I.

Introduction The prostate is the genital organ most commonly affected by benign and malignant

neoplasm. Benign enlargement of the prostate gland is an extremely common process that occurs in nearly all men with functioning testes. Hyperplasia is a general medical term referring to excess cell replication. Benign prostatic hyperplasia (BPH) is a noncancerous growth of the prostate gland. It is the most common noncancerous form of cell growth in men and usually begins with microscopic nodules in younger men. It should be noted that BPH is not a precancerous condition. Some evidence has reported a higher incidence of benign prostatic hyperplasia -particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and type 2 diabetes. Diabetes and hypertension, in any case, worsens urinary tract symptoms in men with BPH. In one study, flow rates were adversely affected by diabetes, although residual urine volumes were not significantly greater. The exact cause of BPH is unknown. Potential risk factors include age, family history, race, ethnicity, and hormonal factors. Androgens (male hormones) most likely play a role in prostate growth. The most important androgen is testosterone, which is produced throughout a man's lifetime. The prostate converts testosterone to a more powerful androgen, dihydrotestosterone (DHT). DHT stimulates cell growth in the tissue that lines the prostate gland (the glandular epithelium) and is the major cause of the rapid prostate enlargement that occurs between puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later adulthood. Additional factors also include a defective cell death in which cells naturally selfdestruct, goes awry and results in cell proliferation a process called as apoptosis. As BPH progresses, overgrowth occurs in the central area of the prostate called the transition zone, which wraps around the urethra (the tube that carries urine through the penis). This pressure on the urethra can cause lower urinary symptoms that have been the basis for diagnosing BPH. It should be noted that BPH is not always the cause of these symptoms. An enlarged prostate may be accompanied by few symptoms, while severe LUTS may be present with normal or even small prostates and are most likely due to other conditions. Symptoms of BPH may include; Difficulty in starting to pass urine (hesitancy), a weak stream of urine, dribbling after urinating, the need to strain to pass urine, incomplete emptying of bladder, difficulty to control the urination urge, having to get up several times in the night to pass urine, feeling a burning sensation when passing urine. Sometimes a man is unaware of an obstruction until he suddenly cannot urinate at all. This condition is called acute urinary retention. It is a dangerous complication that can damage

the kidneys and may require emergency surgery. In general, BPH progresses very slowly and acute urinary retention is very uncommon. Men with BPH at highest risk for this complication tend to be elderly and to have moderate to severe lower voiding symptoms. Taking antihypertensive drugs (except for diuretics) or antiarrhythmic drugs may also increase the risk. Bladder obstruction can also cause bladder stones, blood in the urine, urinary tract infection, and incontinence. Unfortunately, no current tests can accurately predict which men are at higher risk for complications, although men with a weak urine stream and larger prostates are at higher risk for urinary retention. Diagnostic tests used to confirm Benign Prostatic Hyperplasia include Digital Rectal Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy. II. NURSING ASSESSMENT

A. Personal History Mr. Ruben Juco is a 82 years old male, who resides at Purok 4 Jesus St. Pulung Bulo, Angeles City. His religious affiliation is Roman Catholic and is married to Mrs. Rita Juco. Mr. Juco had previously worked at Clark-air based Pampanga. He loss his job when the American soldier leave Pampanga. Since then, he never had a job and just stays in their home. Mr. Juco usually sleeps at 10 in the evening and wakes up at around 4 in the morning. Mr. Juco usually spends time watching TV, dawdle in front of their house, chatting with his neighbors and going to a market via bicycle. Mr. Juco usual viand includes chicken, fish or meat and rice. He also loves eating bread and drinking milk. Before, he used to love eating tinapa, sardines, tocino and bagoong. He also smokes before and is able to consume 1 pack of cigarette a day. He drinks alcohol beverages occasionally. Regarding the finances about health he is using his PHILHEALTH card to compensate the finances needed.

III.

ANATOMY AND PHYSIOLOGY

The prostate gland is located under the urinary bladder, in front of the rectum and wraps around the urethra (the tube that carries urine through the penis). It is basically composed of three different cell types the glandular cells, smooth muscle cells and stromal cells The central area of the prostate that wraps around the urethra is called the transition zone. The entire prostate gland is surrounded by a dense, fibrous capsule. The prostate gland provides the following functions: (1) the glandular cells produce a milky fluid, and during sex the smooth muscles contract and squeeze this fluid into the urethra. Here, it mixes with sperm and other fluids to make semen. (2) the prostate also secretes another substance that may have antibacterial properties. (3) the prostate gland also contains an enzyme called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone that has a major impact on the prostate. The prostate gland undergoes many changes during the course of a man's life. At birth, the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to enlarge rapidly, attaining normal adult size and shape, about that of a walnut, when a man reaches his early 20s. The gland generally remains stable until about the mid-forties, when, in most men, the prostate begins to enlarge again through a process of cell multiplication. Hormonal changes also occur in the prostate gland; testosterone levels fall while dihydrotestosterone remain at normal levels. Neurophysiology of Continence and Micturition: The parasympathetic and sympathetic maintains an important role in urinary continence. During bladder filling, sensory nerve endings detect progressive stretching of the bladder wall and convey information via the parasympathetic to the spinal cord and brain which produces reflex contractions in the bladder neck and prostatic urethra as well as in the external urethral sphincter thereby maintaining continence. As volume of urine increases, starting from 300-500 ml., awareness of the need to void develops. Voluntary voiding is accomplished by stimulation of the parasympathetic nerve fibers causing coordinated contraction of the detrusor muscle and the bladder body. Nerve impulses passing down the sympathetic and pudental motor fibers cease momentarily, allowing relaxation of normally tonically contracted bladder neck, prostatic urethra and external thus allowing urine to flow.

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