1、.1The Prostate and Benign Prostatic Hyperplasia.2Accessory Sex Glands Prostate Seminal vesicles Cowpers glands.3We Will Consider The structure of the prostate and its role in continence The mechanism of ejaculation and the role of the prostatic innervation The role of the secretory products of the p
2、rostate in the prostatic fluid.4The Structure of the ProstateMcNeals Hypothesis Transitional zone the site of origin of BPH Central zone Wolffian duct origin cf vasa and seminal vesicles Peripheral zone the site of origin of 75%of cancers Anterior fibromuscular stroma.5.6Origin Peripheral and centra
3、l zones -UG sinus DHT Central zone Wolffian ducts Testosterone.7Origin of Circulating Testosterone.8Testosterone Uptake.9Development of the Prostate DHT formed mainly in epithelial cells DHT diffuses to stroma(most of the androgen receptors)Stromal nuclei produce growth factors Growth factors drive
4、epithelial cellsStromal epithelial interaction.10Summary.11Growth FactorsNormallybFGFEGFTGF 20%TGF inhibitory80%stimulatory.12The Pre-prostatic Sphincter.13Prostatic Innervation Classical adrenergic cholinergic NANC 5-HT Dopamine-hydroxylase VIP NPY Leu-encephalin Met-encephalin CGRP Sustance P.14Al
5、pha Adrenergic Innervation-adrenergic receptors 98%in stroma alpha-1 90%alpha-2 10%alpha 1a 60%.15Innervation Cholinergic -epithelial secretion Adrenergic -smooth muscle contraction Neuroendocrine cells -serotonin calcitonin TSH somatostatin -regulation of secretion,cell growth NANC -?.16Bladder Nec
6、k v Preprostatic SphincterBladder NeckBoth sexesAt bladder neckCholinergic innervationContinence mechanismPreprostatic sphincterMalesSupraverumontanalAdrenergic innervationGenital sphincter.17Ejaculation-Mechanism Spermatozoa and prostatic fluid,then seminal vesicle fluid=Emission Antegrade despite
7、competent urethral mechanism Voiding difficult with an erection and immediately after ejaculation.18Bladder Neck Tightens U/S.19Urethral Pressure Profile.20Ejaculation Sequence Bladder neck tightens Emission of vasal ampullary sperm Contraction of bulbospongiosus Contraction of prostatic smooth musc
8、le Urethral sphincter mechanism overcome Further contraction of prostate and seminal vesicle contraction.21Seminal Plasma2ml seminal vesicle secretion0.5ml prostatic secretion0.1ml Cowper,s glands and glands of Littr.22Role of Seminal PlasmaOptimise fertilisation(ejaculated sperm v aspirated sperm)p
9、rotective effect enhance motility and survival directlyProtective effect on urinary tract biological esp.Zn,spermine,Ig mechanical washingLubrication.23Prostatic SecretionProteinsAcid phosphatasePSALeucine aminopeptidaseDiamine oxidase GlucuronidasePlasminogen activatorComplement C3 and C4Transferri
10、n,transferritinGrowth factorsAnnexin 1Non proteinsCitrateSpermineSpermidinePutrescineZincMyoinositolCholesterol.24Functions Zinc-4 structure of sperm chromatin PSA semen liquefaction Otherwise?.25Non-ProteinsCitrate 240-1300 times concentration elsewhereZincPolyaminesExist as a complex to maintain e
11、lectrochemical neutralityalso in uniquely high concentrations.26Benign Prostatic Hyperplasia.27BPH-MisconceptionsGeneralised disease of the prostate due to hormonal derangement which leads to enlargement of the gland which causes compression of the urethra leading to symptoms.28Aetiology Age Functio
12、ning testes Prostate normal to begin withPossibly a series of genetic hits which,with further hits,will lead to cancer.29Other Factors Racial -american blacks v orientals Dietary-yellow vegetables,western diet.30PathogenesisAndrogens -permissiveStromal epithelial interaction normal 2:1,BPH 3 or 4:1
13、major change is connective tissue.31.32Stromal-Epithelial Ratio in BPHEpithelium 25%+/-Stroma 75%+/-connective tissue 50%+/-smooth muscle 25%+/-.33Pathogenesis-2Micronodules:transition zone laterallymicronodules in periurethral zone posteriorly.34.35Pathogenesis-3Transition zone enlarges laterally o
14、n each sidestroma and epitheliumPeriurethral zone enlarges posteriorlystroma onlyfiroblasts transforming to smooth muscle cellsembryonic reawakening.36HistologyPosteriorLateral.37Androgens and BPH Permissive in vivo and in vitro Growth factors are just as important.38Growth Factors and the ProstateN
15、ormal bFGF EGF stimulatory TGF TGF -inhibitory.39Growth Factors and the ProstateBPH bFGF stromal autocrine stimulatory KGF stromal paracrine stimulatory TGF1 stromal autocrine/paracrine inhibitory TGF2 epithelial autocrine/paracrine inhibitory IGF stromal paracrine stimulatory.40Growth Factors and t
16、he Prostate?TGF upregulated by declining serum testosterone which then secondarily affects other growth factors?lifelong ejaculation/voiding affecting the bend.41AgeingBPHDetrusor instabilityImpaired detrusor contractile efficiency.42Symptomatic BPH BPH alone BPH plus detrusor instability BPH plus i
17、mpaired detrusor contractility BPH plus DI plus IDC IDC without BPH in the elderly IDC plus DI without BPH in the elderly.43Urodynamic Aspects of BPH age related decline in urinary flow rate age related increase in detrusor instability outflow obstruction.44Outflow Obstruction Obstruction is a pressure-flow phenomenon Pressure is the primary determinant.45QuestionsWhat are the symptoms of BPH alone?How does BPH cause obstruction?Does the obstructed bladder decompensate?What is the cause of acute retention?
