3. Benign Prostate Hyperplasia
It is a condition progressive enlargement of
prostate gland, resulting from an increase in the
number of size of epithelial cells and stromal
tissue.
6. Etiology
Ageing
Excessive accumulation of prostaticandrogen
Family history
Diet increase animal fat and saturated faty acids
Reduced exercise and alcoholconsumption
7. Etiology
Recent studies have identified smoking (both
current and former smoking), heavy alcohol
consumption, hypotension, heart disease and
diabetes mellitus as risk factors associated with
BPH.
8. Pathophysiology
The cause of BPH is uncertain, but studies
suggest that estradiol levels may have a
relationship to prostate size among men with
testosterone levels above the median.
Recent studies have identified smoking both
current and former, heavy alcohol
consumption, hypertension, heart disease and
diabetes as risk factors of BPH.
9. Pathophysiology
The hypertrophied lobes of prostate may
obstruct the vesical neck or prostatic urethra,
causing incomplete emptying of the bladder and
urinary retention.
As a result. A gradual dilation of the ureters
(hydroureter) and kidneys (hydronephrosis)can
occur. Urinary tract infections may result from
urinary stasis. Urine remaining in the urinary
tract serves as a medium for infectve
organisms.
16. Complications
Acute urinary retention
Urinary tract infections(UTI)
Renal stone (kidneystone)/ Bladder stone
Bladderdamage/ decompensation
Hydronephrosis
Pyelonephritis
Sexual Dysfunction
Urinary incontinence
17. Assessment and Diagnostic
Tools
History- H/o surgical procedure (genitourinary),
hematuria, UTIs, DM. Current Medications
(anticholinergics-which impair bladder contractions
or sympathomimetics-that increase outflow
resistance, Use of voiding dairy)
Physical examination- Digital rectal examination to
detect enlarged prostate, to evaluate anal sphincter
tone, to rule out any neurological problems.
Urinary outflow resistance
can be estimated,
provided the bladder
pressure, equivalent exit
pressure, and the urinary
flow rate are measured
simultaneously
18. Assessment and Diagnostic
Tools
Urinanlysis-to rule out UTIs & hematuria
Urine culture and sensitivity
Serum Creatinine-to evaluate LUTS
Prostate Specific Antigen (PSA)-can help to rule out
prostatic carcinoma
Transrectal Ultrasound- to rule out enlargement
Uroflowmetry & Urodynamics -to evaluate the flow-rate
It is electric recording
of urine flow-rate
throughout course of
micturition.
19. Assessment and Diagnostic
Tools
Post-voidal residual urine- to measure residual
urine. It ranges b/w 0.09-2.24 ml.
Pressure flow studies- to distinguish uretheral
obstruction and impaired detrusor contractility.
>15ml/sec flow rate suggests bladder dysfunction.
Filling Cystometry-Invasive urodynamic procedure
to determine bladder capacity & compliance
20. Assessment and Diagnostic
Tools
Cystourethoscopy- to visualise the prostatic urethera
and bladder.
Complete blood studies are performed because
hemorrhage is a major complication of prostate
surgery, all clotting defects must be corrected. A high
percentage of patients with BPH have cardiac or
respiratory complications, or both because of their age
therefore cardiac and respiratory function also
assessed.
21. Medical Management
The main goals of medical management are-
Restore bladder function
Relieve signs and symptoms
Prevent and treat complications
22. Contd..
The treatment Plan depends on the cause of
BPH, the severity of the obstruction, and the
patient’s general health conditions.
If the patient is admitted on an emergency
basis because he can not void, he is
immediately catheterized.
23. Dietary Management
Decrease amount of intake caffeine and
artificial sweetners, limit spicy and acidic foods
and alcohol.
24. Pharmacological Management
Alfa-adrenergic blockers such as doxazosin,
tamsulosin (relaxes smooth muscles of bladder neck
and prostate to facilitate voiding).
5-alfa reductase inhibitors such as finasteride and
dutasteride (exert anti-androgen effect on prostatic
cells and can reverse or prevent hyperplasia).
Aromatase Inhibitors
Symptomatic Management
25. Surgical Management
Several approaches or methods depends on size of
gland, severity of obstruction, age, health of client
& prostatic disease.
Surgery is primary intervention for BPH.
During surgery prostate gland is left intact and
adenomatous soft tissue is removed by one of four
surgical routes.
Transuretheral, Suprapubic, Retropubic, Perineal
26. Contd…
2 newer approaches balloon dilatation of prostate
under endoscopy and TUIP.
Indications-
Acute urinary retention
Recurrent infection
Recurrent hematuria
Azotemia
27. Closed Surgical Procedures
TURP (Transurethral resection of the prostate)
TUIP (Transurethral incision of the prostate)
TUMT (Transurethral Microwave therapy)
TUNA (Transurethral Needle ablation)
29. Others
• Newer treatments include balloon urethroplasty,
laser therapy, and intraurethral stents
• Other minimally invasive surgical techniques
include: ◗ Transurethral needle ablation to burn
away well-defined regions of the prostate, thereby
improving urine flow with less risk
30. TURP
Removal of prostate tissue using a
resectoscope is inserted through the tip of
penis and into the tube that carries urine from
bladder (urethra) under spinal or general
anaesthesia.
31. TUIP
A combined visual and surgical instrument
(resectoscope) is inserted through the tip of penis
into the tube that carries urine from bladder
(urethra). The prostate surrounds the urethra. The
surgeon 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.
32. TUMT
A small microwave antenna is inserted through the
tip of penis into the tube that carries urine from
bladder (urethra)
33. TUNA
Radiofrequency ablation, is a minimally invasive
treatment option used to treat benign prostatic
hyperplasia. During the procedure, radiofrequency
needles are placed through the urethra into the
area of the prostate that is pressing on the urethra.
34. Suprapubic Prostatectomy
Suprapubic Prostatectomy is one method of
removing the enlarged gland through an
abdominal incision . An incision is made into the
bladder and the prostate gland is removed from
above.
35.
36. Perineal prostatectomy
Perineal prostatectomy involves removing the
gland through an incision in the perineum. (This
method is practical when other methods or
approaches are not possible.
37. Retropubic prostatectomy
Retropubic prostatectomy is a another
technique, is more common than suprapubic
approach. Incision made on low abdominal
between prostate gland and pubic arch and the
bladder without entering the bladder.
39. Cancer of Prostate
Abnormal proliferation of cells of prostate.
Most common carcinoma in men over 65 years.
Etiology is UNKNOWN. Increased risk if family
history, influences of dietary intake, S. testosterone
levels are under investigation.
40. Clinical Manifestation
May be asymptomatic at early stage.
Symptoms due to obstruction of urinary flow:
Hesitancy & straining on voiding
Frequency
Nocturia
Diminution in size & force of urinary stream.
41. Clinical Manifestation
Symptoms due to metastasis:
Pain in lumbosacral area radiating to hips &
down legs.
Perineal & rectal discomfort.
43. Investigations
Digital rectal examination (Hard nodule may be felt)
Needle biopsy for Histological study
Trans-rectal USG
PSA (4-10 ng/ml-suspect and > 10 ng/ml indicate
cancer)
44. Medical Management
Periodic PSA determination & examination for
evidence of metastasis
Symptomatic management
Analgesics & Narcotics to relieve pain
TURP to relieve obstruction
Suprapubic cystostomy
45. Surgical Management
Radical Prostatectomy- entire prostate gland,
capsule, seminal vesicle and pelvic lymph nodes
are removed.
Cryosurgery of prostate freezes prostatic tissue
killing tumor cells without removing gland.
48. Hormonal therapy (Palliative)
Aim is to deprive tumor cells & its by-product.
Bilateral orchidectomy (removal of testes)
Luteinizing hormone releasing hormone analogues
Antiandrogen drugs
Complications- hot flushes, N/V, gynaecomastica,
sexual dysfunction.
49. Nursing Management
The goals of nursing management
Restoration of urinary drainage
Treatment of urinary tract infections
Understanding the procedure
50. Nursing Diagnosis
• Impaired urinary elimination related to obstruction of
urethra
• Risk for infection related to surgical incision, urinary
catheter
• Anxiety related to urinary incontinence, difficulty
voiding.
51. Pre-operative Interventions
Avoid alcohol and caffeine
Advise to urinate every 2-3 hours
Normal fluid intake should be maintain and
avoid over fluid intake and volume over land.
Antibiotics before any Invasive procedure
52. Post-Operative Care
Assess the patient’s conditions.
Main complications is hemorrhage, bladder
spasm, urinary Incontinence and infections.
Bladder irrigation
Catheter care
Avoid activities that increase abdominal
pressure.
53. Post-Operative Care
ToRelive bladder spasms use Anti spasmodics
After removing catheter, patient should urinate
within 6 hours.
Patient should practice pelvic floor exercise ( kegel
exercise)
Encourage to practice straining and stoping the
stream during urination.
54. Post-Operative Care
Dietary advice or management including
fiber and easily digestibale food
Adminster stool softners, avoid heavy alcohol
intake, weighting, and sexual intercourse.
56. Prostatitis
An inflammation of the prostate gland.
Prostatitis is most common prostate problem in
men under the age of 50.
It is classified as-
Bacterial Prostatitis
Non-bacterial Prostatitis
57. Bacterial Prostatitis
There are 4 types of bacterial prostatitis
Type I- acute bacterial caused by GI or sexually
transmitted bacteria
Type II- chronic bacterial caused by GI (gram
negative ) organisms
Type III- chronic pelvic pain syndrome
Type IV- asymptomatic inflammatory prostatitis
58. Pathophysiology & Etiology
Acute bacterial invasion of prostate from reflux of
infected urine into ejaculatory & prostatic duct or
secondary to urethritis or rectal examination when
bacteria are present. It is often caused by gram
negative bacteria- pseudomonas, gram positive
cocci- streptococcus, staphylococcus.
59. Contd…
Chronic bacterial prostatitis: Ascending infection
from urethera. Due to gram negative bacteria-
E.Coli, proteus, klebsiella, pneumonia &
pseudomonas aeruginosa.
Non-bacterial prostatitis: May be complication of
urethritis.
60. Clinical Management
Sudden chills & fever with body aches with acute
prostatitis.
More subtle symptoms with chronic prostatitis.
Bladder irritability, frequency, dysuria, nocturia,
urgency, hematuria
Pain in perineum, rectum, lower back and lower
abdomen & penile head.
Pain after ejaculation, symptoms of uretheral
obstruction.
61. Investigations
Culture & Sensitivity test for urine
Rectal examination- tender, painful swollen
prostate, warm to touch in acute cases.
Elevated leucocytes (leucocytosis)
66. Nursing Diagnosis &
Interventions
Ineffective thermoregulation related to infection/
Hyperthermia related to infection
Monitor vitals
Cooling measures
Hydration status
Oral/Parenteral fluids
Antipyretics as prescribed.
67. Nursing Diagnosis &
Interventions
Pain & discomfort related to inflammation
Bed rest
Warm sitz bath to relieve pain & promote
muscular relaxation of pelvic floor
Stool softeners, high fibers diet to prevent
constipation
Anti-inflammatory & Analgesics as prescribed