Professional Documents
Culture Documents
HYPERPLASIA
(BPH)
Clip
Dihydrotestosterone (DHT)
may play a role
Etiology
Ageing
Excessive
accumulation of
prostatic androgen
[dihydroxytestosterone]
Stimulation by estrogen
Local growth hormone action
Risk factors
Family
history
Environment
Diet [saturated fatty acids]
Reduced exercise
Alcohol consumption
Clinical Manifestations
OBSTRUCTIVE
IRRITATIVE
Frequency
Urgency
Intermittency
Dysuria
Bladder pain
Hesitancy
Nocturia
Urinary retention
Incontinence
Inflammation/ infection
Prolonged micturation
n Prostate
n Pressure
flow
complications
Acute
urinary retention
UTI
Incomplete
bladder emptying
residual urine
Stone formation
Hydronephrosis
Pyelonephritis
Bladder damage
Diagnosis
History
& PE
Digital Rectal examination
Urinalysis
Urine c/s
PSA [Prostate specific antigen]
Transrectal ultrasound
Measure Postvoidal residual urine
Cystourethroscopy
enlarged prostate
treatment
options
n
Medication
Heat therapies
Surgical approaches
Medication
n
Alpha-1-blocker - relax
the
1.5-alpha
inhibitor
reductase
heat therapies
n
n
Impotence
Incontinence
SURGICAL PROCEDURES
Types
of prostatectomy
Transurethral prostatectomy
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy
SURGICAL APPROACHES
Several approaches can be used to remove
the hypertrophied portion of the prostate
gland:
CLOSED
Transurethral resection of the prostate
(TURP),
Transurethral incision of the prostate (TUIP)
OPEN
Suprapubic prostatectomy,
Perineal prostatectomy,
Retropubic prostatectomy, and
SUPRAPUBIC PROSTATECTOMY
Suprapubic prostatectomy is one
method of removing the gland
through an abdominal incision. An
incision is made into the bladder,
and the prostate gland is removed
from above.
PERINEAL PROSTATECTOMY
Perineal
prostatectomy
involves removing the gland
through an incision in the
perineum. This approach is
practical when other approaches
are not possible and is useful for
an open biopsy.
RETROPUBIC PROSTATECTOMY
More
TURP
Minimally invasive
therapy
Transurethral
microwave
thermotherapy (TUMT)
OTHER..
Laser
prostatectomy
Visual laser ablation
Interstitial laser coagulation
Intra prostatic urethral stents
PREOPERATIVE NURSING
DIAGNOSIS
1.
2.
3.
4.
5.
Pre-operative nursing
interventions
Reducing
patient anxiety
Always remain with thepatient. Establish trusting
relationship with patient.
Ask the patient what he knows about the
procedure and its aftermath
Reinforce previous information patient has been
given
Clarify the nature of the operation and expected
post-operative outcomes
Provide privacy, and establish a trusting and
professional relationship
Encourage the to discuss feelings and concerns
Offer emotional support
Pre-operative nursing
interventions
Reducing
some types of
prostectomy can result in
impotence, it is important to
arrange for sexual counseling to
help the patient and his partner
cope
If the patient is schedule for
TURP, explain that this
procedure often causes
retrograde ejaculation but
otherwise doesnt impair sexual
preparation
Post-operative care
TURP
a 3-way catheter is kept in position after
surgery
One way is connected to a continuous
irrigation bag hanged above usually
containing 0.9% normal saline
Suprapubic prostatectomy
2 different catheters are inserted with
one in the bladder through the abdomen
and the other in the urethra
The suprapubic catheter is connected to
a continuous
Post-operative care
Observation
Post-operative care
Observation
Post-operative care
Management
of
catheters/irrigation
Maintain indwelling urinary catheter
patency through intermittent or
continuous irrigation as ordered.
Secure catheters in position
Ensure that specially prepared sterile
fluid or normal saline is used for
irrigation
Ensure that the rate of flow is
regulated to specification
THANKS