Benign Prostatic Hyperplasia: Pathogenesis and Medications
Aging
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646
Description

Benign Prostatic Hyperplasia: Pathogenesis and Medications

Aging

 -> Increased Testosterone -> Testosterone metabolized into DHT by type II 5-a-reductase in prostate -> DHT binds to androgen receptor in prostate cell nuclei -> Hyperplasia of the prostate -> Prostate encapsulated by fibromuscular tissue, therefore grows inwards -> Prostatic urethral compression and bladder outlet obstruction

 -> Increased Bladder pressures -> Bladder smooth-muscle hyperplasia (detrusor thickening) -> Increased Sensitivity (i.e. overactive detrusor) -> Decreased Volume to first detrusor contractio

 -> LUTS

 - alpha-1 blockers (e.g. tamsulosin) -> Bladder and prostate smooth-muscle alpha-1 receptor antagonism Relaxation of bladder outlet and prostate smooth-muscle -> Improved urinary outflow

 - PDE-5 inhibitors (e.g. tadalafil) -> Decr PDE-5-mediated cGMP degradation in prostate smooth-muscle and associated vascular supply -> Relaxation of prostate smooth-muscle -> Improved urinary outflow

 - 5-ARIs (e.g. dutasteride) -> Decr 5-a-reductase activity -> Decr Conversion of testosterone into DHT -> Decr Progression of LUTS

 - LHRH receptor antagonists (e.g. cetrorelix) -> GnRH antagonism -> Decr LH secretion from pituitary -> Decr Testosterone secretion from testicular Leydig cells -> Decr DHT production -> Decr progression of LUTS

 - ß3-adrenergic  agonists (e.g. mirabegron)  -> Relaxation of detrusor muscle -> Incr Bladder capacity -> Improved LUTS

 - anticholinergics (e.g. oxybutynin) -> Acetylcholine antagonism at muscarinic receptors -> Relaxation of bladder outlet smooth-muscle -> Incr volume to first detrusor contraction -> Improved LUTS

 - NSAlDs -> Decr COX activity -> Decr Prostaglandin release -> Analgesia and Decreased Prostatic inflammation





#BPH #Benign #Prostatic #Hyperplasia #Prostate #Pathophysiology #Medications #Pharmacology #Urology
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The Calgary Guide to Understanding Disease
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Account created for The Calgary Guide to Understanding Disease - Linking pathophysiology to clinical presentation - http://calgaryguide.ucalgary.ca/
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