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Male Anatomy: The Reproductive Organs
Get an overview of the male sexual anatomy and male reproductive system.
By Connie Brichford
Medically reviewed by Pat F. Bass III, MD, MS, MPH

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For reproduction to occur, the female sex cell, called the egg, must be fertilized by a male sex cell, called the sperm. Not
only are the sex cells different, but the organs that produce and store them are different as well.

Male Sexual Anatomy

The organs and glands that make up the male sexual anatomy include:
• Testicles — After puberty, a man’s testicles, located at the base of the penis, produce male sex cells called sperm. Also
starting at puberty, testicles produce testosterone, the male sex hormone. A man’s sperm production, once started,
continues throughout his life; sexually mature males produce millions of sperm cells each day. The testicles are located
below the penis, outside the body, where the appropriate temperature to make sperm may be maintained as it is several
degrees too hot for sperm to be viable (able to fertilize eggs) inside the body.

• Scrotum — The testicles are covered by a pouch of skin called the scrotum. The scrotum and the muscles surrounding
it can pull the testicles toward the body when they are too cold, and relax away from the body when the testicles are too
warm. The scrotum also holds the epididymis.

• Epididymis and vas deferens — The epididymis stores the sperm after the testicles produce them, and the vas
deferens transports the sperm from the epididymis to the urethra.

• Urethra — The urethra is a duct, or tube, that transports fluids from the inside of the body to the outside. In both men
and women, the urethra is connected to the bladder and is used to pass urine out of the body. In males, however, the
urethra is also connected to the “accessory glands,” which produce semen, and to the vas deferens, the duct that brings
the sperm from the epididymus.

• Penis — The penis is perhaps the most visible part of the male sexual anatomy. It is made up of two parts, the shaft and
the head (also called the glans.) The shaft houses the corpora cavernosa (two flexible cylinders comprised of erectile
tissue that run the length of the penis and support erections), and the corpus spongiosum (erectile tissue surrounding
the urethra). In its reproductive capacity, the urethral opening at the tip of the penis delivers sperm into the vagina. Urine
also flows out of the body through the urethral opening.
• Accessory glands — There are several glands that work together to produce semen, or seminal fluid. Sperm can live
inside the female reproductive system for up to 48 hours, and seminal fluid helps the sperm move around and stay
nourished. The seminal vesicle produces a fluid that provides energy to the sperm as they seek out the female sex cell,
or the egg. The prostate gland makes a different fluid that helps the sperm move more quickly through the female
reproductive system. Another set of glands, called bulbourethral or Cowper's glands, makes a small quantity of fluid that
helps protect the sperm on its way through the urethra by neutralizing any leftover traces of acidic urine.

Male Genitals
The male reproductive system (like the female reproductive system) is a wonder of science: None of us would be here
without

Organ Function
1. Penis a. Conduit for urine form bladder
b. Male organ for sexual intercourse
2. Scrotum a. House testes and maintains their temperature at a level
cooler than the body thus promoting normal sperm
formation
3. Testes a. Endocrine glands that secrete the primary male
 hormone, testosterone
4. Seminiferous a. Location of spermatogenesis (within the testes)
Tubules
5. Epididymis a. Storage for some sperm
b. Final sperm maturation
c. Where sperm develops the ability to be motile.
6. Vas Deferens a. Storage of sperms
b. Conduction of sperm form epididymis to urethra
7. Seminal Vesicle, a. Secretion of seminal fluids that carry sperm and
Prostate, provide for:
Bulbourethral - Nourishment of sperm
gland - Protection of sperm from hostile acidic environment of
vagina
- Enhancement of motility of sperm
Chronic Obstructive Pulmonary Disease
(COPD) is a disease characterized by airflow
limitation that is not fully reversible. Airflow
limitation is usually progressive and associated with
an inflammatory response in the lungs stimulated
by irritants. COPD includes chronic bronchitis and
pulmonary emphysema. Although sometimes
included in COPD, asthma is a reversible disorder
and is therefore considered elsewhere.
Chronic bronchitis is chronic inflammation of the
lower airways characterized by excessive secretion
of mucus, hypertrophy of mucous glands, and
recurring infection, progressing to narrowing and
obstruction of airflow. Emphysema is the
enlargement of the air spaces distal to the terminal
bronchioles, with breakdown of alveolar walls and
loss of elastic recoil of the lungs. The two
conditions may overlap, resulting in subsequent
derangement of airways dynamics (e.g., obstruction
to airflow). In pulmonary emphysema, lung
function progressively deteriorates for many years
before the illness becomes apparent.
The most common cause of COPD is cigarette
smoking. Air pollution, occupational exposures,
allergens, and infections may also act as irritants.
Alpha1-antitrypsin deficient is an infrequent cause.
Complications include respiratory failure, pneumonia or other overwhelming respiratory
infection, right heart failure (cor pulmonale), arrhythmias, and depression.
Appendicitis is inflammation of the vermiform appendix caused by an obstruction attributable to
infection, structure, fecal mass, foreign body, or tumor. Appendicitis can affect either gender at
any age, but is most common in males 10 to 30. Appendicitis is the most common disease
requiring surgery. If left untreated, appendicitis may progress to abscess, perforation, subsequent
peritonitis, and death. Prostate Gland
The prostate is an exocrine gland of the male reproductive system. Its main
function is to store and secrete a clear fluid that constitutes up to one-third
of the volume of semen.
• A healthy prostate is slightly larger than a walnut.
• It is situated in front of the rectum, just below the bladder where urine
is stored, and surrounds the tube (urethra) that carries urine from the
body.
• The gland functions as part of the male reproductive system by
producing the white fluid that contains semen.
• The prostate also contains smooth muscle that helps expel semen
during ejaculation; thus, prostate problems can lead to impotence.
The prostate gland has four distinct glandular regions:
1. The Peripheral Zone (PZ) - The sub-capsular portion of the posterior
aspect of the prostate gland which surrounds the distal urethra and
comprises up to 70% of the normal prostate gland in young men. It is from
this portion of the gland that more than 70% of prostatic cancers originate.
2. The Central Zone (CZ) - This zone constitutes approximately 25% of the
normal prostate gland and surrounds the ejaculatory ducts. Central zone
tumors account for more than 25% of all prostate cancers.
3. The Transition Zone (TZ) - This zone is responsible for 5% of the prostate
volume and very rarely is associated with carcinoma. The transition zone
surrounds the proximal urethra and is the region of the prostate gland which
grows throughout your lifetime. It is involved in benign prostatic
enlargement.
4. The Anterior Fibro-muscular zone - This zone accounts for approximately
5% of the prostatic weight, is usually devoid of glandular components, and
composed only, as its name suggests, of muscle and fibrous tissue.
Prostate Disorders
Three types of disorders can occur in the prostate gland: inflammation or
infection (prostatitis), enlargement (benign prostatic hyperplasia - BPH), and
cancer.

Normal Inflamed Enlarged

1) Prostatitis is a clinical term used to describe a wide spectrum of disorders
ranging from bacterial infection to chronic pain syndromes. It is not
contagious (generally not spread through sexual contact):
• Acute Bacterial Prostatitis is the least common but easiest to diagnose
and treat. It is caused by bacteria and comes suddenly with chills and
fever, pain in the lower back and genital area, and burning or painful
urination. Additional indications are excessive white blood cells and
bacteria in the urine.
• Chronic (Nonbacterial) Prostatitis (chronic pelvic pain syndrome) is the
most common, but least understood, form of prostatitis. Found in men
of any age from the late teens on, the symptoms go away and then
return without warning, and may be inflammatory or non-
inflammatory. In the inflammatory form, urine, semen, and other
fluids from the prostate show no evidence of a known infecting
organism, but do contain the kinds of cells the body usually produces
to fight infection. In the non-inflammatory form, no evidence of
inflammation, including infection-fighting cells, is present.
• Asymptomatic Inflammatory Prostatitis is the diagnosis when there are
no symptoms, but the patient has infection-fighting cells in the
semen. It is often found when a doctor is looking for causes of
infertility or is testing for prostate cancer.
2) BPH, or benign prostatic hyperplasia, is the second common problem that
can occur in the prostate. "Benign" means "not cancerous" and
"hyperplasia" means "too much growth." As men age, the prostate gland
slowly enlarges. The gland tends to expand in an area that doesn't expand
with it, causing pressure on the urethra, which can lead to urinary
problems. The urge to urinate frequently, a weak urine flow, breaks in urine
stream, and dribbling are all symptoms of an enlarged prostate. At its
worst, BPH can lead to a weak bladder, bladder or kidney infections,
complete blockage in the flow of urine, and kidney failure.
Since the prostate has propensity to grow once manhood is reached, BPH is
the most common prostate problem for men older than 50. The American
Urological Association assesses that by age 60, more than half of American
men will have BPH. By age 70, almost all men have some prostate
enlargement. By age 85, about 90 percent of men have BPH but only 30
percent will exhibit symptoms!

Signs of BPH
 The urinary symptoms of Benign Prostatic Hyperplasia (BPH) can be bothersome and affect many aspects of a man’s life. Whether golfing with friends,
delivering an important presentation at work, or just trying to get a good night’s sleep, there’s no telling when or how often your enlarged prostate may impact you.
And while the urinary symptoms may only seem like a nuisance now, for some men, delaying treatment may allow the symptoms to get worse.

Think you could have BPH? The following urinary symptoms may give you a clue:

• Feeling the need to urinate frequently

• Difficulty starting to urinate
• Difficulty emptying your bladder completely, and because of this, urine may dribble after you are done
• The stream of your urine is weak and may start and stop
• Frequently going at night
• Sudden strong urges to urinate
Contrary to popular opinion, bothersome urinary symptoms may not be a natural part of aging. If you have any of these symptoms, talk to your doctor.

•
• Benign Prostatic Hyperplasia: A Common Part of Aging
• Why BPH Occurs
• Symptoms
• Diagnosis
• Treatment
• Your Recovery After Surgery in the Hospital
• Do's and Don'ts
• Getting Back to Normal
• Sexual Function After Surgery
• Is Further Treatment Needed?
• Hope through Research
• Additional Reading
• Glossary

The Prostate Gland

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland
is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the
prostate is located in front of the rectum and just below the bladder, where urine is stored. The
prostate also surrounds the urethra, the canal through which urine passes out of the body.
Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze
fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make
up semen, energizes the sperm and makes the vaginal canal less acidic.
[Top]

Benign Prostatic Hyperplasia: A Common Part of Aging

It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition
benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.
 Normal urine flow.

Urine flow with BPH.

As a man matures, the prostate goes through two main periods of growth. The first occurs early
in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again.
This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't
usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more
than half of men in their sixties and as many as 90 percent in their seventies and eighties have
some symptoms of BPH.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the
gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes
thicker and irritable. The bladder begins to contract even when it contains small amounts of
urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to
empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and
partial emptying of the bladder cause many of the problems associated with BPH.
Many people feel uncomfortable talking about the prostate, since the gland plays a role in both
sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life
expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5
million visits to physicians for BPH.
[Top]

Why BPH Occurs

The cause of BPH is not well understood. No definite information on risk factors exists. For
centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in
men whose testes were removed before puberty. For this reason, some researchers believe that
factors related to aging and the testes may spur the development of BPH.
Throughout their lives, men produce both testosterone, an important male hormone, and small
amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the
blood decreases, leaving a higher proportion of estrogen. Studies done on animals have
suggested that BPH may occur because the higher amount of estrogen within the gland increases
the activity of substances that promote cell growth.
Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in
the prostate, which may help control its growth. Most animals lose their ability to produce DHT
as they age. However, some research has indicated that even with a drop in the blood's
testosterone level, older men continue to produce and accumulate high levels of DHT in the
prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also
noted that men who do not produce DHT do not develop BPH.
Some researchers suggest that BPH may develop as a result of “instructions” given to cells early
in life. According to this theory, BPH occurs because cells in one section of the gland follow
these instructions and “reawaken” later in life. These “reawakened” cells then deliver signals to
other cells in the gland, instructing them to grow or making them more sensitive to hormones
that influence growth.
[Top]

Symptoms
Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder
function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but
the most common ones involve changes or problems with urination, such as
 • a hesitant, interrupted, weak stream
• urgency and leaking or dribbling
• more frequent urination, especially at night
The size of the prostate does not always determine how severe the obstruction or the symptoms
will be. Some men with greatly enlarged glands have little obstruction and few symptoms while
others, whose glands are less enlarged, have more blockage and greater problems.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to
urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-
counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a
sympathomimetic. A potential side effect of this drug may prevent the bladder opening from
relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also
can be brought on by alcohol, cold temperatures, or a long period of immobility.
It is important to tell your doctor about urinary problems such as those described above. In eight
out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious
conditions that require prompt treatment. These conditions, including prostate cancer, can be
ruled out only by a doctor's examination.
Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can
lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the
inability to control urination. If the bladder is permanently damaged, treatment for BPH may be
ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such
complications
gy:
• Pathogenesis of BPH is more complex than the simplistic notation of "large
prostate = obstruction"
○ Complex interaction of anatomic and physiologic processes result in
increased resistance of prostatic urethra.
 Glandular enlargment
 Hyperplastic process in the glandular tissues of the
transitional zone and periurethral tissues (Figure 1 and 2,
see prostate anatomy page for full description of prostate
anatomy).
 Presence of prostatic capsule results in compressive
forces on prostatic urethra (BPH in dogs, for example,
does not cause bladder outlet obstruction, since there is
no prostatic capsule).
 Increased prostatic smooth muscle tone - mediated by the
alpha-1a receptors.
 Decreased prostatic compliance.
 Changes in prostatic urethral geometry.
 ○ Important to note that pathology unrelated to the prostate can result
in identical lower urinary tract symptoms (LUTS) -- e.g.: urethral
stricture disease, bladder neck dysfunction, bladder pathology.

In-Depth From A.D.A.M. Causes

The causes of benign prostatic hyperplasia are not fully understood. Several theories have been
proposed to explain benign cell growth in older men.

Hormonal Changes
Male Hormones. Androgens (male hormones) most likely play a role in prostate growth. The
most important androgen is testosterone, which is produced in the testes throughout a man''s
lifetime. The prostate converts testosterone to a more powerful androgen, dihydrotestosterone
(DHT). DHT stimulates cell growth in the tissue that lines the prostate gland (the glandular
epithelium) and is the major cause of the rapid prostate enlargement that occurs between
puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later
adulthood.
Female Hormones. The female hormone estrogen may also play a role in BPH. (Some estrogen
is always present in men.) As men age, testosterone levels drop, and the proportion of estrogen
increases, possibly triggering prostate growth.

Late Activation of Cell Growth

Another theory focuses on cells in a certain section of the gland that may become active late in
life, signaling other prostate cells to replicate or causing them to be sensitive to growth-
stimulating hormones.
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 supplement > managed-care > 2007 > 2007-02-vol13-n1Suppl > Feb07-2457ps04-s09

Previous Article

13: s04-s09 February 2007 Number 1 Suppl

Next Article

E-mail To Friend

Medical Therapy for Benign Prostatic Hyperplasia - Present and Future Impact

Muta M. Issa, MD, MBA; and Timothy S. Regan, BPharm, RPh, CPh

Published Online: January 31, 2007 - 11:00:00 PM (CST)

PDF

The purpose of this manuscript is to provide clinicians, health plan decision makers, and policy makers with
highlights of key findings pertaining to our current understanding of the condition of enlarged prostate (EP) from
a managed care perspective. This includes a brief discussion regarding the prevalence and economic burden of
EP, followed by a review of clinical characteristics and pathophysiology, with the final section on treatment
approaches with a focus on pharmacologic options. This supplement is not intended to be a comprehensive
review of EP, because many review articles on this subject are available elsewhere. This manuscript does,
however, serve to introduce 3 additional manuscripts contained within this supplement.

The first article provides the readers with a real-world comparison of dutasteride and finasteride relative to acute
urinary retention and surgery attenuation rates. The second article investigates differences in discontinuation
rates of alpha blockers when used in combination with dutasteride or finasteride. The last article addresses the
cost implications associated with dutasteride and finasteride therapy. All 3 articles represent data from a
naturalistic, managed care population.

This supplement is intended to assist managed care formulary decision makers in evaluating key clinical and
economic data which could help to differentiate dutasteride and finasteride. Although the information presented
does not prove superiority of either product, it will answer some important questions and raise some important
issues beyond ingredient cost.

(Am J Manag Care. 2007;13:S4-S9)

With the advent of the Medicare Modernization Act and the introduction of a drug benefit for eligible beneficiaries, health plans and
potential shifts in disease management priorities. This is especially true for certain subsets of the population, such as elderly men.
from the year 2000 to 2020, the number of men older than the age of 64 will grow to nearly 9.3 million.1 In a recent retrospective
managed care population, coronary artery disease, hyperlipidemia, hypertension, type 2 diabetes, osteoarthritis, and enlarged pro
(Table 1).2 Perhaps the most surprising finding from this study was the inclusion of EP among the 5 most prevalent diseases. Altho
most health plans, EP may become one of the new priorities for disease management in this rapidly growing population of men cur
This supplement is not intended as a comprehensive review of EP, because this topic has been reviewed elsewhere.
decision makers, and policy makers with some key findings pertaining to our current understanding of this important condition from
brief discussion of the prevalence and economic burden of EP, the clinical characteristics and pathophysiology, and treatment appr

DISEASE PREVALENCE AND ECONOMIC BURDEN

Enlarged prostate or benign prostatic hyperplasia (BPH) is a chronic progressive urologic condition6 which affects a significant numb
prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged
medical care for management of symptomatic BPH by age 80.11-13 Approximately 90% of men have histologic evidence of the disea

The reported economic burden estimates of EP vary depending on the data sets studied. The incremental direct annual cost per pa
estimated between $1536 and $2577 in 1999.7,14 Data from the early 1990s estimate the cost of treatment to be $4 billion annually
between the ages of 45 and 64 years, the estimated annual healthcare expenditure to treat BPH in this population was $3.4 billion
America BPH Project indicated that in the year 2000, the disease carried an economic burden of $1.1 billion in direct annual health
outpatient pharmacotherapy costs.7

Since the late 1980s, pharmacologic therapy utilization has increased while more invasive surgical interventions have declined.
continue to be adjusted as this trend continues. At the same time, population estimates provide a trajectory of increasing costs as

The economic burden should not overshadow the tremendous impact of EP on patients' quality of life. As severity of voiding sympt
compromise in their overall well-being. For men with severe symptoms, the greatest impact appears to be on role limitations due t
limitations due to emotional problems, and general perception of health.18 These data support the importance of quality of life in th
treatment decisions with this condition.

CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGY

The clinical impact of an EP is characterized by LUTS—including urinary frequency, urgency, nocturia, weak stream, hesitancy, and
events, such as acute urinary retention (AUR) or surgery. Recent evidence suggests that the likelihood of AUR and/or surgery occu
approximately 19%.19
The pathophysiology of EP includes both static and dynamic components. Abnormal and excessive nonmalignant growth of prostate
the tissue growth starts impinging on the prostatic urethra and the bladder neck, leading to bladder outlet obstruction. This is the
Continued exposure of the prostate to dihydrotestosterone (DHT) plays a central pathophysiologic role in this age-associated prost
also an increase in the amount and tone of the smooth muscle within the prostate. Stimulation of alpha1- adrenergic receptors on t
tissue results in constriction of the urethral lumen. This is the dynamic component of prostatic hyperplasia. Although other factors
these 2 components provide a rationale for the 2 main pharmacologic approaches to BPH: alpha1-adrenergic antagonists (alpha
(5ARIs).

Bottom of Form

HCPLive | American Journal of Managed Care | American Journal of Pharmacy Benefits

ONCLive | Physicians Money Digest | iMedicalApps | Medgadget | EchoJournal
Mobile Health Computing | Non-Clinical Medical Jobs, Careers, and Opportunities

Search Filter:

• Home

• Archives

○ Issues

○ Supplements

• Submit

○ Instructions for Authors

○ Authorship Forms

○ Information for Reviewers

○ Submit / Track a Manuscript

 • Advertising

○ Information for Advertisers

○ Circulation

○ Classifieds

• Services

○ Subscribe

○ Meetings Calendar

○ Links

○ Reprints

○ Copyrights & Permissions

• About Us

○ About the Journal

○ Co-Editors-in-chief

○ Editorial Board

○ Editorial Philosophy

○ Where we're indexed

• Contact Us

• E-mail Alerts

• Follow AJMC

supplement > managed-care > 2007 > 2007-02-vol13-n1Suppl > Feb07-2457ps04-s09

Previous Article

13: s04-s09 February 2007 Number 1 Suppl

Next Article

E-mail To Friend

Medical Therapy for Benign Prostatic Hyperplasia - Present and Future Impact

Muta M. Issa, MD, MBA; and Timothy S. Regan, BPharm, RPh, CPh

Published Online: January 31, 2007 - 11:00:00 PM (CST)

PDF
 The purpose of this manuscript is to provide clinicians, health plan decision makers, and policy makers with
highlights of key findings pertaining to our current understanding of the condition of enlarged prostate (EP) from
a managed care perspective. This includes a brief discussion regarding the prevalence and economic burden of
EP, followed by a review of clinical characteristics and pathophysiology, with the final section on treatment
approaches with a focus on pharmacologic options. This supplement is not intended to be a comprehensive
review of EP, because many review articles on this subject are available elsewhere. This manuscript does,
however, serve to introduce 3 additional manuscripts contained within this supplement.

The first article provides the readers with a real-world comparison of dutasteride and finasteride relative to acute
urinary retention and surgery attenuation rates. The second article investigates differences in discontinuation
rates of alpha blockers when used in combination with dutasteride or finasteride. The last article addresses the
cost implications associated with dutasteride and finasteride therapy. All 3 articles represent data from a
naturalistic, managed care population.

This supplement is intended to assist managed care formulary decision makers in evaluating key clinical and
economic data which could help to differentiate dutasteride and finasteride. Although the information presented
does not prove superiority of either product, it will answer some important questions and raise some important
issues beyond ingredient cost.

(Am J Manag Care. 2007;13:S4-S9)

With the advent of the Medicare Modernization Act and the introduction of a drug benefit for eligible beneficiaries, health plans and
potential shifts in disease management priorities. This is especially true for certain subsets of the population, such as elderly men.
from the year 2000 to 2020, the number of men older than the age of 64 will grow to nearly 9.3 million.1 In a recent retrospective
managed care population, coronary artery disease, hyperlipidemia, hypertension, type 2 diabetes, osteoarthritis, and enlarged pro
(Table 1).2 Perhaps the most surprising finding from this study was the inclusion of EP among the 5 most prevalent diseases. Altho
most health plans, EP may become one of the new priorities for disease management in this rapidly growing population of men cur

This supplement is not intended as a comprehensive review of EP, because this topic has been reviewed elsewhere.
decision makers, and policy makers with some key findings pertaining to our current understanding of this important condition from
 brief discussion of the prevalence and economic burden of EP, the clinical characteristics and pathophysiology, and treatment appr

DISEASE PREVALENCE AND ECONOMIC BURDEN

Enlarged prostate or benign prostatic hyperplasia (BPH) is a chronic progressive urologic condition6 which affects a significant numb
prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) is 26% in men aged 40 to 49 years and 46% in men aged
medical care for management of symptomatic BPH by age 80.11-13 Approximately 90% of men have histologic evidence of the disea

The reported economic burden estimates of EP vary depending on the data sets studied. The incremental direct annual cost per pa
estimated between $1536 and $2577 in 1999.7,14 Data from the early 1990s estimate the cost of treatment to be $4 billion annually
between the ages of 45 and 64 years, the estimated annual healthcare expenditure to treat BPH in this population was $3.4 billion
America BPH Project indicated that in the year 2000, the disease carried an economic burden of $1.1 billion in direct annual health
outpatient pharmacotherapy costs.7

Since the late 1980s, pharmacologic therapy utilization has increased while more invasive surgical interventions have declined.
continue to be adjusted as this trend continues. At the same time, population estimates provide a trajectory of increasing costs as

The economic burden should not overshadow the tremendous impact of EP on patients' quality of life. As severity of voiding sympt
compromise in their overall well-being. For men with severe symptoms, the greatest impact appears to be on role limitations due t
limitations due to emotional problems, and general perception of health.18 These data support the importance of quality of life in th
treatment decisions with this condition.

CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGY

The clinical impact of an EP is characterized by LUTS—including urinary frequency, urgency, nocturia, weak stream, hesitancy, and
events, such as acute urinary retention (AUR) or surgery. Recent evidence suggests that the likelihood of AUR and/or surgery occu
approximately 19%.19

The pathophysiology of EP includes both static and dynamic components. Abnormal and excessive nonmalignant growth of prostate
the tissue growth starts impinging on the prostatic urethra and the bladder neck, leading to bladder outlet obstruction. This is the
Continued exposure of the prostate to dihydrotestosterone (DHT) plays a central pathophysiologic role in this age-associated prost
also an increase in the amount and tone of the smooth muscle within the prostate. Stimulation of alpha1- adrenergic receptors on t
tissue results in constriction of the urethral lumen. This is the dynamic component of prostatic hyperplasia. Although other factors
these 2 components provide a rationale for the 2 main pharmacologic approaches to BPH: alpha1-adrenergic antagonists (alpha
(5ARIs).

Why BPH Occurs

The cause of BPH is not well understood. No definite information on risk factors exists. For
centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in
men whose testes were removed before puberty. For this reason, some researchers believe that
factors related to aging and the testes may spur the development of BPH.
Throughout their lives, men produce both testosterone, an important male hormone, and small
amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the
blood decreases, leaving a higher proportion of estrogen. Studies done on animals have
suggested that BPH may occur because the higher amount of estrogen within the gland increases
the activity of substances that promote cell growth.
Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in
the prostate, which may help control its growth. Most animals lose their ability to produce DHT
as they age. However, some research has indicated that even with a drop in the blood's
testosterone level, older men continue to produce and accumulate high levels of DHT in the
prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also
noted that men who do not produce DHT do not develop BPH.
Some researchers suggest that BPH may develop as a result of “instructions” given to cells early
in life. According to this theory, BPH occurs because cells in one section of the gland follow
these instructions and “reawaken” later in life. These “reawakened” cells then deliver signals to
other cells in the gland, instructing them to grow or making them more sensitive to hormones
that influence growth.
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Symptoms
Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder
function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but
the most common ones involve changes or problems with urination, such as
• a hesitant, interrupted, weak stream
• urgency and leaking or dribbling
• more frequent urination, especially at night
The size of the prostate does not always determine how severe the obstruction or the symptoms
will be. Some men with greatly enlarged glands have little obstruction and few symptoms while
others, whose glands are less enlarged, have more blockage and greater problems.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to
urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-
counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a
sympathomimetic. A potential side effect of this drug may prevent the bladder opening from
relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also
can be brought on by alcohol, cold temperatures, or a long period of immobility.
It is important to tell your doctor about urinary problems such as those described above. In eight
out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious
conditions that require prompt treatment. These conditions, including prostate cancer, can be
ruled out only by a doctor's examination.
Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can
lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the
inability to control urination. If the bladder is permanently damaged, treatment for BPH may be
ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such
complications.