良性前列腺增生英文课件

The Prostate and Benign Prostatic Hyperplasia,Accessory Sex Glands,ProstateSeminal vesiclesCowpers glands,We Will Consider,The structure of the prostate and its role in continenceThe mechanism of ejaculation and the role of the prostatic innervationThe role of the secretory products of the prostate in the prostatic fluid,The Structure of the Prostate,McNeals HypothesisTransitional zone the site of origin of BPHCentral zone Wolffian duct origin cf vasa and seminal vesiclesPeripheral zone the site of origin of 75% of cancersAnterior fibromuscular stroma,Origin,Peripheral and central zones - UG sinus DHTCentral zone Wolffian ducts Testosterone,Origin of Circulating Testosterone,Testosterone Uptake,Development of the Prostate,DHT formed mainly in epithelial cellsDHT diffuses to stroma (most of the androgen receptors)Stromal nuclei produce growth factorsGrowth factors drive epithelial cellsStromal epithelial interaction,Summary,Growth Factors,NormallybFGFEGFTGF 20%TGF inhibitory,80%,stimulatory,The Pre-prostatic Sphincter,Prostatic Innervation,Classicaladrenergiccholinergic,NANC5-HTDopamine-hydroxylaseVIPNPYLeu-encephalinMet-encephalinCGRPSustance P,Alpha Adrenergic Innervation,-adrenergic receptors 98% in stromaalpha-1 90%alpha-2 10%alpha 1a 60%,Innervation,Cholinergic - epithelial secretionAdrenergic - smooth muscle contractionNeuroendocrine cells - serotonin calcitonin TSH somatostatin - regulation of secretion, cell growthNANC - ?,Bladder Neck v Preprostatic Sphincter,Bladder NeckBoth sexesAt bladder neckCholinergic innervationContinence mechanism,Preprostatic sphincterMalesSupraverumontanalAdrenergic innervationGenital sphincter,Ejaculation - Mechanism,Spermatozoa and prostatic fluid, then seminal vesicle fluid = EmissionAntegrade despite competent urethral mechanismVoiding difficult with an erection and immediately after ejaculation,Bladder Neck Tightens U/S,Urethral Pressure Profile,Ejaculation Sequence,Bladder neck tightensEmission of vasal ampullary spermContraction of bulbospongiosusContraction of prostatic smooth muscleUrethral sphincter mechanism overcomeFurther contraction of prostate and seminal vesicle contraction,Seminal Plasma,2ml seminal vesicle secretion0.5ml prostatic secretion0.1ml Cowper,s glands and glands of Littr,Role of Seminal Plasma,Optimise fertilisation(ejaculated sperm v aspirated sperm)protective effectenhance motility and survival directlyProtective effect on urinary tractbiological esp. Zn, spermine, Igmechanical washingLubrication,Prostatic Secretion,ProteinsAcid phosphatasePSALeucine aminopeptidaseDiamine oxidase GlucuronidasePlasminogen activatorComplement C3 and C4Transferrin, transferritinGrowth factorsAnnexin 1,Non proteinsCitrateSpermineSpermidinePutrescineZincMyoinositolCholesterol,Functions,Zinc - 4 structure of sperm chromatinPSA semen liquefactionOtherwise?,Non-Proteins,Citrate 240-1300 times concentration elsewhereZincPolyaminesExist as a complex to maintain electrochemical neutrality,also in uniquely high concentrations,Benign Prostatic Hyperplasia,BPH - Misconceptions,Generalised disease of the prostate due to hormonal derangement which leads to enlargement of the gland which causes compression of the urethra leading to symptoms,Aetiology,AgeFunctioning testesProstate normal to begin withPossibly a series of genetic hits which, with further hits, will lead to cancer,Other Factors,Racial - american blacks v orientalsDietary - yellow vegetables, western diet,Pathogenesis,Androgens - permissiveStromal epithelial interactionnormal 2:1, BPH 3 or 4:1major change is connective tissue,Stromal-Epithelial Ratio in BPH,Epithelium 25%+/-Stroma 75%+/- - connective tissue 50%+/- - smooth muscle 25%+/-,Pathogenesis - 2,Micronodules:transition zone laterallymicronodules in periurethral zone posteriorly,Pathogenesis - 3,Transition zone enlarges laterally on each sidestroma and epitheliumPeriurethral zone enlarges posteriorlystroma onlyfiroblasts transforming to smooth muscle cellsembryonic reawakening,Histology,Posterior,Lateral,Androgens and BPH,Permissive in vivo and in vitroGrowth factors are just as important,Growth Factors and the Prostate,Normal bFGF EGF stimulatory TGF TGF - inhibitory,Growth Factors and the Prostate,BPH bFGF stromal autocrine stimulatory KGF stromal paracrine stimulatory TGF1 stromal autocrine/paracrine inhibitory TGF2 epithelial autocrine/paracrine inhibitory IGF stromal paracrine stimulatory,Growth Factors and the Prostate,?TGF upregulated by declining serum testosterone which then secondarily affects other growth factors?lifelong ejaculation/voiding affecting the bend,Ageing,BPHDetrusor instabilityImpaired detrusor contractile efficiency,Symptomatic BPH,BPH aloneBPH plus detrusor instabilityBPH plus impaired detrusor contractilityBPH plus DI plus IDCIDC without BPH in the elderlyIDC plus DI without BPH in the elderly,Urodynamic Aspects of BPH,age related decline in urinary flow rateage related increase in detrusor instabilityoutflow ob