Care Conference on BPH

3. LEARNING
OBJECTIVES
State the definition of
BENIGN PROSTATE
HYPERPLASIA.
List the etiology of
BENIGN PROSTATE
HYPERPLASIA..
Identify the

4. Cont.
 State the clinical
manifestation of BENIGN
PROSTATE HYPERPLASIA..
Identify the complication of
BENIGN PROSTATE
HYPERPLASIA..
Identify the nursing
intervention & appreciate the

6. Doctor = Dr N
Diagnosis
= BENIGN PROSTATE
HYPERPLASIA with
acute urinary
retention

7. Mr S was admitted to
5XX-1 with complaint of :
 Difficulty passing
urine
 Nocturia & frequency
 Urgency
 Incomplete emptying

8. S/B Dr N 10/7 ago (2/7/12) :
 US done findings – Grade 111 BPH.
Put on CBDand tried to removed the
CBD2/7 ago (10/7/12) but failed and
problem remained same.
 Came again to clinic 12/7/12 and
agreed forop as suggested by DrN.

10. ADMITTED ON 12/7/12 @ 1150H
 Mr S
 Male
 64 years old
 Pensioner
 Malay
 Wheeled in to ward

11. Medical history
- Diabetic (20 years)
- Hypertension (20 years)
- IHD (2009)
Surgical history
- COROS (2009) in Pantai Ipoh
Family medical history
- Unknown
Allergic
- NIL

12. Current Medication
- Amlodipine
- Metoprolol
- Metformin
- Daonil
- Aspirin (On admission Dr N asked
patient to stop taking)

14. VITAL SIGNS
Temp = 37.5˚C
Pulse = 82 bpm
Resp = 21 bpm
B/P = 170/80 mmHg

15. VITAL SIGNS
Weight = 62 kg
Pain Score = 2

16. PHYSICAL EXAMINATION

17. PHYSICAL EXAMINATION
•SUNKEN EYES
•DRY LIPS

18.  Frequency
 Urgency
 Straining
 Dribbling & poor
stream
 Nocturia
 Insomnia
Other ADL normal

19. ON ARRIVAL
• GXM 1 pint WB
• IV Sulperazone 1gm BD
• Ural 1/1 TDS
• Celebrex 200mg BD
• Proscar 5mg Daily
• BD dextrosmeter
• TURP under SA on 15/7/12
• Cont own medication but stop Aspirin

20. 12/7/12 @ 2250H
• Phone noted to Dr N patient put
all medication mix together &
cannot recognize which one is
Aspirin. Dr N asked to withold all
own medication.

21. Phone ordered from Dr N :
• Metformin 1gm BD
• Amlodipine 7.5mg Daily
• Lovastatin 10mg ON
• Metoprolol 50mg BD
• Daonil 7.5mg BD

24. Understanding the prostate
Walnut-shaped gland that forms part of the
male reproductive system
Surrounds the urethra - the tube that carries
urine from the bladder out of the body



25. Secretes semen which
carries sperm
During orgasm, prostate
muscles contract and
propel ejaculate out of the
penis
Understanding the prostate



27. The size of prostate enlarged microscopically since the age
of 40.Half of all men over the age of 60 will develop an
enlarged prostate
By the time men reach their 70’s and 80’s, 80% will
experience urinary symptoms
But only 25% of men aged 80 will be receiving BPH treatment
BPH



28. Peripheral zone
Transition zone
Urethra
What is Benign Prostatic Hyperplasia?

29. Peripheral zone
Transition zone
Urethra

32. What causes BPH?
BPH is part of the natural aging
process, like getting gray hair
or wearing glasses
BPH cannot be prevented
BPH can be treated




46. SURGICAL PROFILE
Biochemistry
• Glucose 10.6 mmol/L

47. SURGICAL PROFILE
Microscopic Examination, urine
• WBC , urine 4/hpf
• Bacteria, urine +

48. CHEST X-RAY
- Normal
ECG
- Normal sinus rhythm

49. URINE C&S
More than 100000 cfu/ml of
Pseudomonas aeruginosa isolated.

50. DIGITAL RECTAL EXAMINATION

51. ULTRASONOGRAPHY
• To give clearer view on size and
shape and determine stages of BPH.

52. International Prostate Symptom
Score (IPSS)
– Symptom assessment based on questionnaires
developed by American Urological Association
(AUA).
– Contains 7 questions about severity of symptoms.
– Total score : 0–7 (mild), 8–19 (moderate), 20–35
(severe)

53. Prostate Specific Antigen (PSA)
– Men with larger prostates have higher PSA levels
– PSA is a predictor of disease progression and
screening tool for Ca Prostate
– As PSA values tend to increase with increasing PV
and increasing age, PSA may be used as a
prognostic marker for BPH

55. When should BPH be treated?
BPH needs to be treated ONLY IF:
Symptoms are severe enough to bother the
patient and affect his quality of life
Complications related to BPH


56. 
“Watchful waiting”
 Medication
 Surgical approaches
 TURP
Treatment options

57. Choosing the right treatment
Consider risks, benefits and
effectiveness of each
treatment
Consider the outcome and
lifestyle needs



59. “watchful waiting”
For mild symptoms. Follow up 1 to 2 times
yearly
Offer suggestions that help reduce
symptoms
Avoid caffeine and alcohol
Avoid decongestants and antihistamines





60. Medication
First line of defense against
bothersome urinary symptoms
Two major types:
α blockers - relax the smooth muscle of
prostate and provide a larger urethral
opening (Hytrin,Doxaben,Harnalidge)
5 α reductase inhibitor - Shrink
the prostate gland (Proscar,
Avodart)





61. Benefits
Convenient
No loss of work
time
Minimal risk
Disadvantages
Drug Interactions
Must be taken every day
Manages the problem
instead of fixing it
Medication







62. Possible side effects of
• Impotence
• Dizziness
• Headaches
• Fatigue
• Loss of sexual drive
medication






63. Distribution of α1-Adrenergic Receptors

65. Localization of α1-Adrenergic
Receptors (α1-ARs)

66. DRUGS
ORDERED ON PRE MED
DATE
ORDERED
Tab Zantac 150 mg STAT 15/7/12
Tab Maxalon 10 mg STAT 15/7/12
Tab Celebrex 200 mg STAT 15/7/12

67. POST OP 15/7/12 @ 1045H
- IVD 3 pint Normal Saline
- Continue bladder irrigation
- Continue rest of RX
- Allow orally

68. POST OP 15/7/12 @ 1800H
- Continue bladder irrigation, stop once
completed
- IV Lasix 20mg once CBI completed
- Transfer out tonight

70. Indication of surgical intervention
• Acute urinary retention
• Gross hematuria
• Frequent UTI
• Vesical stone
• BPH related hydronephrosis or renal function
deterioration
• Obstruction

71. Conventional Surgical Therapy
• Transurethral resection of the
prostate (TURP)
• Open simple prostatectomy

73. TURP
“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)




76. TURP
Benefits
Widely available
Effective
Long lasting
Disadvantages
Greater risk of side effects
and complications
1-4 days hospital stay
1-3 days catheter
4-6 week recovery








77. Complication of TURP
• Immediate complication
bleeding
capsular perforation with fluid extravasation
TUR syndrome
• Late complication
urethral stricture
bladder neck contracture (BNC)
retrograde ejaculation
impotence (5-10%)
incontinence (0.1%)

78. Open Simple Prostatectomy
• “too large prostate” -- >100 gm
• Combined with bladder diverticulum or vesical
stone surgery
• Suprapubic or retropubic method

79. Minimally invasive therapy for BPH
• transurethral balloon dilatation of the prostate
(TUBDP)
• transurethral incision of the prostate (TUI)
• intraprostatic stent
• transurethral microwave thermotherapy (TUMT)
• transurethral needle ablation of the prostate (TUNA)
• transurethral electrovaporization of the prostate
(TUVP)
• photoselective vaporization of the prostate (PVP)
• Cryotherapy
• Transurethral ethanol ablation of the prostate (TEAP)

80. Minimally invasive therapy for BPH
• transurethral laser-induced prostatectomy (TULIP)
• visual laser ablation of the prostate (VLAP)
• contact laser prostatectomy (CLP)
• interstitial laser coagulation of the prostate (ILC)
• holmium:YAG laser resection of the prostate
(HoLRP)
• holmium:YAG laser enucleation of the prostate
(HoLEP)
• high-intensity focused ultrasound (HIFU)
coagulation
• botulinum toxin-A injection of the prostate

84.  Alteration in emotional
status anxiety related to
surgical procedure and
post op care.
NURSING DIAGNOSIS

85. NURSING DIAGNOSIS
Potential infection related
to prolonged catherization of
bladder.

86. NURSING DIAGNOSIS
Alteration in sleeping
pattern related to nocturia.

88. NURSING DIAGNOSIS
 Potential bleeding related
to surgical wound.

89. NURSING DIAGNOSIS
Potential infection related
to surgical incision.

90. NURSING DIAGNOSIS
 Alteration in ADL related to
post spinal anaesthesia.

91. NURSING DIAGNOSIS
 Potential infection
related to intravenous
cannula insertion.

92. NURSING DIAGNOSIS
 Potential infection related
to CBD catherization.

93. NURSING DIAGNOSIS
 Knowledge deficit related
to treatment regime and
post operative care.