良性前列腺增生英文课件

TheProstateandBenignProstaticHyperplasia,AccessorySexGlands,ProstateSeminalvesiclesCowpersglands,WeWillConsider,ThestructureoftheprostateanditsroleincontinenceThemechanismofejaculationandtheroleoftheprostaticinnervationTheroleofthesecretoryproductsoftheprostateintheprostaticfluid,TheStructureoftheProstate,McNealsHypothesisTransitionalzonethesiteoforiginofBPHCentralzoneWolffianductorigincfvasaandseminalvesiclesPeripheralzonethesiteoforiginof75%ofcancersAnteriorfibromuscularstroma,Origin,Peripheralandcentralzones-UGsinusDHTCentralzoneWolffianductsTestosterone,OriginofCirculatingTestosterone,TestosteroneUptake,DevelopmentoftheProstate,DHTformedmainlyinepithelialcellsDHTdiffusestostroma(mostoftheandrogenreceptors)StromalnucleiproducegrowthfactorsGrowthfactorsdriveepithelialcellsStromalepithelialinteraction,Summary,GrowthFactors,NormallybFGFEGFTGF20%TGFinhibitory,80%,stimulatory,ThePre-prostaticSphincter,ProstaticInnervation,Classicaladrenergiccholinergic,NANC5-HTDopamine-hydroxylaseVIPNPYLeu-encephalinMet-encephalinCGRPSustanceP,AlphaAdrenergicInnervation,-adrenergicreceptors98%instromaalpha-190%alpha-210%alpha1a60%,Innervation,Cholinergic-epithelialsecretionAdrenergic-smoothmusclecontractionNeuroendocrinecells-serotonincalcitoninTSHsomatostatin-regulationofsecretion,cellgrowthNANC-?,BladderNeckvPreprostaticSphincter,BladderNeckBothsexesAtbladderneckCholinergicinnervationContinencemechanism,PreprostaticsphincterMalesSupraverumontanalAdrenergicinnervationGenitalsphincter,Ejaculation-Mechanism,Spermatozoaandprostaticfluid,thenseminalvesiclefluid=EmissionAntegradedespitecompetenturethralmechanismVoidingdifficultwithanerectionandimmediatelyafterejaculation,BladderNeckTightensU/S,UrethralPressureProfile,EjaculationSequence,BladdernecktightensEmissionofvasalampullaryspermContractionofbulbospongiosusContractionofprostaticsmoothmuscleUrethralsphinctermechanismovercomeFurthercontractionofprostateandseminalvesiclecontraction,SeminalPlasma,2mlseminalvesiclesecretion0.5mlprostaticsecretion0.1mlCowper,sglandsandglandsofLittr,RoleofSeminalPlasma,Optimisefertilisation(ejaculatedspermvaspiratedsperm)protectiveeffectenhancemotilityandsurvivaldirectlyProtectiveeffectonurinarytractbiologicalesp.Zn,spermine,IgmechanicalwashingLubrication,ProstaticSecretion,ProteinsAcidphosphatasePSALeucineaminopeptidaseDiamineoxidaseGlucuronidasePlasminogenactivatorComplementC3andC4Transferrin,transferritinGrowthfactorsAnnexin1,NonproteinsCitrateSpermineSpermidinePutrescineZincMyoinositolCholesterol,Functions,Zinc-4structureofspermchromatinPSAsemenliquefactionOtherwise?,Non-Proteins,Citrate240-1300timesconcentrationelsewhereZincPolyaminesExistasacomplextomaintainelectrochemicalneutrality,alsoinuniquelyhighconcentrations,BenignProstaticHyperplasia,BPH-Misconceptions,Generaliseddiseaseoftheprostateduetohormonalderangementwhichleadstoenlargementoftheglandwhichcausescompressionoftheurethraleadingtosymptoms,Aetiology,AgeFunctioningtestesProstatenormaltobeginwithPossiblyaseriesofgenetichitswhich,withfurtherhits,willleadtocancer,OtherFactors,Racial-americanblacksvorientalsDietary-yellowvegetables,westerndiet,Pathogenesis,Androgens-permissiveStromalepithelialinteractionnormal2:1,BPH3or4:1majorchangeisconnectivetissue,Stromal-EpithelialRatioinBPH,Epithelium25%+/-Stroma75%+/-connectivetissue50%+/-smoothmuscle25%+/-,Pathogenesis-2,Micronodules:transitionzonelaterallymicronodulesinperiurethralzoneposteriorly,Pathogenesis-3,TransitionzoneenlargeslaterallyoneachsidestromaandepitheliumPeriurethralzoneenlargesposteriorlystromaonlyfiroblaststransformingtosmoothmusclecellsembryonicreawakening,Histology,Posterior,Lateral,AndrogensandBPH,PermissiveinvivoandinvitroGrowthfactorsarejustasimportant,GrowthFactorsandtheProstate,NormalbFGFEGFstimulatoryTGFTGF-inhibitory,GrowthFactorsandtheProstate,BPHbFGFstromalautocrinestimulatoryKGFstromalparacrinestimulatoryTGF1stromalautocrine/paracrineinhibitoryTGF2epithelialautocrine/paracrineinhibitoryIGFstromalparacrinestimulatory,GrowthFactorsandtheProstate,?TGFupregulatedbydecliningserumtestosteronewhichthensecondarilyaffectsothergrowthfactors?lifelongejaculation/voidingaffectingthebend,Ageing,BPHDetrusorinstabilityImpaireddetrusorcontractileefficiency,SymptomaticBPH,BPHaloneBPHplusdetrusorinstabilityBPHplusimpaireddetrusorcontractilityBPHplusDIplusIDCIDCwithoutBPHintheelderlyIDCplusDIwithoutBPHintheelderly,UrodynamicAspectsofBPH,agerelateddeclineinurinaryflowrateagerelatedincreaseindetrusorinstabilityoutflow