良性前列腺增生英文课件.pptVIP

The Prostate and Benign Prostatic Hyperplasia Accessory Sex Glands Prostate Seminal vesicles Cowper’s glands We Will Consider The structure of the prostate and its role in continence The mechanism of ejaculation and the role of the prostatic innervation The role of the secretory products of the prostate in the prostatic fluid The Structure of the Prostate McNeal’s Hypothesis Transitional zone – the site of origin of BPH Central zone – Wolffian duct origin cf vasa and seminal vesicles Peripheral zone – the site of origin of 75% of cancers Anterior fibromuscular stroma Origin Peripheral and central zones - UG sinus DHT Central zone – Wolffian ducts Testosterone Origin of Circulating Testosterone Testosterone Uptake Development of the Prostate DHT formed mainly in epithelial cells DHT diffuses to stroma (most of the androgen receptors) Stromal nuclei produce growth factors Growth factors drive epithelial cells Stromal – epithelial interaction Summary Growth Factors Normally bFGF EGF TGFα 20% TGFβ inhibitory The Pre-prostatic Sphincter Prostatic Innervation Classical adrenergic cholinergic NANC 5-HT Dopamine-β-hydroxylase VIP NPY Leu-encephalin Met-encephalin CGRP Sustance P Alpha Adrenergic Innervation α-adrenergic receptors – 98% in stroma alpha-1 90% alpha-2 10% alpha 1a – 60% Innervation Cholinergic - epithelial secretion Adrenergic - smooth muscle contraction Neuroendocrine cells - serotonin calcitonin TSH somatostatin - regulation of secretion, cell growth NANC - ? Bladder Neck v Preprostatic Sphincter Bladder Neck Both sexes At bladder neck Cholinergic innervation Continence mechanism Preprostatic sphincter Males Supraverumont