BPH, or Benign Prostatic Hyperplasia, is a non-cancerous enlargement of the prostate gland that commonly affects older men. It's a very common condition, with many men experiencing some degree of prostate enlargement as they age. The enlarged prostate can press on the urethra and bladder, leading to urinary problems

1. BENIGN PROSTATE
BENIGN PROSTATE
HYPERTROPHY
HYPERTROPHY
By; JK

2. LEARNING OUTCOMES
LEARNING OUTCOMES
 Review the anatomy and physiology of
the prostate gland
 Definition of terms
 Causes of BPH
 Signs and symptoms
 Diagnostic criteria
 Management of BPH

3. Basic facts about prostate gland
Basic facts about prostate gland
 Walnut sized gland located below bladder
and surrounds the urethra.
 Its growth is influenced by male hormone
androgen, testosterone and oestrogen.
 It secretes fluid that supports viability and
motility of the sperm. It modifies the pH
of the vagina to help protect the sperm

4.  During puberty prostate gland growth is
rapid, but thereafter it slows by the age
of 30.
 The next change in size and firmness of
the gland occur after the age of 50 and
commonly produce signs and symptoms
of BPH

5. WHAT IS BENIGNE PROSTATE
WHAT IS BENIGNE PROSTATE
HYPERTROPHY?
HYPERTROPHY?
 Also known as benign prostate
hypertrophy.
 It is a non cancerous (benign) growth of
the prostate gland.
 Some parts of the prostate may atrophy
while other parts enlarge and become
nodular.

6. CAUSES OF BPH
CAUSES OF BPH
 Cell growth is stimulated by an increase
in the hormones : androgen and
oestrogen and increase in an enzyme 5-
alpha reductase.
 The enzyme convert testosterone into
hyperactive dihydrotestosterone (which
is 10x active than testosterone)
 This stimulates growth of prostate
 Castration has been associated with
reduced incidence of BPH

7. PREDISPOSING FACTORS
PREDISPOSING FACTORS
Age, especially above 50yrs

8. PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
 The growth of prostate creates bladder
outlet obstruction.
 Urine stream becomes weak, causing man
to strain to empty the bladder.
 This leads to compensatory hypertrophy
of bladder muscles
 Change in contours of bladder muscle
leads to urine retention &
hydronephrosis & increase in urine
alkalinity& UTI

9. SIGNS AND SYMPTOMS
SIGNS AND SYMPTOMS
 Straining to start the stream
 Decrease in force of the stream
 Dysuria
 Hesitancy in starting
 Postvoid dribbling
 Nocturia, urgency, incontinence
 Haematuria (break in vessels)
 Incomplete bladder emptying

10. Diagnostic evaluations
Diagnostic evaluations
 History taking
 DRE: digital rectal examination is a procedure
in which a health care provider inserts a gloved,
lubricated finger into the rectum to feel the
prostate.
 TRUS: Transrectal ultrasonography: device
(transducer) inserted into the rectum which
produces sound waves directed at prostate and
a picture is created.
10

11. Diagnostic investigation
Diagnostic investigation
 CT: Computed tomography; a picture
produced by a computer fro x-rays showing the
prostate and the surrounding tissues.
 Bone scan and chest x-ray when cancer is
suspected to detect metastases.
 Intravenous pyelogram (IVP) : dye injected then
x-ray done.
 Cystourethroscopy
11

12. Diagnostic evaluation of prostate
Diagnostic evaluation of prostate
BLOOD TESTS
 Full blood count
 Blood urea and creatinine
 Prostate-specific antigen (PSA): Detects
blood substances that often increases in
cases of prostate cancer and relatively
lower level about 18% may indicate BPH
12

13. DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION
 Urine analysis
 Tissue biopsy
 Pelvic node dissection
(lymphadenectomy)
13

14. Medical management
Medical management
 Drugs that in hibit activity of 5-alpha-
reductase: flomax, doxasin, terazosin
 Surgical management (Prostatectomy):
when its recurrent, causing obstruction.
14

15. PROSTATECTOMY
PROSTATECTOMY
 Removal of the prostate gland

16. INDICATIONS
INDICATIONS
 Benign prostate hyperplasia
 Cancer of the prostate
 prostatitis

17. APPROACHES
APPROACHES
TRANSURETHRAL:
 Ideal in enlarged medial lobe BPH
 No incision made
 Device for cutting and cauterization is
inserted in the urethra
 Bladder spasm may occur
 Hemorrhage and obstruction can occur
 Irrigation of the bladder is done to
prevent obstruction
17

18. Supra-pubic resection (transvesicle)
Supra-pubic resection (transvesicle)
 Indicated in large tumour
 Low midline incision made
 Bladder incised to access the prostate
 Foley catheter with 30 ml inserted
 Irrigation done
 Abdominal dressing may be soaked with urine
 Impotence, sterility, infection, haemorrhage are
some of the complications
18

19. Retro-pubic resection
Retro-pubic resection
 Indicated in large mass
 Low midline incision
 Bladder not incised
 Foley catheter inserted
 Abdominal dressing may be soaked
 Haemorrhage, bleeding, obstruction may
occur postoperatively
19

20. Perineal resection
Perineal resection
 For large mass located low in the pelvic area
 Incision made between the scrotum and rectum
 Foley catheter with 30 ml balloon in urethra
 Perineal drain used but perineal dressing is not
soaked with urine
 Haemorrhage, obstruction , impotence,
sterility, incontinence, wound infection are
some of the complication.
20

21. Retro-pubic resection
Retro-pubic resection
 Indicated in large mass
 Low midline incision
 Bladder not incised
 Foley catheter inserted
 Abdominal dressing may be soaked
 Haemorrhage, bleeding, obstruction may
occur postoperatively
21

22. Pre-op care
Pre-op care
 risk for infection, urinary retention,
bladder injury, incontinence, obstruction
 Knowledge deficit related to lack of
previous exposure.
22

23. PAIN
PAIN
 Assess the location, severity and precipitating
factors to pain as baseline data for intervening.
 Position in supine position which put the
bladder in relaxed position thereby promoting
comfort
 Catheterize the bladder if any difficult consult
the specialist to avoid trauma while aiming at
relieving bladder distension
23

24. PAIN…
PAIN…
 Incase of a full bladder catheterize the bladder
to release the tension hence promoting
comfort.
 Assess for a full bladder and patient ability to
void urine because full bladder aggravate pain.
 Strap the catheter on the thigh and avoid
kinking to promote drainage of the catheter to
promote relief from pain.
24

25. PAIN..
PAIN..
 Put the catheter bag below the level of the
patient but making sure that it is not pulling the
catheter to promote drainage by gravity and
preventing trauma to the bladder.
 Warm compress may help to relieve the
spasms of the bladder.
 Administer analgesia (as prescribed) Pethedine
50 mg IM.
 Non-pharmacotherapy pain management
25

26. Anxiety
Anxiety
 Provide/ create an enabling environment for the patient
and spouse to express themselves freely.
 Assess her concerns and respond accordingly or refer
when appropriate; Patients are often not comfortable
to discuss sexuality issues
 Explain disease process and treatment plan to promote
understanding and autonomy before signing the consent
form.
 Have him sign the consent form
26

27. Anxiety …
Anxiety …
 Explain on retrograde ejaculation: first urine
voiding may have semen but this will fade over
time.
 Explain on possibility of urinary problems like
retention, dribbling and incontinence and their
possible management
 Explain that sexual intercourse will be delayed
for about three weeks to allow healing of the
wound, prevent pain and infection.
27

28. Anxiety
Anxiety
 Explain on the use of pads in case of
dribbling to prevent embarrassment.
 Explain on bed accessories, iv lines
catheter that he will have after operation
to promote cooperation and reduce
anxiety after the operation
28

29. Haemorrhage
Haemorrhage
 Assess the blood pressure and pulse rate as
baseline data and detect any deviation.
 Check Hgb, blood group and clotting time as
baseline data, preparing for transfusion and to
detect coagualopathy.
 Arrange with the lab to serve at least two units
of blood in readiness for intra-operative
bleeding management.
 Anaesthetist to assess the patient.
 Correct any anaemia before operation
29

30. Infection, dribbling, obstruction,
Infection, dribbling, obstruction,
 Check temperature as base line data to rule
infection.
 Ensure all assessments have been done to have
baseline condition of the patient before
operation: HIV, BUN, FBC, blood sugar, urine
analysis.
 Few days before operation the diet should be
soft and fluid encouraged to prevent
constipation after surgery
 Put the irrigation fluids close to the patient bed
30

31. Infection
Infection
 Encourage to pas stools the morning before
operation to prevent intra-operative contamination.
 Starve from midnight or 8 hours before opration
 Clean the patient and dress him in theatre gown.
 Administer prophylactic antibiotics:
 Chloramphenicol 1 gm iv start
 Benzyl penicillin 3mu iv start
 Metronidazole 5oomg iv start
31

32. Knowledge: Dribbling, obstruction,
Knowledge: Dribbling, obstruction,
sexual alterations
sexual alterations
 Explain on the possibility of having
urinary dribbling and that use of pad will
help to prevent embarrassment.
 Explain on bladder irrigation that will be
done after operation to gain cooperation
and reduce anxiety.
 On his part explain what he will have to
report ant abnormality.
 Sex to be delayed for 6 months
32

33. Post operative care
Post operative care
 Ineffective airway clearance
 Haemorrhage related to surgery
 Pain related to surgery, bladder spasms
 Risk of urinary obstruction related to the clot
formation following surgery
 Anxiety related to surgery out comes
 Risk of infection
 risk of incontinence or dribbling related to weak
sphincter muscles
 Knowledge deficit related to lack of previous exposure
33

34. Ineffective airway clearance
Ineffective airway clearance
 Individual assignment: just as any post
operative patient.
34

35. Haemorrhage
Haemorrhage
 Assess for overt bleeding on the abdominal or perineal dressing
for prompt intervention.
 Assess the colour of drainage in the drainage tubes. Red, bloody
colour is acceptable in the first 2 hours but it should come clearer
overtime.
 Assess the general condition of the patient, bp and pulse to detect
any deviations and signs of shock.
 vital signs be checked every 15 minutes to monitor condition
35

36. Haemorrhage…
Haemorrhage…
 Turn the patient gently to prevent pulling
the tube which can cause pain and
bleeding.
 Keep the man warm to maintain good
vessel calibre.
 Nurse in supine position for relaxation
and a pain relief and for easy visualization
of the abdominal incision dressing
36

37. Haemorrhage…
Haemorrhage…
 Check mucus membranes for anaemia.
 Keep intravenous infusion flowing as
ordered to ensure adequate intravascular
volume but also assist in flushing the
bladder.
 Transfuse blood is any signs of shock or
evidence of blood loss in intra-operatively
or post operatively.
 Check haemogobin. after 48 hours
37

38. Pain
Pain
 Position in supine with legs raised on a
pillow for relaxation of the bladder.
 Assess any pain and aggravating factors for
appropriate interventions.
 Secure catheter, drainage tubes to prevent
movement which can trigger pain.
 Assess for any full bladder, blockage in
irrigation system or kinked drainage tubes
because full bladder can trigger pain.
38

39. Pain…
Pain…
 Advise patient not to pull the catheter.
 Empty the urinary bag when full to prevent its
weight from pulling the bladder
 Administer prescribed analgesics: pethedine
100mg IM 6 hourly to promote comfort.
 Warm compress may used but not on the
wound.
 Provide soft diet (when bowel sounds are
present) to prevent constipation
 Diversion therapy of reducing pain.
39

40. Pain…
Pain…
 Catheter may be irritating, therefore
advise the patient not to urge because
this may precipitate pain and bleeding.
 When coughing advise the patient to
support the abdomen to prevent straining
and pressure on the suture line which
might cause pain.
40

41. Risk of urinary retention
Risk of urinary retention
 Assess the patency of the irrigation system and any leakage on
supra-pubic dressing for appropriate interventions.
 Keep the irrigating fluids available and close to the patient bed for
easy access.
 Use normal saline for irrigation because it has clot dissolving
properties thereby preventing clot formation in the urinary
system.
 Monitor intake and output to avoid fluid overload.
 Avoid introducing air into the system to this can lead to bladder
spasms and slow flow of irrigation.
 Milk the catheter toward the bag to facilitate drainage.
41

42. Dribbling
Dribbling
 Deflating of the balloon should be done in consultation with the
surgeon to prevent haemorrhage.
 Before removal of catheter bladder irrigation can be done four
hourly to train the bladder muscles.
 Spigotting the catheter intermittently to train the sphincter muscles.
 After removal of the catheter, explain and demonstrate on perineal
exercises (squeezing the buttocks and relaxing them2 hourly)
 Advise him to reduce fluid intake at night to prevent nocturnal/
nocturia.
42

43. Anxiety
Anxiety
 Explain the events that took place during
operation and the findings + plan of care
to allay anxiety and facilitate his
participation.
 Show him some of the resources than
have been connected to his body and
what is expected of him to allay anxiety.
 Allow him and the spouse to ask
questions and answer in simple terms to
promote understanding and allay anxiety.
43

44. Anxiety…
Anxiety…
 Explain on that sexual intercourse will be
delayed for 6 weeks in good course
 Explain on retrograde ejaculation which is
manifested in milky urine but will resolve
after sometime.
 Evaluating the coping of the patient
through his participation of his care.
44

45. Infection
Infection
 Check body temperature as baseline data
after operation and every 4 hours to
detect infection.
 Infuse sterile fluids during irrigation to
prevent infection.
 Keep theatre dressing intact for 48-72
hours unless it is soiled.
 Use aseptic technique when dressing the
wound
45

46. Infection…
Infection…
 Do catheter care using aseptic technique:
clean the urethral meatus and the glans
gently to prevent irritation and irritation.
Administer prescribed antibiotics:
 Gentamycin 80 mg iv 8hourly for 48
hours
 X-pen 3mu iv 6hourly for 48 hours
 Metronidazole 500mg iv 8 hourly for 48
hours.
46

47. Infection
Infection
 Check the colour, consistence and smell
of bladder drainage for signs of infection
and report urgently.
 Ensure catheter is draining well to ensure
flushing out of the micro-organisms.
 Provide food rich in proteins, vitamins,
carbohydrates for wound healing process
but be soft to prevent constipation.
 Less fat to avoid precipitating recurrence.
47

48. Knowledge deficit
Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft diet
and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
48

49. Education..
Education..
 Bladder training: hold the stream of urine
to train the bladder
 Perineal exercises
 Reduce fluid intake at night
 Avoid strenuous exercises
 Take medication as prescribed
 Stop taking pepper and alcohol
 Avoid sitting for too long
49

50. Pre-operative care
Pre-operative care
 Altered comfort, pain, related to urinary
retention, bladder distension secondary
to enlarged as verbalized by the patient.
 Anxiety related to pending pending
surgery; fear about sexual dysfunction
after surgery.
 High risk for reduced cardiac output
related to surgery
50

51. Knowledge deficit
Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft diet
and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
51

52. Knowledge deficit
Knowledge deficit
 Explain rationale for sense of urge to void
 Tell them not to remove the catheter
 Explain importance of adequate fluids, soft diet
and stool softeners
 Explain on the importance of review visit
 Sex to be resumed in 6 weeks
 Report at the hospital if any challenge
 Complications: impotence, retrograde
ejaculation
52

53. Education..
Education..
 Bladder training: hold the stream of urine
to train the bladder
 Perineal exercises
 Reduce fluid intake at night
 Avoid strenuous exercises
 Take medication as prescribed
 Stop taking pepper and alcohol
 Avoid sitting for too long
53

54. Complications of prostatectomy
Complications of prostatectomy
 Impotence
 Dribbling of urine
 Urine incontinence
 DVT
 Urinary tract infection
 sterility
54