This document discusses benign prostate hypertrophy (BPH). It begins by reviewing the anatomy and physiology of the prostate gland. BPH is defined as a non-cancerous enlargement of the prostate gland caused by increased hormones like testosterone. Common signs include difficulty urinating. Diagnosis involves digital rectal exam, ultrasound, and blood tests like PSA. Treatment options include medications that block hormones or surgery to remove part of the prostate. Post-operative care focuses on risks like infection, bleeding, pain, and urinary problems.

1. BENIGN PROSTATE
HYPERTROPHY
By; JK

2. LEARNING OUTCOMES
 Review the anatomy and physiology of
the prostate gland
 Definition of terms
 Causes of BPH
 Signs and symptoms
 Diagnostic criteria
 Management of BPH

3. Basic facts about prostate
gland
 Walnut sized gland located below
bladder and surrounds the urethra.
 Its growth is influenced by male
hormone androgen, testosterone and
oestrogen.
 It secretes fluid that supports viability
and motility of the sperm. It modifies
the pH of the vagina to help protect

4.  During puberty prostate gland growth
is rapid, but thereafter it slows by the
age of 30.
 The next change in size and firmness
of the gland occur after the age of 50
and commonly produce signs and
symptoms of BPH

5. WHAT IS BENIGNE PROSTATE
HYPERTROPHY?
 Also known as benign prostate
hypertrophy.
 It is a non cancerous (benign) growth
of the prostate gland.
 Some parts of the prostate may
atrophy while other parts enlarge and
become nodular.

6. CAUSES OF BPH
 Cell growth is stimulated by an
increase in the hormones : androgen
and oestrogen and increase in an
enzyme 5-alpha reductase.
 The enzyme convert testosterone into
hyperactive dihydrotestosterone
(which is 10x active than testosterone)
 This stimulates growth of prostate
 Castration has been associated with
reduced incidence of BPH

7. PREDISPOSING FACTORS
Age, especially above 50yrs

8. PATHOPHYSIOLOGY
 The growth of prostate creates
bladder outlet obstruction.
 Urine stream becomes weak, causing
man to strain to empty the bladder.
 This leads to compensatory
hypertrophy of bladder muscles
 Change in contours of bladder muscle
leads to urine retention &
hydronephrosis & increase in urine
alkalinity& UTI

9. SIGNS AND SYMPTOMS
 Straining to start the stream
 Decrease in force of the stream
 Dysuria
 Hesitancy in starting
 Postvoid dribbling
 Nocturia, urgency, incontinence
 Haematuria (break in vessels)
 Incomplete bladder emptying

10. Diagnostic evaluations
 History taking
 DRE: digital rectal examination is a
procedure in which a health care provider
inserts a gloved, lubricated finger into the
rectum to feel the prostate.
 TRUS: Transrectal ultrasonography: device
(transducer) inserted into the rectum which
produces sound waves directed at prostate
and a picture is created.
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11. Diagnostic investigation
 CT: Computed tomography; a picture
produced by a computer fro x-rays showing
the prostate and the surrounding tissues.
 Bone scan and chest x-ray when cancer is
suspected to detect metastases.
 Intravenous pyelogram (IVP) : dye injected
then x-ray done.
 Cystourethroscopy
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12. Diagnostic evaluation of
prostate
BLOOD TESTS
 Full blood count
 Blood urea and creatinine
 Prostate-specific antigen (PSA):
Detects blood substances that often
increases in cases of prostate cancer
and relatively lower level about 18%
may indicate BPH
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13. DIAGNOSTIC EVALUATION
 Urine analysis
 Tissue biopsy
 Pelvic node dissection
(lymphadenectomy)
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14. Medical management
 Drugs that in hibit activity of 5-alpha-
reductase: flomax, doxasin, terazosin
 Surgical management
(Prostatectomy): when its recurrent,
causing obstruction.
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15. PROSTATECTOMY
 Removal of the prostate gland

16. INDICATIONS
 Benign prostate hyperplasia
 Cancer of the prostate
 prostatitis

17. APPROACHES
TRANSURETHRAL:
 Ideal in enlarged medial lobe BPH
 No incision made
 Device for cutting and cauterization is
inserted in the urethra
 Bladder spasm may occur
 Hemorrhage and obstruction can
occur
 Irrigation of the bladder is done to
prevent obstruction
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18. Supra-pubic resection (transvesicle)
 Indicated in large tumour
 Low midline incision made
 Bladder incised to access the prostate
 Foley catheter with 30 ml inserted
 Irrigation done
 Abdominal dressing may be soaked with
urine
 Impotence, sterility, infection, haemorrhage
are some of the complications
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19. Retro-pubic resection
 Indicated in large mass
 Low midline incision
 Bladder not incised
 Foley catheter inserted
 Abdominal dressing may be soaked
 Haemorrhage, bleeding, obstruction
may occur postoperatively
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20. Perineal resection
 For large mass located low in the pelvic
area
 Incision made between the scrotum and
rectum
 Foley catheter with 30 ml balloon in urethra
 Perineal drain used but perineal dressing is
not soaked with urine
 Haemorrhage, obstruction , impotence,
sterility, incontinence, wound infection are
some of the complication.
20

21. Retro-pubic resection
 Indicated in large mass
 Low midline incision
 Bladder not incised
 Foley catheter inserted
 Abdominal dressing may be soaked
 Haemorrhage, bleeding, obstruction
may occur postoperatively
21

22. Pre-op care
 risk for infection, urinary retention,
bladder injury, incontinence,
obstruction
 Knowledge deficit related to lack of
previous exposure.
22

23. PAIN
 Assess the location, severity and
precipitating factors to pain as baseline
data for intervening.
 Position in supine position which put the
bladder in relaxed position thereby
promoting comfort
 Catheterize the bladder if any difficult
consult the specialist to avoid trauma while
aiming at relieving bladder distension
23

24. PAIN…
 Incase of a full bladder catheterize the
bladder to release the tension hence
promoting comfort.
 Assess for a full bladder and patient ability
to void urine because full bladder aggravate
pain.
 Strap the catheter on the thigh and avoid
kinking to promote drainage of the catheter
to promote relief from pain.
24

25. PAIN..
 Put the catheter bag below the level of the
patient but making sure that it is not pulling
the catheter to promote drainage by gravity
and preventing trauma to the bladder.
 Warm compress may help to relieve the
spasms of the bladder.
 Administer analgesia (as prescribed)
Pethedine 50 mg IM.
 Non-pharmacotherapy pain management
25

26. Anxiety
 Provide/ create an enabling environment for the
patient and spouse to express themselves freely.
 Assess her concerns and respond accordingly or
refer when appropriate; Patients are often not
comfortable to discuss sexuality issues
 Explain disease process and treatment plan to
promote understanding and autonomy before
signing the consent form.
 Have him sign the consent form
26

27. Anxiety …
 Explain on retrograde ejaculation: first urine
voiding may have semen but this will fade
over time.
 Explain on possibility of urinary problems
like retention, dribbling and incontinence
and their possible management
 Explain that sexual intercourse will be
delayed for about three weeks to allow
healing of the wound, prevent pain and
infection.
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28. Anxiety
 Explain on the use of pads in case of
dribbling to prevent embarrassment.
 Explain on bed accessories, iv lines
catheter that he will have after
operation to promote cooperation and
reduce anxiety after the operation
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29. Haemorrhage
 Assess the blood pressure and pulse rate
as baseline data and detect any deviation.
 Check Hgb, blood group and clotting time
as baseline data, preparing for transfusion
and to detect coagualopathy.
 Arrange with the lab to serve at least two
units of blood in readiness for intra-
operative bleeding management.
 Anaesthetist to assess the patient.
 Correct any anaemia before operation
29

30. Infection, dribbling,
obstruction,
 Check temperature as base line data to rule
infection.
 Ensure all assessments have been done to
have baseline condition of the patient
before operation: HIV, BUN, FBC, blood
sugar, urine analysis.
 Few days before operation the diet should
be soft and fluid encouraged to prevent
constipation after surgery
 Put the irrigation fluids close to the patient
bed
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31. Infection
 Encourage to pas stools the morning before
operation to prevent intra-operative
contamination.
 Starve from midnight or 8 hours before opration
 Clean the patient and dress him in theatre gown.
 Administer prophylactic antibiotics:
 Chloramphenicol 1 gm iv start
 Benzyl penicillin 3mu iv start
 Metronidazole 5oomg iv start
31

32. Knowledge: Dribbling, obstruction,
sexual alterations
 Explain on the possibility of having
urinary dribbling and that use of pad
will help to prevent embarrassment.
 Explain on bladder irrigation that will
be done after operation to gain
cooperation and reduce anxiety.
 On his part explain what he will have
to report ant abnormality.
 Sex to be delayed for 6 months
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33. Post operative care
 Ineffective airway clearance
 Haemorrhage related to surgery
 Pain related to surgery, bladder spasms
 Risk of urinary obstruction related to the clot
formation following surgery
 Anxiety related to surgery out comes
 Risk of infection
 risk of incontinence or dribbling related to weak
sphincter muscles
 Knowledge deficit related to lack of previous
exposure
33

34. Ineffective airway clearance
 Individual assignment: just as any post
operative patient.
34

35. Haemorrhage
 Assess for overt bleeding on the abdominal or perineal
dressing for prompt intervention.
 Assess the colour of drainage in the drainage tubes. Red,
bloody colour is acceptable in the first 2 hours but it should
come clearer overtime.
 Assess the general condition of the patient, bp and pulse to
detect any deviations and signs of shock.
 vital signs be checked every 15 minutes to monitor condition
35

36. Haemorrhage…
 Turn the patient gently to prevent
pulling the tube which can cause pain
and bleeding.
 Keep the man warm to maintain good
vessel calibre.
 Nurse in supine position for relaxation
and a pain relief and for easy
visualization of the abdominal incision
dressing
36

37. Haemorrhage…
 Check mucus membranes for
anaemia.
 Keep intravenous infusion flowing as
ordered to ensure adequate
intravascular volume but also assist in
flushing the bladder.
 Transfuse blood is any signs of shock
or evidence of blood loss in intra-
operatively or post operatively.
 Check haemogobin. after 48 hours
37

38. Pain
 Position in supine with legs raised on
a pillow for relaxation of the bladder.
 Assess any pain and aggravating
factors for appropriate interventions.
 Secure catheter, drainage tubes to
prevent movement which can trigger
pain.
 Assess for any full bladder, blockage
in irrigation system or kinked drainage
tubes because full bladder can trigger
pain.
38

39. Pain…
 Advise patient not to pull the catheter.
 Empty the urinary bag when full to prevent
its weight from pulling the bladder
 Administer prescribed analgesics:
pethedine 100mg IM 6 hourly to promote
comfort.
 Warm compress may used but not on the
wound.
 Provide soft diet (when bowel sounds are
present) to prevent constipation
 Diversion therapy of reducing pain.
39

40. Pain…
 Catheter may be irritating, therefore
advise the patient not to urge because
this may precipitate pain and bleeding.
 When coughing advise the patient to
support the abdomen to prevent
straining and pressure on the suture
line which might cause pain.
40

41. Risk of urinary retention
 Assess the patency of the irrigation system and any leakage
on supra-pubic dressing for appropriate interventions.
 Keep the irrigating fluids available and close to the patient
bed for easy access.
 Use normal saline for irrigation because it has clot dissolving
properties thereby preventing clot formation in the urinary
system.
 Monitor intake and output to avoid fluid overload.
 Avoid introducing air into the system to this can lead to
bladder spasms and slow flow of irrigation.
 Milk the catheter toward the bag to facilitate drainage.
41

42. Dribbling
 Deflating of the balloon should be done in consultation with
the surgeon to prevent haemorrhage.
 Before removal of catheter bladder irrigation can be done four
hourly to train the bladder muscles.
 Spigotting the catheter intermittently to train the sphincter
muscles.
 After removal of the catheter, explain and demonstrate on
perineal exercises (squeezing the buttocks and relaxing
them2 hourly)
 Advise him to reduce fluid intake at night to prevent nocturnal/
nocturia.
42

43. Anxiety
 Explain the events that took place
during operation and the findings +
plan of care to allay anxiety and
facilitate his participation.
 Show him some of the resources than
have been connected to his body and
what is expected of him to allay
anxiety.
 Allow him and the spouse to ask
questions and answer in simple terms
to promote understanding and allay
anxiety. 43

44. Anxiety…
 Explain on that sexual intercourse will
be delayed for 6 weeks in good course
 Explain on retrograde ejaculation
which is manifested in milky urine but
will resolve after sometime.
 Evaluating the coping of the patient
through his participation of his care.
44

45. Infection
 Check body temperature as baseline
data after operation and every 4 hours
to detect infection.
 Infuse sterile fluids during irrigation to
prevent infection.
 Keep theatre dressing intact for 48-72
hours unless it is soiled.
 Use aseptic technique when dressing
the wound
45

46. Infection…
 Do catheter care using aseptic
technique: clean the urethral meatus
and the glans gently to prevent
irritation and irritation.
Administer prescribed antibiotics:
 Gentamycin 80 mg iv 8hourly for 48
hours
 X-pen 3mu iv 6hourly for 48 hours
 Metronidazole 500mg iv 8 hourly for
48 hours.
46

47. Infection
 Check the colour, consistence and
smell of bladder drainage for signs of
infection and report urgently.
 Ensure catheter is draining well to
ensure flushing out of the micro-
organisms.
 Provide food rich in proteins, vitamins,
carbohydrates for wound healing
process but be soft to prevent
constipation.
 Less fat to avoid precipitating
47

48. Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft
diet and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
48

49. Education..
 Bladder training: hold the stream of
urine to train the bladder
 Perineal exercises
 Reduce fluid intake at night
 Avoid strenuous exercises
 Take medication as prescribed
 Stop taking pepper and alcohol
 Avoid sitting for too long
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50. Pre-operative care
 Altered comfort, pain, related to
urinary retention, bladder distension
secondary to enlarged as verbalized
by the patient.
 Anxiety related to pending pending
surgery; fear about sexual dysfunction
after surgery.
 High risk for reduced cardiac output
related to surgery
50

51. Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft
diet and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
51

52. Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft
diet and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
52

53. Education..
 Bladder training: hold the stream of
urine to train the bladder
 Perineal exercises
 Reduce fluid intake at night
 Avoid strenuous exercises
 Take medication as prescribed
 Stop taking pepper and alcohol
 Avoid sitting for too long
53

54. Complications of
prostatectomy
 Impotence
 Dribbling of urine
 Urine incontinence
 DVT
 Urinary tract infection
 sterility
54