BENIGN PROSTATIC HYPERPLASIA (BENIGN ENLARGEMENT OF THE PROSTATE) AND THERAPEUTIC EFFECTIVENESS OF PYGEUM AFRICANUM EXTRACT

Prostate gland.

External shape: is a cone-shaped gland with the base directed upwards and the apex downwards.

Location: lies in front of the rectum, behind the pubic bone and directly beneath the bladder, surrounding the prostatic part of the urethra. (Illustrated in the Picture 1).

Structure: includes about 20-30 complexes of tubulo-alveolar glands wrapped in a structure of fibers and smooth muscles, The outside is a bag of thick fibers. McNeal divided prostate gland into 4 zones: peripheral zone, central zone, transitional zone and buffer zone. (Illustrated in the Picture 2).

Apart from the exocrine function (secreting semen and pouring it into the urethra), prostate gland also has the endocrine function. The gland is more likely enlarged in the elderly and thus cause urine retention. 

Picture 1: Prostate gland 


Picture 2: Division of prostate gland by McNeal
Pathological anatomy:

On macroscopic anatomy, Benign prostatic hyperplasia (BPH) is a round-shaped mass which comprises from 2 to 3 lobes pressing together forwards but adhering together at the back, developing from the transitional zone to the peripheral zone, directing at the heart of the bladder or towards the rectum, sometimes lifting the whole triangular zone of bladder up.  On the bottom, BPH may be appressed along the 2 sides of the mound. BPH’s tissues are pushed out peripherally, constituting a cortex with several layers wrapping BPH. In surgeries at the upper line, BPH can be peeled off the fiber bag established.

On microscopic anatomy, BPH contains several nuclei. In every nucleus, there is participation of many or few of ingredients such as glands, fibers and smooth muscle fibers. In the buffer tissues there exist smooth muscle fibers and collagen. After all, there are about 10 to 20% of BPH coming with prostate cancer (according to Moore, 1935).

Picture 3: Illustrating pictures for a normal prostate gland (on the left) and benign prostatic hyperplasia (on the right) 

BPH is the most common reason causing the syndrome of under-bladder urinary tract congestion. Prostatic part of urethra is extended, compressed by the 2 side lobes and covered by the middle lobe at the same time. The bladder wall is twice or 3 times more thicker than normal, the muscle fibers are enlarged, infected by cytoplasm and lymphocytes. On the other hand, because the pressure in the bladder increases significantly in urination process compared with in normal people, over 50 centimeters of water, the mucosa of the bladder is pushed through the outer muscle fibers, forming convex and concave shapes in the heart of the bladder called cylinder and cavity shapes. Some cavities may be swelled into bladder diverticula; the more the bladder wall is enlarged, the more obstructs and narrows the part of ureter that leads to the bladder. This limits the flow of urine down from the kidney, increases pressure in the heart of the ureter causing hydronephrosis, pyelonephritis and renal failure, while the bladder gradually loses its tone and is no longer able to discharge the urine out of the body.

Symptoms of the illness can be devided into 3 stages:

Early stage: There is no physical injury. The patients urinate difficultly, the urine flows slowly with weak and interrupted stream, leaking after urination, prolonged urination time, urgent urination, sometimes incontinent, frequent urination especially at night, nearly dawn.

Stage 2: There are physical injuries, dilated bladder and urine retention. The patients urinate difficultly, have the feeling of urine retention, often accompanied with such symptoms of infection as painful urination, or with opaque urine. In fact, bladder stones, bladder inflammation or prostate inflammation may be discovered.

Stage 3: There exist severe physical injuries, affecting the kidney functions. At the time, the muscle of the bladder wall is thin, lost the tone and there exist increasing urine retention, severe infection, at times continuous urine leakage since the bladder is highly filled with urine. Systemic symptoms such as anemia, nausea, loss of appetite, sleepiness, fatigue, edema, hypertension because of urinary tract obstruction. In reality, the situation doesn’t always undergo 3 stages as mentioned but based on other elements.

In the later stage, there are popular complications such as complete urinary retention causing intense twisted pain in the lower abdomen; or incomplete urinary retention, urine retained in the bladder; or blood in the urine; bladder calculi; or urinary infection.

Internal cure: surgery is not always indicated for big BPH. Subjective and objective symptoms may change over time. Thus, besides surgery indications accepted when there are severe complications, monitoring the illness and using therapy of internal medicine are recommended.

Firstly, use appropriate antibiotics to counteract the urinary tract infections, use painkillers in perineal diseases or after a surgery in hypogastric region to reduce irritations that cause urination disorder. Avoid or limitedly use such drugs as ephedrine, phenylephrine, etc. to avoid increasing the resistance at the bladder neck. Also use herbal extracted drugs and traditional medicines of Vietnam.

Experiments conducted in France in 1960s pointed out that the extract from Pygeum Africanum (African plum tree) had positive actions in treating prostatic diseases. In France, the use of Pygeum Africanum helped successfully cure 81% of the patients with BPH.

The Pygeum Africanum extract has been approved by Health authorities of France and Germany to be used in treating BPH.

Results of researches show that Pygeum africanum extract affects the target organ – prostate gland in men. Results of the chemical ingredients analysis and recent researches on pharmacological actions show that the composition of the extract from the trunk-bark of Pygeum africanum contains 3 active pharmaceutical groups of substances as follow:

Group of Phytosterols: includes beta–sitosterol, with the anti-inflammatory action by preventing the formation of pre-inflammatory prostaglandins– a substance likely to deposit in prostate gland of BPH patients.

Group of Pentacyclic Terpenes: has anti-edema action.

Group of Esters of Ferulic Acid: primarily affect endocrine system.

Experiments on animals reveal that the ingredient n-Docosanol of the group helps significantly reduce the concentration of prolactin in the plasma. This activity plays an important role because prolactin is the reason that causes the increase of testosterone and through which indirectly helps increase the synthesis of dihydrotestosterone in the prostate gland, while dihydrotestosterone is said to be the element mainly contributing to BPH.

Picture 4: The proprietary drug “Connec” produced by OPC Pharmaceutical joint-stock company with the main ingredients extracted from the trunk-bark of Pygeum Africanum, in the form of soft capsule with modern Softgel technology from Korea. The production process is carried out at the manufacturing plant complied with GMP-WHO specifications.

Picture 5: The soft capsules production line at the manufacturing plant complied with GMP-WHO specifications of OPC Pharmaceutical joint-stock company.