Benign Prostatic Hyperplasia

Definition

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, leading to lower urinary tract symptoms due to bladder outlet obstruction.

Epidemiology

• Common in men over 50 years of age
• Prevalence increases with age: ~50% by age 60, ~80% by age 80
• More common in men with family history of BPH
• Rarely progresses to prostate cancer, but both can coexist
• Significant cause of urinary morbidity in aging males
• Prevalence varies geographically and ethnically
• Associated with significant impact on quality of life

Etiology

• Age-related hormonal changes: increased dihydrotestosterone (DHT) in prostate
• Androgen receptor-mediated growth of stromal and epithelial cells
• Genetic predisposition and family history
• Chronic inflammation and oxidative stress may contribute
• Lifestyle factors: obesity, metabolic syndrome, and sedentary lifestyle
• Altered balance of growth factors (FGF, TGF-β) in prostate tissue
• Interaction between epithelial and stromal components leading to hyperplasia

Pathophysiology

• Hyperplasia of prostate stromal and epithelial cells, especially in transitional zone
• Compression of urethra leading to bladder outlet obstruction
• Bladder hypertrophy due to increased work against obstruction
• Increased bladder sensitivity and detrusor overactivity
• Progressive urinary symptoms: frequency, urgency, weak stream
• Chronic obstruction may lead to urinary retention and hydronephrosis
• BPH is a progressive condition influenced by hormonal and cellular factors