Montanari E, Guarneri A, Dell'Orto P, Gelosa M
Istituto di Urologia, Università di Milano.
Arch Ital Urol Androl. 1995 Feb;67(1):7-12.
The pathogenesis of benign prostatic hyperplasia (BPH) remains largely unresolved. The natural history of the disease involves two distinct phases, a pathological and a clinical one, whose pathogenesis is different. The pathologic phase is composed of two stages microscopic and macroscopic neither of which produces clinical dysuria. Nearly all men develop microscopic BPH if they live long enough but only in 50% of men microscopic BPH grows to produce a macroscopic enlargement of the gland and the evolvement happens in a period between 5 and 7 years. So different etiologies for the microscopic and macroscopic evolution of prostate can be argued. The clinical phase of BPH involves the progression of pathologic BPH to the clinical form in which the patients develop symptomatic dysuria. Again only about 50% of the men with macroscopic BPH progress to the clinical form: although macroscopic enlargement of the prostate is necessary for the development of clinical BPH it is not sufficient by itself for the progression to clinical phase and additional factors are required such as phlogosis, vascular infarct, enanchement of alpha adrenergic tone. These remarks on natural history suggest a multiple approach to BPH not addressed to treat the pathologic phase but the clinical one.(ABSTRACT TRUNCATED AT 250 WORDS)
良性前列腺增生（BPH）的发病机制在很大程度上仍未得到解决。该疾病的自然史包括两个不同阶段，一个是病理阶段，另一个是临床阶段，其发病机制不同。病理阶段由两个阶段组成，微观阶段和宏观阶段，这两个阶段均不会产生临床排尿困难。几乎所有男性如果活得足够长都会发展为微观BPH，但只有50%的男性微观BPH会发展为前列腺的宏观增大，这种演变发生在5至7年的时间段内。因此，可以探讨前列腺微观和宏观演变的不同病因。BPH的临床阶段涉及病理BPH进展为临床形式，即患者出现有症状的排尿困难。同样，只有约50%的有宏观BPH的男性会进展为临床形式：虽然前列腺的宏观增大是临床BPH发展的必要条件，但它本身不足以进展到临床阶段，还需要其他因素，如炎症、血管梗死、α肾上腺素能张力增强。这些关于自然史的论述表明，对于BPH需要采取多种方法，不是针对治疗病理阶段，而是针对临床阶段。（摘要截断于250字）
