CHAPTER 17 Prostatic Hyperplasia
The development of the transition zone of the prostate begins at what week of embryologic development?
This occurs at week 16 of development of the fetus.
The transition zone constitutes what percent of the prostate?
The transition zone comprises 4% to 5% of the glandular prostate.
What is the average weight of the prostate in an adult male at 40 years of age?
At this age, the mean weight of the prostate is approximately 20 g.
The prostate is in contact with how many and what fascial layers?
The 3 fascial layers, which abut the prostate, include Denonvilliers posteriorly, the endopelvic fascia cranially, and the lateral pelvic fascia.
What artery provides the major source of blood for the prostate?
The prostatovesicular artery arising from the inferior vesical artery is the main source of arterial blood to the prostate.
The plexus of Santorini drains into what major veins?
This venous complex drains into the hypogastric veins.
The urethra divides the prostate into what areas?
The urethra demarcates the prostate into the fibromuscular (ventral) and glandular (dorsal) areas.
What is the largest zone of the prostate?
Typically, the peripheral zone is the largest zone accounting for approximately 75% of the prostate gland.
The outer zone of the prostate is of what embryologic origin?
The endoderm gives rise to the outer (peripheral) zone of the prostate.
What is the anatomic female equivalent to the prostate gland?
The Skene glands in the female urethra are the homolog to the male prostate.
What typical female malignant neoplasm can arise in the prostate?
Endometrial carcinoma can occur at the prostatic utricle.
Where are Cowper’s glands located?
They are located within the urogenital diaphragm.
Lymphatic drainage of the prostatic urethra is primarily to which lymph nodes?
The obturator and external iliac lymph nodes are the main lymphatic drainage group.
What effect do finasteride and dutasteride have on serum testosterone levels?
There is no change in serum testosterone levels. Dutasteride may lower serum dihydrotesterone.
What percent of the ejaculate arises from the prostate gland?
Prostatic secretions constitute 15% of the total ejaculate volume.
The fibromuscular stroma is composed of mainly what type of tissue?
Smooth muscle fibers are the main component of the fibromuscular stroma.
What cell types are present in the acinar epithelium?
There are 2 cell types: glandular cells and basal cells.
Dutasteride and finasteride have what effect on prostatic tissue levels of 5 alpha-DHT?
Both decrease 5 alpha-DHT prostatic tissue levels.
Dutasteride and finasteride produce what side effects in regard to sexual function?
The side effects include decreased libido, decreased ejaculatory volume, and erectile dysfunction.
The majority of alpha-1 adrenoceptors are located where in the genitourinary (GU) tract?
The alpha-1 receptors are located mainly in the bladder neck and prostate.
Define the respective temperature ranges for thermotherapy and hyperthermia of the prostate.
Temperatures >44.5°C constitute thermotherapy and temperatures <44°C are termed hyperthermia.
How many isoenzymes exist for 5-alpha-reductase?
There are 2 isoenzymes: type 1 and type 2, with type 2 being the major isoenzyme in the prostate.
What 2 growth factors are important in the development of BPH?
Transforming growth factor alpha and epidermal growth factors have been identified as the major growth factors in the development of BPH.
Describe the effect of androgen ablation on the cell populations of the prostate.
Epithelial cells are mainly affected by a decrease in androgens and show varying degrees of atrophy as compared to stromal cells.
What alpha-receptor subtype is most numerous in the prostate?
Alpha 1A is the most prevalent alpha-receptor subtype in the prostate.
Prostatic secretions include what element?
A high level of zinc is present in prostatic secretions.
What drugs penetrate into the prostatic fluid?
Trimethoprim—sulfamethoxazole and fluoroquinolones are the only drugs that achieve therapeutic levels in the prostatic parenchyma.
What is the average age at which men develop symptomatic BPH?
Sixty-nine years.
Does prostate doubling time normally increase or decrease with age?
Decreases.
What portion of the male population develops a prostate of 100 g or more?
4%.
On an average, how much does the prostate grow each year?
0.6 cc/y with a mean decrease in urinary peak flow rate of 2 mL/s/y.
How many patients with BPH present with some degree of renal failure?
10%.
Where in the prostatic cell is testosterone converted to 5-alpha-dihydrotestosterone?
This conversion occurs in the cytoplasm.
What specific receptor does tamsulosin work on?
Alpha 1A.
What are the main side effects of alpha-blockers?
Dizziness and asthenia.
What specific side effect does tamsulosin tend to produce more than other alpha-blockers?
Tamsulosin is more likely to cause ejaculatory problems than other alpha-blockers so patients should be warned about this before starting therapy especially if sexually active.
What is the mechanism of action for BPH phytotherapeutic agents such as saw palmetto?
It is unknown at this time.
What is the known effect of saw palmetto on symptomatic BPH in randomized controlled trials?
No significant difference has been found between placebo and saw palmetto in controlled trials.
When were the technical improvements to create the modern resectoscope first completed and by whom?
In 1932 by Dr. Joseph McCarthy.
Who first described the prostate anatomically and who named it prostate?
Vesalius described it in 1538. Caspar Bartholin named it “prostate” in 1611.
What advances to the resectoscope were designed by Dr. Theodore M. Davis?
Thicker cutting loop, insulated outer sheath, and the dual foot pedal control.
Who provided the first correct and detailed description of the prostatic blood supply and when?
Ruben Flocks in 1937.
Who is credited with the first description of modern transurethral resection of the prostate (TURP) technique?
Reed M. Nesbit who published his technique in 1943 in his landmark book Transurethral Prostatectomy.
What is the difference between the Stern—McCarthy and Iglesias resectoscopes?
The Stern—McCarthy uses a rack and pinion lever action while the Iglesias uses a spring-loaded thumb control.
What percent of patients with BPH will have symptom improvement or stabilization without treatment?
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