notes of b.sc nursing students.

1. Benign prostrate Hyperplasia
By:
Kirandeep kaur
Professor of MSN

2. DEFINITION
It is the enlargement of the prostate gland
resulting from an increase in the number of
epithelial cells and prostate tissue

3. CAUSES
 Family history particularly involving first degree
relatives, environment history like exposure to
environmental allergens and diet history like
consumption of increased saturated fatty acids
like butter, beef.
 Age over 80 years associated with endocrine
changes.
 Increased alcohol intake
 Obesity
 Excessive accumulation of
dihydroxytestosterone hormone

4. PATHOPHYSIOLOGY
Due to endocrine changes in ageing
Stimulation of estrogen and local growth hormone
Increased production of 5-α reductase
Conversion of testosterone to dihydroxytestosterone
Excessive accumulation of dihydroxytestosterone
Enlargement of prostate tissue
Compression of the urethra
Obstruction of urinary outflow
Hydroureter & hydronephrosis

5. CLINICAL MANIFESTATIONS
 Obstructive symptoms:
decrease in the force of urinary stream
difficulty in initiating voiding
intermittency (stopping and starting stream
many times while voiding)
dribbling at the end of urination
 Irritative symptoms:
urinary frequency, urgency, dysuria
bladder pain, nocturia & incontinence.

6. DIAGNOSTIC FINDINGS
 Digital rectal examination to evaluate the size, symmetry
and consistency of prostate gland.
 Urine analysis to determine the presence of infection.
 Prostate specific antigen test to rule out prostate cancer
 Trans rectal ultrasound to detect the prostate size
 Uroflowmetry to study the volume of urine expelled from
the bladder per second help in determining the extent of
uretheral blockage.
 Post voidal residual urine volume to determine the degree
of urine outflow obstruction
 Cystourethroscopy to allow visualisation of the urethra
and bladder.

7. MANAGEMENT
 Dietary modifications like decrease caeffine, artificial sweeteners,
spicy and alcoholic foods.
 Avoid medications like decongesants and anticholinergics and
restrict evening fluid intake to reduce irritative symptoms.
 Drug therapy :
5 α reductase inhibitors like finasteride & dutasteride to block the
conversion of testosterone to di-hydroxy testosterone.
α- adrenergic receptor blockers like alfuzosin, doxazosin,
terazosin to promote the smooth muscle relaxation in the prostate
and facilitate urinary outflow through the urethra.
herbal therapy like saw palmetto for management of urinary
symptoms.

8. SURGICAL MANAGEMENT
 Trans urethral resection of prostate(TURP):
This involves removal of prostate tissue using
resectoscope inserted through the urethra.
 Trans urethral incision of prostate (TUIP): this
involves making transurethral slits or incisions in to
the prostate tissue to relieve obstruction.
 Trans urethral microwave thermotherapy:
this involves a use of microwave radiating heat to
produce coagulative necrosis to the prostate.
 Trans urethral needle ablation (TUNA): this uses a
low wave radiofrequency to heat the prostate causing
necrosis.

9. CONTD…..
 Open Prostatectomy: this is the surgery of
choice for men with large prostates which
involves the surgical excision of the prostate
tissue.
 Laser Prostatectomy: this procedure uses a
laser beam to cut or destroy the part of the
prostate. The destroyed prostate tissue
gradually sloughs in the urinary stream.

10. NURSING MANAGEMENT
 Urinary drainage must be established with the
catheter before surgery
 Bladder irrigation is done either intermittently or
continuously to remove clotted blood from the
bladder.
 Careful aseptic technique should be used when
irrigating the bladder to prevent possible
infections
 Activities that increase abdominal pressure like
sitting or standing for long periods and straining
during defecation should be avoided.