benign prostate hypertrophy

1. Benign Prostatic Hyperplasia
Presented By
Karana Ram
Msc.(n) 1st year

2. Anatomy of Prostate Gland
❑

4. ➢BPH is one of the most common pathologic
conditions in older men .
➢50% of men start experiencing symptoms
between the age of 51-60 years.
➢Enlargement compresses the urethra,
resulting in partial or complete obstruction.
• Benign – not cancer.
• Prostatic – to do with the prostate.
• Hyperplasia – an increase in size.
INTRODUCTION

5. Definition
Benign prostatic hyperplasia (BPH), a
noncancerous enlargement of the prostate
gland which involves hyperplasia of prostatic
stomal and glandular epithelial cell resulting
in formation of large, fairly discrete nodules
in transitional zone of prostate, which push
on and narrow the urethra resulting in an
increase resistance to flow of urine from the
bladder.

6. Epidemiology
•BPH typically occurs in men older
than 40 years.
•Relatives and brothers had a 4-
fold and 6-fold increase chances
for developing BPH

8. Risk factors
Modifiable
•Obesity
•Sedentary life style
•Erectile dysfunction.
•Hormones
•Metabolic syndrome
•Increase prostatic specific antigen

9. Non-modi
fi
able
•40 years and older.
•Family history of BPH

10. Pathophysiology-
Enzyme aromatase and 5-α reductase
increase in activity
Convert androgen hormones into
estrogen and
DHT(Dihydroxytestosterone)
Increase in estrogen and DHT but
decrease in testosterone
Hyperplasia of epithelial cells
and stromal cells

11. .
Compression of urethra leading
to obstruction
Incomplete emptying of bladder
Infections Hydronephrosis
Frequeny
Ascend to kidney
Kidney damage

12. Stages of BPH
•Stage 1- No bothersome
symptoms and no significant
obstruction
•Stage 2- Those with bothersome
symptoms but without significant
obstruction, they can be treated
with pharmacotherapy/
thermotherapy.

13. Contd,,,
•Stage 3- Significant obstruction
defined as uroflow of less than 10 ml/
s with persistent residual urine of >
100 ml, transurethral prostatic
resection (turp) would be
recommended.
• Stage 4- Complications of bph such
as chronic retention of urine and
bladder stone, they would need turp

14. Clinical manifestation
•Weak stream of urine
•Urinary frequency
•Urinary urgency
•Hesistency
•Straining
•Nocturia
•Urinary retention and bladder distention
•Hematuria

15. Cont,,
•Dysuria and bladder pain
•Incontinence or dribling of
urine
•Nausea and vomitting
•Pelvic discomfort and pain
•Azotemia
•Recurrent UTI

17. Dignostic evaluation
✓Personal and Family Medical
History-
✓Physical examination-
✓Digital rectal Examination

19. Medical tests-
Urinalysis-
❖For the test, a strip of chemically
treated paper called a dipstick is dip
into the urine.
❖Patches on the dipstick change color
to indicate signs of infection in urine.

20. PSA blood test-
❖ Blood for a PSA test is drawn
and send for lab analysis
❖ Prostate cells create a protein
called PSA.
❖BPH, prostate infections,
inflammation, aging, and normal
fluctuations often cause high
PSA levels

21. Urodynamic tests
➢ Uroflowmetry
➢ Postvoid residual measurement
➢ Reduced urine flow.

22. Cystoscopy
❖ To look inside the urethra and
bladder for blockage or stones in the
urinary tract.

23. Cystoscopy

24. Transrectal ultrasound
❖ Safe, painless sound waves send
off to organs to create an image of
their structurae.
❖The ultrasound image shows the
size of the prostate and any
abnormalities, such as tumors.

26. Management of BPH
Watchful waiting-
•Symptoms are mild and not
causing any change in the day-
to-day activities, wait and
watch.
•Regular check-up is
recommended.

27. Drug name Dosage Mechanism Side effects
1.Finasteride
2. Dutasteride
5 mg once
daily
0.5 mg
once daily
5- alpha reductase inhibitors
➢Block the production of DHT
➢Decrease prostate growth.
➢Shrink the size of prostate
decreased libodo,
decreased semen
quantity decreased
semen prostate
specific antigen,
gynecomastia

28. Drug name Dosage Mechanism Side effects
1. Terazosin
2. Doxazosin
1 mg/day may
upto 10 mg/
day
1mg/day may
upto 8 mg/day
Α1-adrenergic receptor
antagonist
➢Relax the smooth muscle of
prostate and bladder
➢Improve urine flow
➢Reduce bladder blockage
hypotension,
dizziness, dyspnea,
aggrevate GI
problem such as
peptic ulcer.

29. Surgical management
Minimally invasive therapy-
Transurethral electrovaporization (TUVP)
•In TUVP, the surgeon inserts a thin, tube-
like instrument (resectoscope) into the
urethra. This instrument has a lens, a light,
and a tool that sends out an electrical current
to destroy prostate tissue. Heat from the
electrical current seals small blood vessels,
reducing the risk of bleeding

30. Transurethral microwave thermotherapy
(TUMT)
➢More specific destruction of malignant cells
without affecting normal cells.
➢ Can be achieved by raising the temperature
of the cells using low-level radiofrequency
(microwave) in the prostate up to 40 to 45°C,
46 to 60°C (thermotherapy), and 61 to 75°C
(transrectal thermal ablation).

32. Transurethral needle ablation (TUNA)
➢Utilizes needle to deliver High-
frequency radio waves to destroy the
enlarged prostatic tissue
➢ Successful for small-sized gland.
➢ Poses a low or no risk for Incontinence
and impotence.

34. Transurethral ethanol ablation of the prostate
➢Transurethral injection of
absolute ethanol into the lateral
lobes of prostate
➢Produces necrotic effect on
prostatic tissue

35. Transurethral Water Jet Ablation (TWJA)
➢ Simple technique that uses a
cylindrical balloon to circulate hot water
➢Resulting in even coagulation necrosis
in the prostate by raising the temperature
of the prostatic cells up to 60 to 70°C

36. Water induced thermotherapy
This procedure uses heated water to
destroy prostate tissue.

37. INVASIVE PROCEDURE-
Transurethral resection of prostate (TURP)
•Three-way indwelling catheter with a 30-mL
balloon is inserted into the bladder after the
procedure to provide hemostasis and to
facilitate urinary drainage. The bladder is
irrigated, either continuously or intermittently,
usually for the first 24 hours to prevent
obstruction from mucus and blood clots.

38. Transurethral Resection of Prostate
• gold standard for surgical treatments of obstructing BPH.

39. Transurethral incision of the prostate (TUIP)
•Several small incisions are made
into the prostate gland to expand the
urethra, which relieves pressure on
the urethra and improves urine flow.
•option for patients with a small or
moderately enlarged prostate gland

40. Transurethral Incision of Prostate

41. Open prostatectomy
➢Incision or cutis made through the skin to
reach the prostate.
➢ The urologist can remove all or part of the
prostate through the incision.
➢ Indicated when the prostate is greatly
enlarged, complications occur, or the bladder
is damaged and needs repair.

43. Nursing management
Nursing diagnosis
Acute pain related to musosal irritation
secondary to bladder distension.

44. Intervention
•Assess the level of pain
•Tape drainage tube to thigh to prevent
pull on bladder and erosion of the penile-
scrotal junction
•Recommend bed rest as indicated
•Provide comfort measures such as back
rub
•Helping patient assume position of
comforts

45. Incomplete emptying of the bladder /urinary
retention related to mechanical obstruction
secondary to enlarged prostate gland.
Intervention-
•Encourage the patient to void every 2-4 hours
and when urge is felt.
•Asses for S/s of urinary retention, amount and
frequency of urination, suprapubic distention,
complaint of urgency and discomfort

46. Anxiety related to concern and lack of knowledge
about diagnosis treatment plan and prognosis
Intervention
• Determine patient’s concern, level of understanding
whether he is aware of diagnosis and prognosis
• Explain the investigations and diagnosis in simple
term and in language known to the patient
• Asses his psychological reaction

47. Risk for fluid volume related post obstructive
diuresis from rapid drainage of chronically
overdistended bladder.
Intervention
•Monitor intake and output carefully. Note outputs
of 100 to 200 ml/hour
•Encourage increased oral intake based on
individual needs.
•Monitor BP, pulse. Evaluate capillary refill and
oral mucosa membranes

48. Risk of infection related to surgical incision,
immobility and presence of catheter
Intervention
•Assess the health status of patient
•Observe urine for cloudiness, colour,
•Observe testicular swelling, pain, tenderness,
and redness
•Provide adequate perineal care

49. Complications-
1. urinary retention
2. Urinary tract infections
3. Bladder stones
4. Bladder damage
5. Kidney damage
6. Renal stone

50. RESEARCH ARTICLE
HoLEP: The new gold standard for surgical treatment of benign
prostatic hyperplasia
Abstract
INTRODUCTION
Transurethral resection of the prostate (TURP) was considered the
"gold standard" surgical treatment for medication-refractory benign
prostatic hyperplasia (BPH) for decades. With the desire to reduce
hospital stay, complications, and cost, less invasive procedures.With
the advent of a soft tissue morcellator, holmium laser enucleation of
the prostate (HoLEP) was introduced as an efficacious alternative to
TURP and due to its advantageous side effect profile compared to
TURP,

51. Contd,,
Materials and methods: We provide a review on
the evolution of HoLEP as a gold standard compared
to the historical reference procedures for BPH, and
provide a review of emerging laser technologies.
Results: A growing body of literature has shown
HoLEP(holmium laser prostate surgery) to be a safe
and efficient procedure for the treatment of BPH for
all prostate sizes. Long term studies have proven the
durability of HoLEP, as a first line surgical therapy
for BPH.

52. Conclusion
•BPH is the nonmalignant enlargement of the prostate
gland and a common cause of voiding dysfunction in
men.
•The primary goal of the treatment is not only to
improve urinary flow and reduce symptoms scores, but
also to prevent serious complications and improve
quality of life. Selection of therapy depends on a
number of factors like history, severity of symptoms,
procedural complications, and associated side effects

53. SUMMARY-
We have learnt about-
•Definitions of benign prostatic hyperplasia,Its
epidemiology and causes,Pathophysioly of
BPH ,Clinical manifestation,Diagnostic
evaluation,Management and its prognosis.

54. References
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Kluwer Publication.
2)Lewis. Medical Surgical Nursing Assessment and
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3)Petrica A. Potter; Fundamentals of Nursing South Asian
Edition Volume I. New Delhi; Elsevier Publications
4)Joyce M. Black, Jane Hokanson Hawks. Medical Surgical
Nursing Clinical Management of Positive Outcomes.2015.
New Delhi. Reed Elsevier India Private Limited. Volume
II.

55. Contd,
•Deters LA. Benign prostatic hypertrophy. Emedicine
website. http://emedicine.medscape.com . Updated March
28, 2014. Accessed september 30, 2018.
•BPH: surgical management. Urology Care Foundation
website. www.urologyhealth.org . Updated July 2013.
Accesse October 1, 2018
•Enlarged prostate. MedlinePlus
website. www.nlm.nih.gov . Updated October 2, 2013.
Accessed October 7, 2018
•Wikepedia.com. benign prostatic hyperplasis [Internet].
2018[updated 2018 Sept]. available from: URL: http://
en.wikipedia.org/wiki/ benign prostatic hyperplasis.htm.
Retrieved on: 17 Sept 2018