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1. Benign Prostatic
Hyperplasia
(BPH)
By,
Mr. Aby Thankachan, M.Sc(N), Ph.D (N), PGDSH, RN, RM
Asst . Professor , Dept. of Medical Surgical Nursing
Hindusthan College of Nursing, Coimbatore

2. Also known as
Benign Prostatic
Hypertrophy (BPH)
Benign enlargement of the prostate (BEP,
BPE), Adenofibromyomatous hyperplasia,
Benign prostatic obstruction

3. BENIGN vs MALIGNANT
A benign tumor is a mass of cells (tumor) that
lacks the ability to invade neighboring
tissue (spread throughout the body)
or metastasize.
A malignant tumor contrasts with a non-
cancerous benign tumor in that a malignancy is
not self-limited in its growth, is capable of
invading into adjacent tissues, and may be
capable of spreading to distant tissues.

5. Hypertrophy/ Hyperplasia
Hypertrophy is the increase in the volume of
an organ or tissue due to the enlargement of
its component cells. It is distinguished from
hyperplasia, in which the cells remain
approximately the same size but increase in
number.

7. Hypertrophic cardiomyopathy

11. Introduction:
• Benign prostatic hyperplasia (BPH) is a
benign enlargement of the prostate gland.
• In many patients older than 50 years, the
prostate gland enlarges, extending upward
into the bladder and obstructing the outflow
of urine by encroaching on the vesicle
orifice.

12. • This condition is known as benign prostatic
hyperplasia (BPH), the enlargement, or
hypertrophy, of the prostate.
• It is the most common urologic problem
in male adults.

13. • About 50% of all men in their lifetime
will develop BPH.
• Of these men, almost half of them will
have bothersome lower urinary tract
symptoms.

14. Definition:
• It is defined as, “ noncancerous increase in
size of prostate gland which involves
hyperplasia of prostatic stromal and
epithelial cell resulting in formation of large,
fairly discrete nodules in transitional zone
of prostate, which push on and narrow the
urethra resulting in an increase resistance
to flow of urine from the bladder.”

15. Incidence:
• 50% of men having evidence of BPH
by age of 50years.
• 75% by age of 80 years.

16. Causes and risk
factors:
• Dihydrotestosterone (DHT).
•Early in puberty, prostate actually doubles in size.
Later in life, around age 25, it starts to grow
again. For most men, this growth happens for
the rest of their lives. For some, it causes BPH.
•It isn't entirely clear what causes the prostate to
enlarge. However, it might be due to changes in
the balance of sex hormones as men grow older.

17. • Risk factors for prostate gland
enlargement include:
• Aging. Prostate gland enlargement rarely
causes signs and symptoms in men
younger than age 40. About one-third of
men experience moderate to severe
symptoms by age 60 and about half do so
by age 80.

18. • Family history. Having a blood
relative, such as a father or brother,
with prostate problems means more
likely to have problems.

19. • Diabetes and heart disease.
Studies show that diabetes, as well
as heart disease and use of beta
blockers, might increase the risk of
BPH.
• Lifestyle. Obesity increases the risk
of BPH, while exercise can lower
your risk.

20. Non
cancerous
increase in
of
size
prostate
gland
Which
involves
hyperplasia of
prostatic
stromal and
epithelial cell
Resulting in
formation of
fairly
large,
discrete
of
nodules in
transitional
zone
prostate
Pathophysiology

21. Which push on
and narrow the
urethra
in an
Resulting
increase
resistance to
flow of urine
from the bladder

22. At normal size, the prostate gland is
about the size and shape of a walnut
or golf ball. When enlarged, the
prostate may obstruct urine flow from
the bladder and out the urethra.

24. Clinical Manifestations:
• Hesitancy in starting urination
• Increased frequency of urination
• Nocturia
• Urgency
• Abdominal straining

25. • Decrease in volume and force of
urinary stream
• Interruption of urinary stream
• Dribbling.
• Sensation of incomplete emptying of
the bladder

26. • Acute urinary retention (more than 60
ml)
• Recurrent UTIS.
• Fatigue
• Anorexia

27. • Nausea and vomiting
• Pelvic discomfort and pain
• Ultimately azotemia
• Renal failure result with chronic
urinary retention and large residual
volumes
• Blood in the urine

28. Assessment and
Diagnostic Methods:
• History collection
• Physical examination- including
digital rectal examination(DRE)
• Urinalysis to screen for hematuria
and UTI.

29. • Prostate-specific antigen (PSA) level
is obtained if the patient has at least
a 10-year life expectancy and for
whom knowledge of the presence of
prostate cancer would change
management.

30. • Urinary flow-rate recording and the
measurement of postvoid residual (PVR)
urine.
• Urodynamic studies
• Urethrocystoscopy
• Ultrasound
• Complete blood studies, including clotting
studies.

31. UWIN score
(Urgency, Weak
stream, Incomplete
emptying, and
Nocturia)

32. Medical Management:
• The treatment plan depends on the cause,
severity of obstruction, and condition of the
patient. Treatment measures include the
following:

33. 1. Immediate catheterization if patient cannot
void (an urologist may be consulted if an
ordinary catheter cannot be inserted).
2. A suprapubic cystostomy is sometimes
necessary.
3
. “Watchful waiting” to monitor disease
progression.

34. Pharmacologic
Management
• Alpha blockers.
These medications relax bladder neck
muscles and muscle fibers in the prostate,
making urination easier. Alpha blockers —
which include alfuzosin (Uroxatral), doxazosin
(Cardura), tamsulosin (Flomax), and silodosin
(Rapaflo) — usually work quickly in men with
relatively small prostates.

35. • 5-alpha reductase inhibitors.
These medications shrink prostate by
preventing hormonal changes that
cause prostate growth. These
medications — which include finasteride
(Proscar) and dutasteride (Avodart) —
might take up to six months to be effective.

36. • Combination drug therapy.
Doctor might recommend taking an
alpha blocker and a 5-alpha
reductase inhibitor at the same time if
either medication alone isn't effective.

37. • Tadalafil (Cialis).
Studies suggest this medication, which is
often used to treat erectile dysfunction,
can also treat prostate enlargement.
However, this medication is not routinely
used for BPH and is generally prescribed
only to men who also experience erectile
dysfunction.

38. • Minimally
Invasive Therapy
1.
• Invasive Therapy
2.

39. (A). Minimally Invasive
Therapy.
Minimally invasive therapies are becoming
more common as an alternative to watchful
waiting and invasive treatment. They
generally do not require hospitalization or
catheterization.

40. • Transurethral
Microwave
Thermotherapy
1
• Transurethral
Needle
Ablation.
2
• Laser
Prostatectomy.
3
• Photovaporiza-
tion
4
• Interstitial
laser
coagulation
(ILC).
5
• Intraprostatic
Urethral
Stents.
6

41. 1. Transurethral Microwave
Thermotherapy.
• Transurethral microwave thermotherapy
(TUMT) is an outpatient procedure that
involves the delivery of microwaves
directly to the prostate through a
transurethral probe to raise the
temperature of the prostate tissue to about
113° F (45° C). The heat causes death of
tissue, thus relieving the obstruction.

42. • A rectal temperature probe is used during
the procedure to ensure that the
temperature is kept below 110° F (43.5°
C) to prevent rectal tissue damage.

43. • The procedure takes about 90 minutes.
Postoperative urinary retention is a
common complication. Thus the patient
is generally sent home with an indwelling
catheter for 2 to 7 days to maintain
urinary flow and to facilitate the passing
of small clots or necrotic tissue.

44. • Antibiotics, pain medication, and
bladder antispasmodic medications
are used tolerate and prevent post
procedure problems.

45. • The procedure is not appropriate for men
with rectal problems.
• Anticoagulant therapy should be stopped
10 days before treatment. Mild side
effects include occasional problems of
bladder spasm, hematuria, dysuria, and
retention.

48. 2. Transurethral Needle
Ablation.
• Transurethral needle ablation (TUNA) is
another procedure that increases the
temperature of prostate tissue, thus causing
localized necrosis. TUNA differs from TUMT
in that low-wave radiofrequency is used to
heat the prostate. Only prostate tissue in
direct contact with the needle is affected,
thus allowing greater precision in removal of
the target tissue.

49. • The extent of tissue removed by this
process is determined by the amount
of tissue contact (needle length),
amount of energy delivered, and
duration of treatment.

50. • This procedure is performed in an outpatient
unit or physician’s office using local
anesthesia and IV or oral sedation. The
TUNA procedure lasts approximately 30
minutes. The patient typically experiences
little pain with an early return to regular
activities.

51. • Complications include urinary retention,
UTI, and irritative voiding symptoms (e.g.,
frequency, urgency, dysuria). Some
patients require a urinary catheter for a
short time. Patients often have hematuria
for up to a week.

53. 3. Laser Prostatectomy.
• The use of laser therapy through visual or
ultrasound guidance is an effective alternative to
transurethral resection of the prostate (TURP) in
treating BPH.
• The laser beam is delivered transurethrally
through a fiber instrument and is used for cutting,
coagulation, and vaporization of prostatic tissue.
There are a variety of laser procedures using
different sources, wavelengths, and delivery
systems.

56. 4. Photovaporization
• (PVP) uses a high-power green laser
light to vaporize prostate tissue.
• Improvements in urine flow and symptoms
are almost immediate after the procedure.
Bleeding is minimal, and a catheter is
usually inserted for 24 to 48 hours
afterward. PVP works well for larger
prostate glands.

58. 5. Interstitial laser
coagulation (ILC).
• The prostate is viewed through a
cystoscope.
• A laser is used to quickly treat precise
areas of the enlarged
• prostate by placement of interstitial
light guides directly into the prostate
tissue.

61. 6. Intraprostatic Urethral
Stents.
• Symptoms from obstruction in
patients who are poor surgical
candidates can be relieved with
intraprostatic urethral stents. The
stents are placed directly into the
prostatic tissue. Complications
include chronic pain, infection, and
encrustation.

63. (B). Invasive Therapy
(Surgery)
• Invasive treatment of symptomatic BPH
involves surgery. The choice of the
treatment approach depends on the size
and location of the prostatic enlargement
and patient factors such as age and
surgical risk.

64. 1. Transurethral Resection
of the Prostate.
• Transurethral resection of the
prostate (TURP) is a surgical
procedure involving the removal of
prostate tissue using a resectoscope
inserted through the urethra.

66. • TURP has long been considered the gold
standard for surgical treatments of
obstructing BPH. Although this procedure
remains the most common operation
performed, the number of TURP procedures
done in recent years has declined due to
the development of less invasive
technologies.

67. • TURP is performed under a spinal or
general anesthetic and requires a 1-
to 2-day hospital stay. No external
surgical incision is made. A
resectoscope is inserted through the
urethra to excise and cauterize
obstructing prostatic tissue.

68. • A large three-way indwelling catheter with
a 30-mL balloon is inserted into the
bladder after the procedure to provide
hemostasis and to facilitate urinary
drainage. The bladder is irrigated, either
continuously or intermittently, usually for
the first 24 hours to prevent obstruction
from mucus and blood clots.

69. • The outcome for 80% to 90% of patients is
excellent, with marked improvements in
symptoms and urinary flow rates.
• Postoperative complications include
bleeding, clot retention, and dilutional
hyponatremia associated with irrigation.

72. 2. Transurethral Incision of
the Prostate.
• Transurethral incision of the prostate (TUIP)
is a surgical procedure done under local
anesthesia for men with moderate to severe
symptoms. Several small incisions are made
into the prostate gland to expand the urethra,
which relieves pressure on the urethra and
improves urine flow.

73. • TUIP is an option for patients with a
small or moderately enlarged
prostate gland. TUIP has similar
patient outcomes to TURP in relieving
symptoms.

74. Prostatic urethral lift (PUL)
Special tags are used to compress the sides of the
prostate to increase the flow of urine. The procedure
might be recommended with lower urinary tract
symptoms. PUL also might be offered to some men
concerned about treatment impact on erectile
dysfunction and ejaculatory problems, since the
effect on ejaculation and sexual function is much
lower with PUL that it is with TURP.
OTHER TREATMENT OPTIONS

76. Embolization
Through catheters, embolic agents are
released in the main branches of the
prostatic artery, though blood supply to or
from the prostate is selectively blocked,
causing the prostate to decrease in size.

77. Open or robot-assisted prostatectomy
The surgeon makes an incision in lower
abdomen to reach the prostate and remove
tissue. Open prostatectomy is generally done if
pt has very large prostate, bladder damage or
other complicating factors. The surgery usually
requires a short hospital stay and is associated
with a higher risk of needing a blood transfusion.

78. Nursing Assessment
• Obtain history of voiding symptoms,
including onset, frequency of day and
presence of
sensation of
nighttime
urgency,
incomplete
urination,
dysuria,
bladder emptying, and
decreased force of stream.
Determine impact on quality of life.

79. • Perform rectal (palpate size, shape, and
consistency) and abdominal examination
to detect distended bladder, degree of
prostatic enlargement.
• Perform simple urodynamic measures
uroflowmetry and measurement of
postvoid residual, if indicated.

80. Patient Education and
Health Maintenance
• Explain to patient not undergoing
treatment the symptoms of
complications of BPH urinary
retention, cystitis, and increase in
irritative voiding symptoms.
Encourage reporting these problems.

81. • Advise patients with BPH to avoid
certain drugs that may impair voiding,
particularly OTC cold medicines
containing sympathomimetics such
as phenylpropanolamine.

82. • Advise patient that irritative voiding
symptoms do not immediately resolve
after relief of obstruction; symptoms
diminish over time.

83. • Tell patient postoperatively to avoid
sexual intercourse, straining at stool,
heavy lifting, and long periods of
sitting for 6 to 8 weeks after surgery,
until prostatic fossa is healed.

84. • Advise follow-up visits after treatment
because urethral stricture may occur
and regrowth of prostate is possible
after TURP.
of herbal or
marketed for
natural•
prostate
• Be aware
products
health.

85. Complications
• Acute urinary retention
• Involuntary bladder contractions
• Bladder diverticula
• Cystolithiasis
• Vesicoureteral reflux( back flow )

86. Bladder diverticula

87. • Hydroureter - dilation of the ureter.
• Hydronephrosis - swelling of a kidney due to a
build-up of urine. It happens when urine cannot
drain out from the kidney to the bladder
• Gross hematuria
• UTI