention "to its characteristics of low bladder compliance, intravesical pressure urine storage above the 40cm of water, upper urinary tract dilatation, postoperative functional recovery of upper urinary tract is also poor; pressure chronic urinary retention: the bladder sensation impaired, a large residual urine for its features, and more associated with bladder weakness, the reservoir of the bladder of urine down to 40cm of water. Slow progression of the disease, early may be asymptomatic. As the disease gradually increased, the lesion development accelerated, the symptoms gradually worsened.
(1) Frequent urination: usually the first symptoms the patient is, first, the increased frequency of nocturia, frequent urination during the day then. However, this symptom is not specific.
(2), voiding difficulties and urinary retention: the voiding difficulty is the most important clinical benign prostatic hyperplasia symptoms, early in the disease, showing the starting position as slow urination, urinary stream tapered, weakness, range shortened. A urine flow interruption Xianxiang, prolonged urination, such as the condition gradually worsened, the more effort urination, increased abdominal pressure required to help urination. Increased residual urine volume, urinary retention occurs. Such as bladder over-filling, the pressure is high, a small amount of urine from the urethral orifice out of their own, called filling urinary incontinence, enuresis may occur after sleeping.
(3) hematuria: can be expressed as gross hematuria or microscopic hematuria. Heavy bleeding can be condensed into a blood clot, causing acute urinary retention.
(4), urinary tract infection: may have fever, back pain, frequent urination, urgency, dysuria and other symptoms.
(5) bladder stones: incidence of bladder stones up to 10% or more.
(6) renal impairment: there may be blood pressure, anemia, loss of appetite, drowsiness, retardation and other symptoms.
2 important signs
(1) digital rectal examination: palpable in the rectal wall and hyperplasia of the prostate, smooth, medium texture, edge clear. Can be divided into three:
I degree of hyperplasia: prostate 1.5-2 times larger than normal, the central sulcus shallow, protruding into the rectum height of about 1-2cm.
II hyperplasia: prostate was moderately increased 2-3 times greater than normal, disappearance of the central sulcus or slightly prominent, convex into the rectum about 2-3cm.
III degree of hyperplasia: prostate increased significantly, the central sulcus was prominent, convex above 3cm into the rectum to check into the fingers can not touch the upper edge of the gland.
(2) abdominal mass: benign prostatic hyperplasia cause severe hydronephrosis, abdominal mass palpable on both sides, for the enlargement of the kidneys. Pigs stay with urine, in the pubic area will be touched on the cystic mass, a mass push to urinate.
(3) Long-term voiding difficulty, could occur inguinal hernia, hemorrhoids, and rectal prolapse.
3 auxiliary examination
(1) Urine examination: non-specific, visible red blood cells in urine, pus and so on.
(2) Determination of residual urine: normal bladder after voiding little or no residual urine, usually 5ml below. Patients with benign prostatic hyperplasia increased urinary obstruction, residual urine volume were increased, such as up to 50ml or more, the tips have been in detrusor decompensation. Determined by catheterization after voiding residual urine volume is more accurate, but also can be applied to determination of residual urine by abdominal ultrasound, but Wang and accurate enough.
(3) Ultrasound: a transrectal B-and B by abdominal ultrasound and other methods could be observed in prostate size, shape and structure.
(4) cystoscopy: trabeculae seen in the bladder and the pouch, the deformable bladder neck, prostate, bladder neck and lateral sides of the pressure lobular hyperplasia may be presented "human" shape, while in lobular hyperplasia, bladder neck lip was elevated, convex into the bladder.
(5), cystography: see the bottom elevation and widening of the bladder, and appears semi-circular notch.
Differential Diagnosis
1 bladder neck fibrosis (bladder neck spasms) caused by long-term chronic inflammation, in patients with longer course, and have similar symptoms with benign prostatic hyperplasia, but the younger patients, more than five years old before onset. Check enlarged prostate digital rectal examination is not obvious. Also common to the clinical bladder neck fibrosis combined with benign prostatic hyperplasia, surgical treatment must also contracture of the bladder neck and prostate enlargement, or difficult to lift the lower urinary tract obstruction.
2 Prostate Cancer prostate digital rectal examination as nodular touch, hard as stone, need to take biopsy for pathological examination to help confirm the diagnosis.
3 chronic prostatitis may have a similar history of benign prostatic hyperplasia, some patients may be combined with benign prostatic hyperplasia, digital rectal examination and imaging the urinary system is also difficult to distinguish between the two. Prostatic fluid examination may have inflammation.
4 bladder tumor near the bladder neck tumors can be clinically manifested as lower urinary tract obstruction, often hematuria. Cystoscopy can identify.Original articles, prohibited reproduced! Keywords: Benign prostatic hyperplasia Bladder Cancer Hospital, Lanzhou, Gansu prostate dysuria


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