BENGIN PROSTATE HYPERPLASIA (BPH)ANILKUMAR BRMSC. N (MSN)

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Definition Etiology and risk factors Pathophysiology clinical manifestations complications Diagnostic assessment Medical management Surgical management Nursing management

It is a condition progressive enlargement of prostate gland, resulting from an increase in the number of size of epithelial cells and stromal tissue.

Etiology

Ageing Excessive accumulation of prostatic

androgen Family history Diet increase animal fat and saturated faty

acids Reduced exercise and alcohol consumption

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Recent studies have identified smoking (both current and former smoking), heavy alcohol consumption, hypotension, heart disease and diabetes mellitus as risk factors associated with BPH.

PATHOPHYSILOGY

The cause of BPH is uncertain, but studies suggest that estradiol levels may have a relationship to prostate size among men with testosterone levels above the median.

Recent studies have identified smoking both current and former, heavy alcohol consumption, hypertension, heart disease and diabetes as risk factors of BPH.

Conti

The hypertrophied lobes of prostate may obstruct the vesical neck or prostatic urethra, causing incomplete emptying of the bladder and urinary retention.

As a result. A gradual dilation of the ureters (hyroureter) and kidneys (hydronephrosis) can occur. Urinary tract infections may result from urinary stasis. Urine remaining in the urinary tract serves as a medium for infectve organisms.

Signs and symptoms

Obstructive Reduced force of urine stream Difficulty in initiating voiding Intermittency Dribbling at the end of urination

Sings and symptoms conti…

Irritative Frequency Urgency Dysuria Bladder pain Nocturia (excessive urination at night) Incontinence

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Inflammation and infection Decrease volume and force of

the urinary stream sensation that the bladder has

not been completely emptied

Generalized symptoms include • Fatigue • Anorexia • Nausea and vomiting • Epigastric discomfort

Complications

Acute urinary retention Urinary tract infections (UTI) Renal stone (kidney stone) Bladder damage Hydronephrosis Pyelonephritis

Assessment and diagnostic findings

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Complete blood studies are performed because hemorrhage is a major complication of prostate surgery, all cloting defects must be corrected. A high percentage of patients with BPH have cardiac or respiratory complications, or both because of their age therefore cardiac and respiratory function also assessed.

Medical management

The main goals of medical management

• Restore bladder function • Relive signs and symptoms and prevent and treat complications.

The treatment Plan depends on the cause of BPH, the severity of the obstruction, and the patient’s general health conditions.

If the patient is admitted on an emergency basis because he can not void, he is immediately catheterized.

Diet

Decrease amount of intake caffeine and artificial swetners, limit spicy and acidic foods and alcohol.

Pharmacologic therapy

Pharmacologic therapy include• Alpha adrenergic blocker and 5-alpha

reductase inhibitors this type of medications relax the smooth muscle of the bladder neck and prostate. The smooth muscle blockade improves urine flow and relives BPH symptoms.

Surgical approaches or therapy

several approaches or methods can be used to remove the portion of the enlarged prostate gland.

Types of surgical therapy for BPH

Closed surgical procedure • TURP (Transurethral resection of the prostate)

• TUIP (Transurethral incision of the prostate)

Open surgical procedure

Suprapubic prostectomy Perineal prostectomy Retropubic prostectomy

TURP (Transurethral resection of the prostate)

Removal of prostate tissue using a resectoscope inserted through the urethra under spinal or general anesthesia.

TUIP (Transurethral resection of the prostate)

Is an out patient basis procedure of delivery microwaves directly to the prostate Transurethral probe

Suprapubic prostectomy

suprapubic prostectomy is one method of removing the enlarged gland through an abdominal incision . An incision is made into the bladder and the prostate gland is removed from above.

Perineal prostectomy

Perineal prostectomy involves removing the gland through an incision in the perineum. (This method is practical when other methods or approaches are not possible.

Retropubic prostectomy

Retropubic prostectomy is a another technique, is more common than suprapubic approach. Incision made on low abdominal between prostate gland and pubic arch and the bladder without entering the bladder.

Nursing management

The goals of nursing management • Restoration of urinary drainage • Treatment of urinary tract

infections • understanding the procedure

Pre operative interventions

Avoid alcohol and caffeine Advise to urinate every 2-3 hours Normal fluid intake should be maintain

and avoid over fluid intake and volume over land.

Antibiotics before any Invasive procedure

Post operative care

Assess the patient’s conditions. Main complications is hemorrhage, bladder

spasm, urinary Incontinence and infections. Bladder irrigation cathter care Avoid activities that increase abdominal

pressure.

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To Relive bladder spasms use Anti spasmodics After removing catheter, patient should

urinate within 6 hours. Patient should practice pelvic floor exercise

( kegel exercise) Encourage to practice straining and stoping

the stream during urination.

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Dietary advice or management including fiber and easily digestibale food

Adminster stool softners, avoid heavy alcohol intake, weighting, and sexual intercourse.