Benigh Prostrate Hyperplasia Disease condition for Nursing Students

2. The Prostate Gland
Clip
 Male sex gland
 Pear-shape,wt7-
16gm
 Size of a walnut
 Helps control urine
flow
 Produces fluid
component of
semen
 Produces Prostate
Specific Antigen
(PSA)

3. Cont….
 Benign prostatic hyperplasia (BPH) is the
condition that occurs when
the prostate gland is increasing in size
without there being any malignant cause.
As the prostate enlarges it leads to
compression and then obstruction of
the urethra, which in turn affects urinary
flow.
 This condition becomes increasingly
common with age and has an impact on the
quality of life for a considerable number of
men aged over fifty years.

4. Four Areas of the Prostate
 Transition Zone
 Peripheral Zone
 Anterior Zone
 Central Zone

5. Definition:
 It is an enlargement of portion of
Prostate, enlarges, Extending upward
into the bladder obstructing the
outflow of urine.

6. Causes:
 Unknown
 Heriditary
 Race
 Hormonal alteration with endocrine
changes (Testicular Antrogen)
 Stimulation of Oestrogen
 Aging
 Mal function of testis
 Diet
 Life style issues
 Excessive accumulation of dihydro
testosterone.

7. Pathophysiology:
 Due to etiological factor
 Enlarged nodules tissues of the Prostate
Gland
 Compress the urethra
 Obstruction of the Urethra
 Hypertrophy and bands of the bladder
muscles

8. Cont….
 Increased Trabaculation of the bladder wall
 Bladder capacity decreases and muscle tone
decreases
 Bladder can’t expel the urine on voiding
 Urinary Retention
 Urine become Alkaline for Bacterial growth
Urinary Obstruction and Irritation

9. Clinical Manifestation:
 Fatigue
 Anorexia
 Nausea & Vomiting
 Epigastric Discomfort
 Acute urinary retension
 Recurrent UTI
 Anemia
 Prostatism (obstructive and
Irritative
symptoms)
• Hesistancy in starting urination
 Haematuria
 Hydronephrosis
 Pylonephrosis
 Renal failure
 Azotemianitrogen-
(nitrogen containing compounds in the blood)
 Sensation of incomplete
emptying of bladder.
 Terminal Dribbling
 Nocturia
 Abdominal Staining

10. Cont….
 Increased frequency of Urination
 Dysuria
 Urgency
 Loss of muscle tone in the bladder
 Change in the angle of the bladder
neck.

11. Common symptoms
Decrease in the
urinary stream
Dribbling or leaking
after urination
Intermittency
Hesitancy
Pain or burning
during urination
Feeling that the
bladder never
completely
empties
n
n
n
n
nn

12. Diagnostic Evaluation:
i) History collection
ii) Physical Examination
iii) Rectal Examination (Digital) – It shows the smooth,
firm, symmetric enlargement of the prostate
iv) Urine Analysis
v) Serum creatnine and blood urea nitrogen
vi) Serum prostate and specific Antigen – It is a blood
test to estimate the volume of prostate.
vii) Urodynamic Flow Studies (Cystourethrography)
- Measures peak urine flow rate, voiding time and volume,
status of the bladder’s ability to effectively contract.

13. Cont….
viii) Trans Rectal Ultrasound/catheterization
– It is done to measure of post void residual time.
ix) Cystourethroscopy
- To determine the urethra, bladder and evaluate prostatic
size.
x) Cystoscopy
- It is done to know the size and force of urinary string.
xi) Electro Mylography (EMG)
- It is done to detect any defect in sphincter of muscle
xii) Prostatic Fluid Examination
- The fluid is examinated to determine the infection
xiii) CBC

14. When should BPH be treated?
BPH needs to be treated ONLY IF:
The symptoms are severe enough
to bother patient and affect the
quality of life
Renal insufficiency
Frequent urinary tract infections
n
n
n

15. Enlarged prostate
Medication
Heat therapies
Surgical approaches
Treatment
options
n
n
n

16. Medication
First line of defense against bother
some urinary symptoms
Manage the condition - don’t fix it
Two major types:
(Alpha-1-blocker) - relax the
prostate and provide a larger
urethral opening (prazosin, terazosin)
Shrink the prostate gland (5-alpha
reductase inhibitor) (finasteride)
n
n
n
n
n

17. Cont….
 Antibiotic Therapy
 Alpha-Adrenergic Blockers – To relax
smooth muscle of bladder base and prostate to
facilitate voiding.
 Catheterization
 Prostatic massage – It is done to reduce the
symptoms and size of prostate.
 Phyto therapy – Herbal medicine extracted from
plant.

18. Possible side effects of
 Impotence
 Dizziness
 Headache
 Fatigue
 Loss of sexual
drive
Medication
n
n
n
n
n

19. Destroy prostate tissue with heat
Tissue is left in the body and is
expelled over time (called sloughing)
Transurethral Microwave Therapy (TUMT)
Transurethral Needle Ablation (TUNA®
)
Interstitial Laser Coagulation (ILC)
Water Induced Thermotherapy (WIT)
Heat therapies
n
n
n
n
n
n

20. Possible side effects of
Urinary Tract Infection
Impotence
Incontinence
heat therapies
n
n
n

21. Surgical treatment

22. SURGICAL PROCEDURES
 TURP (Trans urethral Prostectomy):
=> It is performed by inserting resectoscope
through the urethra and visualize the inside of the
bladder.
 Supra Pubic Prostectomy:
=> It involve a lower abdominal incision
=> Incision is made into the bladder and then
enlarged
tissue is enucleated by blunt dissection.

23. Cont...
.
“Gold Standard” of care for BPH
Uses an electrical “knife” to surgically cut and
remove excess prostate tissue
Effective in relieving symptoms and restoring
urine flow
• Transurethral resection of the prostate:
n
n
n

24. Cont….
 Retro-Pubic Prostectomy:
=> It approaches the prostate through a low abdominal
incision without entry into the bladder.
 Prostatectomy:
=> To remove hypertrophied portion of the prostate
gland.
 Perineal Prostectomy:
=>An incision is made into the perinium between the
anus and the scrotum.
=> Patient must be in the Lithotomy position and
contraindicated for patient with Arthritis and Cardio
pulmonary disease.

25. Cont….
 Trans Urethral Incision of the
Prostate(TUIP):
=> It is option for men with a small prostate the is causing
outlet obstruction.
=> Incision are made into the prostatic tissue to enlarge the
lumen of the prostatic urethra.
 Trans Urethral Balloon Dilation of the
Prostate:
=> It is done to relax smooth muscle of bladder neck
and
prostate.
=> Small catheter is inserted into the urethra and
balloon is
positioned with in the prostatic urethra and is

26. Cont….
 Trans Urethral Ultrasound-Guided
Incision of Prostate:
=>A Laser is used to make the incision into the
prostate
and it usually done in an Ambulatory or Outpatient
setting.
 Visual Laser Ablation of the Prostate:
=> Neodynium- Yttrium Aluminum Garnet(YAG) is the
medium that produces to destroy tissue through a
special endoscope.
=> Sloughing of tissue may be delayed and blood loss
is

27. Cont….
 Microwave Thermotherapy:
=> It done to relieve necrosis and slough.
 Trans Urethral Needle Ablation:
=> It uses Radiofrequency energy to destroy Prostatic
tissue and it is done without anesthesia.
 Prostatic Stent:
=> It is done to patient with extremely poor operative
risk
and mesh like tube can be inserted through and
endoscope into the prostatic urethra to open
Mechanically.

28. Complication:
 Hydronephrosis
 Hydroureter
 Gross Hematuria
 UTI
 Acute Urinary Retension.

29. Nursing Diagnosis:
 Impaired urinary elimination r/t obstruction
of urethra.
 Pain r/t surgical incision.
 Risk for infection r/t Incision, Presence of
catheter.
 Risk for fluid volume deficit r/t fluid
replacement needs.
 Potential for sexual dysfunction r/t
prostatectomy and UTI.

30. Nursing Mgt.
Pre - operative care:
 Inform about the procedure and the expected post
operative care including catheter drainage, Irrigation.
 Complication of surgery should be discussed with the
patient.
 Prophylactic Antibiotic are ordered.
 Bowel preparation is given or the patient is instructed
in home administration and fasting after midnight.
 Optimal cardiac, respiratory and circulatory status
should be achieved to decreased risk of complication.
 Restoring urine drainage and encouraging high fluid
intake are also helpful in managing the infection.

31. Cont….
Post - operative care:
 Maintain patency of catheter system.
 Monitor patient for signs of water after TURP.
 Instruct patient not to try to void around catheter,
explain feeling of needing to void from pressure of
catheter.
 Avoid use of enemas and rectal thermometers.
 Give prescribed medication.
 Change dressing frequently around suprapubic
wounds.
 Give patient opportunities to discuss feelings about
sexuality and possible incontinence.

32. Cont….
 Encourage increased fluid and voiding.
 Avoid vigorous exercise, heavy lifting and sexual
intercourse at least 3 weeks.
 Avoid straining with defecation using stool
softeners or mild laxatives if needed.
 Advise to take high diet fiber facilitates the passage
of stool.
 Avoid driving for 2 weeks.