Benign prostate hypertrophy (BPH) is also known as prostate gland enlargement. This pathologic (non-cancerous) condition mostly affects men with age and provokes lower urinary tract symptoms. People with BPH usually experience pain related to blocked flows of urine out of the bladder. With time, kidney problems may emerge if the condition is poorly managed or remains untreated for some period. About 50% of men aged between 50 and 60 report BPH symptoms from time to time (as cited in Lee et al., 2021). Despite thorough attention being paid to this disease, BPH etiology is poorly explained, addressing aging as the only reasonable risk factor.
Phua (2021) recommends evaluating interdisciplinary evidence from cell biology, evolutionary biology, and inflammatory progressions. Still, it is unclear what research aspect is more effective in understanding the chosen topic. There is no specific cure for this disease, and doctors develop multiple approaches and therapies to mitigate health complications and help patients (Lee et al., 2021). BPH pathophysiology genesis mechanisms are complex and unknown, and the aim of this paper is to analyze normal and pathophysiological conditions to share some preventing and treatment recommendations.
Description of Pathology
BPH is characterized by the growth of prostate tissue that affects the urethra and the bladder and blocks the urine flow. The major symptoms of this disease depend on its severity, but patients report their frequent need to urinate, especially at night, difficulty to start urination, and weak urine streams (Lokeshwar et al., 2019). In addition to BPH prevalence due to increased age, a genetic component plays an important role as more than 50% of patients undergoing surgery for BPH have a heritable form from male relatives (Lim, 2017). The pathology is also related to lifestyle factors like diet (macronutrients that increase total energy intake), physical activity (a sedentary lifestyle increases risks for the disease), and alcohol taking (35% decreased likelihood) (Lim, 2017). There are several metabolic conditions that contribute to the growth of BPH risks. For example, obese men have a high amount of adiposity and a greater prostate volume (Lim, 2017). Common pathological processes are observed in men with type 2 diabetes, erectile dysfunction, and depression (Phua, 2021). Inflammatory markers cannot be ignored in describing the chosen pathology.
Normal Anatomy of the Major Body System Effected
The male reproductive system consists of several internal and outside organs. The penis, testes, epididymis, and scrotum are located outside, and the prostate, urethra, vas deferens, and seminal vesicle are inside. The penis has the root (attached to the abdomen’s wall), the body (a tube with three chambers), and the glands (a cone-shape end with a skin lawyer). The scrotum is a sack behind the penis with two testicles and many blood vessels (Knoblaugh et al., 2018). The epididymis is a tube backside of each teste. Internal organs also play an important role in the male reproductive system anatomy. The prostate gland looks like a nut and is below the bladder (Knoblaugh et al., 2018). The urethra is a tube that passes through the prostate and in which the prostate gland and the ejaculatory ducts drain (Knoblaugh et al., 2018). The vas deferens is another tube behind the bladder that connects the epididymis and the pelvic cavity. Each part of the system is critical, but its functions may worsen with time.
Normal Physiology of the Major Body System Effected
Both internal and external organs help men urinate, have sexual intercourse, and make children. They produce, maintain, and discharge sperm and sex hormones, but the complexity of these processes may be discussed through the analysis of each element in the system. The penis makes it possible to urinate and initiate sexual intercourse (Knoblaugh et al., 2018). There are blood vessels and spongy tissue in the penis, and brain impulses together with local nerves help the corpora cavernosa to relax and fill in open spaces with blood, which provokes an erection. The urine flow from the urethra is blocked, and semen is ejaculated. The scrotum walls are full of muscles that protect and manage the climate of the testes, which, in their turn, reproduce testosterone and produce sperm through seminiferous tubules (Knoblaugh et al., 2018). The prostate gland is responsible for producing the fluid that transports and nourishes sperm (Knoblaugh et al., 2018). Its muscles support the semen in pressing the urethra and expelling it.
Mechanism of Pathophysiology
Androgens, estrogens, and growth factors play an important role in defining the major pathological processes of BPH. This pathology emerges in the periurethral and transition zones of the prostate that may enlarge with age. There are also two separate glands that change their form independently from the nodules’ development (Phua, 2021). The prostatic capsule transmits the pressure of urethra tissue and increases urethral resistance, which provokes BPH clinical symptoms. The prostate is stimulated through its maintenance and secretory functions and the presence of hormones (Madersbacher et al., 2019).
Some researchers underline the lack of logical reasoning of the relationship between aging and increased testosterone levels (Lokeshwar et al., 2019). However, estrogen allows prostatic hyperplasia to grow and affect androgen levels. Androgen receptors are present in the benign epithelium, and their action may be enhanced by other receptors like dihydrotestosterone, which is under control of the 5α-reductase enzyme (Madersbacher et al., 2019). Dihydrotestosterone is synthesized from testosterone and regulates the expression of growth-promoting genes.
In addition, new studies and ideas are developed to find new factors that explain the progress of BPH in men. For example, Phua (2021) introduces the aging triad, consisting of testosterone, vascular, and inflamm. Testosterone aims at improving libido and increasing bone mass, and its deficiency leads to endothelial dysfunction (Phua, 2021). The vascular system is damaged with aging and promotes oxidative stress and prostatic hyperplasia carcinogenesis. Inflammation is also a significant component of negative processes that results in BPH. If individuals are castrated before the age of puberty, they predict the risk of BPH while aging and reduce the role of testosterone in enlarging the prostate (Madersbacher et al., 2019). Due to all these factors, the stromal and epithelial elements arise, and hyperplasia enlarges the prostate and restricts vital flows.
Considering the pathophysiological characteristics of BPH, it is possible to predict the development of this condition by following simple rules and recommendations. According to Madersbacher et al. (2019), religion, socioeconomic factors, sexual activity, and negative habits may affect male health. Body weight is positively associated with prostate volume in men of any age (Lim, 2017). Thus, increased physical activities, vegetable consumption, and the improvement of alcohol/smoking refusal skills can be effective in predicting BPH. Sometimes, people have to delay their urination because of personal or organizational reasons, which also contributes to prostate enlargement. Avoidance of delaying urination and harmful medications that worsen symptoms is preferred in the chosen prevention strategy. Healthy dietary habits allow managing and improving the male reproductive system and preventing BPH to a certain extent. Lim (2017) found out that red meat, fat, milk, bread, and poultry increase the risks of the disease, while vegetables, fruits, and polyunsaturated fatty acids decrease these risks. Improved diets turn out to be a solid contribution to male health.
Unless it is impossible to prevent BPH because of personal or genetic reasons, several treatment options are always available to patients, depending on the severity of the condition and the desired outcomes. Digital rectal examination, blood tests, urine tests, ultrasound, and biopsy are common diagnostic approaches (Lim, 2017). If symptoms are mild, no treatment is possible to give some time to mitigate complications. When patients experience pain or discomfort, medications like alpha-blockers, 5-alpha-reductase-inhibitors, and muscarinic receptor antagonists are prescribed (Miernik & Gratzke, 2020). These drugs focus on facilitating urination, preventing hormonal changes, and managing prostate growth. Transurethral resection of the prostate is an effective surgical intervention, the gold standard for treating BPH when a surgeon removes an outer part of the prostate and facilitates the urine flow (Lee t al., 2021). Laser therapy is highly promoted to mitigate BPH symptoms, but prices remain high, and not all patients can allow this option in their care plan.
BPH is a serious male health problem that emerges with time. Some individuals try to prevent this condition and follow healthy lifestyles, diets, and physical exercises. However, BPH can be a genetic disease when preventing interventions are no longer effective or produce minimal changes. Thus, the evaluation of BPH pathophysiology is required to understand what medication or other therapeutic interventions may be offered to patients. Although there is no definite cure to treat BPH, people get access to medications that manage symptoms and reduce pain and discomfort. It is recommended to continue research of the male reproduction system to ensure that aging is not associated with BPH and other male problems.
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