Benign Prostatic Hyperplasia (BPH)
The cause of BPH not fully understood but hereditary factors and the presence of testosterone believed to be involved. The process involves an imbalance between increased glandular cell proliferation and decreased apoptosis or programmed cell death.
The process begins as early as 25-30 yrs. Microscopic changes present in 90% of men over 85 yrs and half of these men will have actual prostate gland enlargement. 1 adrenergic receptors in bladder base, bladder neck and prostate may be associated with a dynamic component of bladder outlet obstruction.
The natural history of the condition is that it may may wax and wane over time. However, 5-10% of patients progression to surgery within 4 years.
Chronic Prostatitis/Pelvic Pain Syndrome
Chronic prostatitis/pelvic pain syndrome is a potentially debilitating condition diagnosed in the presence of chronic pelvic pain and lower urinary tract symptoms.
30% of all men have such symptoms at some time in their life and 8% of patients referred to urologists are diagnosed with chronic prostatitis/chronic pelvic pain syndrome.
The cause of chronic prostatitis/chronic pelvic pain syndrome is not clear although inflammatory and infective causes have been closely studied. Non-infective inflammatory causes which have been postulated include intra-prostatic reflux of urine and sperm which are immunogenic and which set up inflammatory responses. Links to psychosomatic illness secondary to stress, anxiety and depression may be found in some men.
Only 5%-10% of men are diagnosed with an infective cause by urine testing but most patients may be treated empirically with antibiotics.
