蒲军《泌尿外科学》2.4前列腺增生英文预习资料.docVIP

BENIGH PROSTATIC HYPERPLASIA (BPH) ——《Smith’S General Urology》，the 15th edition INCIDENCE AND EPIDEMIOLOGY BPH is the most common benign tumor in men, and its incidence is age-related, The prevalence of histologic BPH in autopsy studies rises from approximately 20% in men aged 41-50,to 50% in men aged 51-60, and to over 90% in men older than 80 .Although clinical evidence of disease occurs less commonly, symptoms of prostatic obstruction are also age –related. At age 55,approximately 25% of men report obstructive voiding symptoms. At age 75,50% of men complain of a decrease in the force and caliber of their urinary stream. Risk factors for the development of BPH are poorly understood. Some studies have suggested a genetic predisposition, and some have notes racial differences. Approximately 50% of men under the age of 60 who undergo surgery for BPH may have a heritable form of the disease. This form is most likely an autosomal dominant trait, and first-degree male relatives of such patients carry an increased relative risk of approximately 4-fold. Etiology The etiology of BPH is not completely understood, but it seems to be multifactorial and endocrine controlled. The prostate is composed of both stromal and epithelial elements, and each ,either alone or in combination, can give rise to hyperplastic nodules and the sympotoms associated with BPH. Each elements may be targeted in medical management schemes. Laboratory and clinical studies have identified two factors necessary for the development of BPH: dihydrotestosterone (DHT) and aging. A nimal studies in the dog have demonstrated that with aging, the prostate becomes more sensitive to androgens. Of interest is that prostatic growth in aging dogs appears to be more related to a decrease in cell death than to an increase in cell, proliferation. Laboratory studies have suggested several theories in this area, including (1) stromal-epithelial interactions( stromal cells may regulate the growth of epithelial cel