Hyperplastic growth occurs in the stromal and epithelial tissues of the prostate transition zone in BPH patients. Testosterone is converted to DHT by stromal cells, causing growth of epithelial cells and an imbalance in proliferation and apoptosis regulation. This leads to prostate hyperplasia and increased urethral resistance, resulting in urinary tract obstruction. Obstruction causes urine backflow and increased bladder pressure, leading to detrusor muscle hypertrophy and instability. Patients experience lower urinary tract symptoms like increased urinary frequency, urgency, and nocturia.

1. Muhammad Sobri Maulana
Pathogenesis and Pathophysiology BPH
In BPH patients, excessive proliferation occurs from the stromal and
epithelial parts that occur most in the prostate transition zone. The stromal
section consists of collagen fibers and smooth muscle cells. If microscopically
observed, there are images of nodules hyperplastic consisting of stromal and
epithelial components.1
Image 1. Histological Picture of BPH.1
Hyperplasia in this tissue is affected by androgen hormones. Testosterone
hormone will be converted to DHT after being recognized by stromal cells and
will affect epithelial cells and growth factors. In addition, defects can occur in
the balance of cell apoptosis regulation, so that there is excessive cell
proliferation but cannot be balanced with apoptosis cell.1

2. Image 2. The role of DHT in stromal and epithelial cells in the prostate.1
Image 3. Imbalance of regulation of cell proliferation and apoptosis in
BPH.1
Prostate hyperplasia will cause increased resistance in the urethra. If
resistance the larger, can lead to urinary tract obstruction. Obstruction will
cause reflux from the urine flow back to the vesica urinary so that intravesica
pressure will increase due to increased urine tamping volume. Bladder will

3. experience compensation in the form of hypertrophy from the detrusor muscles
which results in instability of the detrusor muscle. Impact that can perceived by
patients is a symptom of increased frequency of urination, urgency and
nocturia.1
Image 4. Pathophysiology of BPH.1
Clinical Manifestations
Symptoms that may occur in patients are known symptoms as a Lower Urinary
Tract Symptoms (LUTS). Symptoms of LUTS in general can be classified into
storage symptoms and voiding symptoms.2
Storage symptoms can be:
• Urgency : complaints cannot resist urination
• Frequency : which is an increase in the frequency of urination
• Nocturia : which often wakes up at night to urinate with urine which is a bit
so it disturbs sleep
Voiding symptoms in the form of:
• Hesitancy, which is urinating that does not go straight out
• Straining, which must be slightly straining to urinate
• Weak / interrupted streams, which are intermittent urine flows

4. • Incomplete bladder emptying, which is the feeling of not dressing after
urinating
Referensi
1. Roehrborn CG. Benign Prostatic Hyperplasia: Etiology, Pathophysiology,
Epidemiology, and Natural History. In: Kavoussi LR, Novick AC, Partin AW,
Peters CA. Campbell-Walsh
2. Presti JC, Kane CJ, Shinohara K, Carroll MD. Neoplasms of The Prostate Glads.
In: Tanagho EA, McAninch JW, editors. Smith’s General Urology. 17 th ed.
New York;McGraw-Hill: 2008. p 348-55