BPH

1. BENIGN
PROSTATIC
ENLARGEMENT

3. Benign Prostatic Enlargement is common disease in
aging men.
Is a non cancerous enlargement or hypertrophy of the
prostate gland.
When prostate enlarges, then it can squeeze down on
urethra and impede (slow) the flow of urine.
It is also known as benign prostatic hyperplasia and
abbreviated as BPH

4. Etiology
•Unknown (Idiopathic)
•Risk Factor
–Aging >40 YR
–Family history
–Ethnic background
Prostate enlargement is less common in Asian
men than in white and black men

5. CONT. ….
–Diabetes, Heart Disease and Cirrhosis Of Liver
–Lifestyle:
oObesity increases the risk of BPH
oPhysical inactivity
oDietary factors

6. PATHOPHYSIOLOGY

8. Clinical Manifestation

10. Less Common Signs And Symptoms Include
• Blood in the urine
• Fatigue
• Anorexia
• Nausea and vomiting
• Pelvic discomfort

11. Diagnosis
• History taking; includes specific question about day
time voiding, frequency, nocturia, urgency.

12. Digital
Rectal
Examination

13. CONT. ….
• Urine analysis and urine C/S
• Intravenous Pyelogram
• Prostate-Specific Antigen (PSA) test:
–PSA is a protein made only by the prostate gland. PSA
level above 4.0 ng/mL.
• Transrectal prostatic ultrasound

14. Medical Management
Medication classes for BPH management are alpha
adrenergic blockers and 5α-reductase inhibitors.
1. Alpha adrenergic blockers
–it is most common choice for initial therapy like
alfuzosin, doxazosin.
–Alpha blockers relax smooth muscle in the prostate
and the bladder neck, thus decreasing the blockage
of urine flow

15. CONT. ….
2. 5α-Reductase inhibitors:
–Finasteride and Dutasteride are used for BPH.
–These medications inhibit the 5α-reductase enzyme,
which, in turn, inhibits production of DHT
{dihydrotestosterone or androstanol one}, a
hormone responsible for enlarging the prostate

16. Relieve Retention:
• Immediate catheterization
• Voiding position: sitting position
Lifestyle:
–Decreasing fluid intake before bedtime
–Avoid alcohol, smoking, consumption

17. Surgical Management

18. Transurethral resection of prostate (TURP)
Remove excessive growth of the prostate gland,
resulting from Benign Prostatic Hyperplasia (BPH)

19. Laser PVP (Photo selective Vaporization of the
Prostate)
During laser PVP surgery, a tube with an imaging
system (cystoscope) is inserted into the penis. A
surgeon places a laser through the cystoscope to burn
away (vaporize) excess tissue that is blocking urine flow
through the prostate

21. Transurethral microwave therapy (TUMT)
It's generally used for men with small- to moderate-
sized prostates.
A small microwave antenna is inserted through tip of
the penis into the bladder (urethra).
The antenna emits a dose of microwave energy that
heats and destroys excess prostate tissue blocking
urine flow.

23. Transurethral needle ablation (TUNA)--
radiofrequency ablation
A combined visual and surgical
instrument(resectoscope) is inserted through the tip of
the penis.
Through which doctor guides a pair of tiny needles into
the prostate tissue that is pressing on the urethra.
Radio waves are then passed through the needles,
generating heat that creates scar tissue. Special shields
protect the urethra from the heat.
The scarring shrinks prostate tissue, allowing urine to

25.  Transurethral incision of the prostate (TUIP)
A combined visual and surgical instrument
(resectoscope) is inserted through the tip of the penis
into the tube that carries urine from the bladder
(urethra).
prostate that surrounds the urethra, cuts one or two
small grooves in the area where the prostate and the
bladder are connected (bladder neck) to open the
urinary channel and allow urine to pass through more
easily.

26. Nursing Management

27. Assessment
• Ask the patient to describe all urinary manifestation
• Assess the patient’s ability to empty his bladder
• After surgery assess vital signs and maintenance of
urinary drainage
• Assess the patient’s urine output
• Assess for the patency of urinary catheter

28. Nursing Diagnosis
• Impaired urinary elimination related to enlargement
of prostate as manifested by frequency, urgency.
• Acute pain related to surgery and bladder spasm.
• Risk for injury related to presence of urinary catheter,
hematuria, irrigation.
• Risk of deficient fluid volume related to renal
dysfunction.

29. Intervention
• Catheterize when the client has urinary difficulties
such as obstruction, urinary retention or diminished
renal function.
• Monitor urine output; it should be at least 0.5 ml/ kg/
hr.
• Maintain irrigation:
If obstruction is suspected, 60ml of irrigant can be
pushed manually and evacuate blood debris and
clot.

30. C O N T . …
• Monitor for bleeding:
Venous blood can be controlled by increasing the
pressure in the balloon.
If arterial bleeding is present then it need
immediate surgical intervention
• Prevent infection:
Keep the skin around the catheter site clean, dry and
protected.

31. CONT. … ..
• Maintain a closed urinary drainage system until
manual irrigation is absolutely required.
• Perform voiding trial 1- 2 days before catheter
removal to prevent urinary retention.
• Antispasmodic drugs; oxybutynin should be given.

32. CONT. ……
• Patient Teaching
Avoid prolong sitting as it increases intra-
abdominal pressure and precipitate bleeding.
Strenuous activities, prolong ride in automobiles is
contraindicated for 4-6 wks.
Avoid to strain during defecation for at least 6 wks.

33. CO NT. ….
Teach to tighten the pelvic muscle for 6-10 second
followed by rest period of equal duration. Begin with
5-10 exercise daily and gradually increase up to 25-30
daily.
Information and supportive care for the patient and
his partner for the uncommon complication of
prostectomy i.e. penile erectile dysfunction.

34. CONT. …
• Follow up:
Ask the patient to report immediately for any
unusual bleeding, obstructed urine flow.
Provide teaching about date, time and place for
follow-up.

35. Complication
• Hydronephrosis
• Renal calculi
• Thickening diverticulation
• Impeded outflow of urine
• Acute or chronic renal failure