1. INSTITUTE OF HEALTH SCIENCES
SCHOOL OF MIDWIFERY AND NURSING
DEPARTMENT OF ADULT HEALTH NURSING AND
MIDWIFERY
PREPARED BY:- KIDANE DINKU.
BENIGN PROSTATIC HYPERPLASIA
1
3. At the end of this session the students will able to:-
Define Benign Prostatic Hyperplasia
Identify risk factors of BPH
Discuss pathophysiology of BPH
List clinical manifestation of BPH
Distinguish diagnosis of BPH
discuss management of BPH
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4. Over view anatomy of Prostate gland
The prostate is a gland of the male reproductive system
It is located in front of the rectum and just below the bladder,
the organ that stores urine.
It is about the size of a chestnut and somewhat conical in shape, and
consists of a base, an apex, an anterior, a posterior and
two lateral surfaces.
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5. Cont…
BPH
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Surrounds the urethra
The main purpose of the prostate is to
produce fluid for semen, which
transports sperm during the male
orgasm
Prostate grows to its normal adult
size in a man’s early 20s; it
begins to grow again during the
mid-40s
6. Benign Prostatic Hyperplasia (BPH)
BPH is one of the most common diseases in aging men.
It is a pathologic process that contributes to the development of
lower urinary tract symptoms (LUTS) in men .
It is a condition that occurs when the prostate gland enlarges,
potentially slowing or blocking the urine stream.
Other names for benign prostatic hyperplasia include benign
prostatic hypertrophy, an enlarged prostate.
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7. Cont…
BPH
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Benign
=
Non-
cancerous
Prostatic
=
Relating to
the prostate
gland
Hyperpla
sia
=
More cells
than
normal3
Commonly known as enlarged prostate, BPH means the prostate
gland has grown larger than normal
Normal adult size = approximately 1.5 inches in diameter1
Benign prostatic hyperplasia/enlargement can lead to bladder outlet
obstruction (BOO)4 which can cause lower urinary tract symptoms
8. Cont…
BPH
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As the prostate enlarges,
pressure can be put on the
urethra causing urinary
problems.
Prostate size does not
correlate with degree of
obstruction or severity of
symptoms.
Normal
Prostate
11. Cont…
BPH
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It can cause bothersome lower urinary tract symptoms that
affect quality of life by interfering with normal daily activities
and sleep patterns.
It typically occurs in men older than 40 years.
12. Epidemiology
By the time they reach 60 years, 50% of men have BPH.
BPH is a common problem that affects the quality of life in
approximately one third of men older than 50 years.
BPH is histologically evident in up to 90% of men by age 85
years.
As many as 14 million men in the United States have symptoms of
BPH.
It is the second most common cause of surgical intervention in men
older than 60 years.
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13. Risk factors
age 40 years and older.
family history of benign prostatic hyperplasia.
medical conditions such as obesity, heart and circulatory
disease, and type 2 diabetes.
lack of physical exercise.
erectile dysfunction.
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14. Pathophysiology
The cause of BPH is not well understood, but testicular
androgens have been implicated. Dihydrotestosterone (DHT),
a metabolite of testosterone, is a critical mediator of prostatic
growth.
BPH generally occurs when men have elevated estrogen
levels and when prostate tissue becomes more sensitive to
estrogens and less responsive to DHT.
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15. Cont…
develops over a prolonged period; changes in the urinary tract are
slow and insidious.
BPH is a result of complex interactions involving
resistance in the prostatic urethra to mechanical and spastic effects,
bladder pressure during voiding, detrusor muscle strength,
neurologic functioning, and general physical health.
The hypertrophied lobes of the prostate may obstruct the bladder
neck or urethra, causing incomplete emptying of the bladder and
urinary retention.
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16. Cont…
As a result, a gradual dilation of the ureters (hydroureter) and
kidneys (hydronephrosis) can occur.
Urinary retention may result in UTIs because urine that
remains in the urinary tract serves as a medium for infective
organisms.
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18. Clinical Manifestations
Obstructive and irritative
symptoms may include:-
urinary frequency,
urgency, nocturia,
hesitancy in starting
urination,
decreased and intermittent
force of stream
the sensation of incomplete
bladder emptying,
abdominal straining with
urination,
a decrease in the volume and
force of the urinary stream,
dribbling (urine dribbles out after
urination),
complications of acute urinary
retention and recurrent UTIs.
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19. Cont..
Generalized symptoms may also be noted, including fatigue,
anorexia, nausea, vomiting, and pelvic discomfort.
Other disorders that produce similar symptoms include
urethral stricture, prostate cancer, neurogenic bladder, and
urinary bladder stones.
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20. Diagnostic Findings
The health history focuses on the urinary tract, previous
surgical procedures, general health issues, family history of
prostate disease, and fitness for possible surgery.
A patient voiding diary is used to record voiding frequency
and urine volume.
A urinalysis to screen for hematuria and UTI is
recommended.
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21. Cont..
If invasive therapy is considered,
Urodynamic studies,
Urethrocystoscopy,
Ultrasound may be performed.
Complete blood studies are performed.
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23. Medical Management
The goals of medical management of BPH are to improve
quality of life, improve urine flow, relieve obstruction, prevent
disease progression, and minimize complications.
Treatment depends on the severity of symptoms, the cause of
disease, the severity of the obstruction, and the patient’s
condition.
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24. Cont..
The ordinary catheter may be too soft and pliable to advance
through the urethra into the bladder.
In such cases, a thin wire is introduced (by a urologist) into the
catheter to prevent the catheter from collapsing when it encounters
resistance.
Ametal catheter with a pronounced prostatic curve may be used if
obstruction is severe.
A cystostomy may be needed to provide urinary drainage.
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25. Cont..
Patients with mild symptoms and patients with moderate or severe
symptoms who are not bothered by them and have not developed
complications may be managed.
Other therapeutic choices include pharmacologic treatment,
minimally invasive procedures, and surgery.
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26. Treatment Options Overview
BPH
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WATCHFUL WAITING/
MEDICAL THERAPIES
MINIMALLY
INVASIVE SURGERY
INVASIVE
SURGERY
Alpha Blockers
5 Alpha-Reductase
Inhibitors
Microwave Therapy
(TUMT
Open
Prostatectomy
27. Pharmacologic Therapy
Includes the use of alpha-adrenergic blockers and 5-alpha-
reductase inhibitors .
Alphaadrenergic blockers, which include alfuzosin (Uroxatral),
terazosin (Hytrin), doxazosin (Cardura), and tamsulosin, relax the
smooth muscle of the bladder neck and prostate.
This improves urine flow and relieves symptoms of BPH.
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28. Cont..
Another method of treatment involves hormonal manipulation
with antiandrogen agents.
The 5-alpha-reductase inhibitors finasteride (Proscar)
and dutasteride (Avodart) are used to prevent the conversion
of testosterone to DHT and decrease prostate size.
Combination therapy (doxazosin and finasteride) has
decreased symptoms and reduced clinical progression of BPH.
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29. Surgical Management
Other treatment options include minimally invasive procedures and
resection of the prostate gland.
Minimally Invasive Therapy
Several forms of minimally invasive therapy may be used to treat
BPH.
Transurethral microwave thermotherapy (TUMT) involves the
application of heat to prostatic tissue.
High-energy TUMT devices and low-energy
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30. Cont..
A transurethral probe is inserted into the urethra,
and microwaves are directed to the prostate tissue.
The targeted tissue becomes necrotic and sloughs.
To minimize damage to the urethra and decrease the discomfort
from the procedure, some systems have a watercooling apparatus.
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31. Cont..
Other minimally invasive treatment options include
(transurethral needle ablation by radiofrequency energy and the
UroLume stent.
TUNA uses low-level radiofrequencies delivered by thin needles
placed in the prostate gland to produce localized heat that
destroys prostate tissue while sparing other tissues.
The body then reabsorbs the dead tissue.
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32. Surgical Resection
Surgical resection of the prostate gland is another option for
patients with moderate to severe lower urinary tract symptoms
of BPH and for those with acute urinary retention or other
complications.
The specific surgical approach (open or endoscopic) and the
energy source are based on the surgeon’s experience, the size of
the prostate gland, the presence of other medical disorders, and
the patient’s preference.
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33. Cont..
If surgery is to be performed, all clotting defects must be
corrected and medications for anticoagulation withheld
because bleeding is a potential complication of prostate
surgery.
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34. Transurethral resection of the prostate
remains the benchmark for surgical treatment for BPH. It involves
the surgical removal of the inner portion of the prostate through an
endoscope inserted through the urethra; no external skin incision is
made.
It can be performed with ultrasound guidance. The treated tissue
either vaporizes or becomes necrotic and sloughs.
The procedure is performed in the outpatient setting and usually
results in less postoperative bleeding than a traditional surgical
prostatectomy.
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35. Cont..
Other surgical options for BPH include transurethral incision of
the prostate (TUIP), transurethral electrovaporization, laser
therapy, and open prostatectomy.
TUIP is an outpatient procedure used to treat smaller prostates.
One or two cuts are made in the prostate and prostate capsule to
reduce constriction of the urethra and decrease resistance to flow
of urine out of the bladder; no tissue is removed.
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36. Cont..
Open prostatectomy involves the surgical removal of the
inner portion of the prostate via a suprapubic, retropubic, or
perineal (rare) approach for large prostate glands.
Prostatectomy may also be performed laparoscopically or by
robotic-assisted laparoscopy.
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37. Summary
BPH, common cause of urinary retention in elderly male.
The goals of medical management of BPH are to improve quality
of life, improve urine flow, relieve obstruction, prevent disease
progression, and minimize complications.
Severity of LUTS and co-morbidities determines
management of BPH.
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38. References
1. Brunner and Suddarth’s textbook of medical surgical nursing
Textbook of medical-surgical nursing Description: 14th
edition,2018.
2. Harrison's Principles of Internal Medicine,21 Edition (Vol1
&Vol2)
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