BENIGNA PROSTAT HIPERPLASIA

(BPH)
Basic Concepts of Illness
2.1 Definitions
Benign Prostate Hyperplasia (BPH) is a condition that often occurs as a
result of growth and control of prostate hormones. (Yuliani elin, 2011).Benign
Prostate Hyperplasia (BPH) is a progressive enlargement of the prostate gland
(in general in men older than 50 years) causing varying degrees of urethral
obstruction and urinary flow restriction. (Marilynn, E.D., 2000: 671).
2.2 Epidemiology
It affects more than 50% of fifty-year-olds and about 90% of them are over
seventy years old.
2.3 Etiology
The exact cause of the occurrence of BPH until now is unknown. But certainly
the prostate gland is highly dependent on androgen hormones. Another factor
closely related to BPH is the aging process. There are several possible causes:
a) Dihydrotestosterone
Increased 5 alpha reductase and androgen receptors cause the epithelium and
stroma of the prostate gland to become hyperplated.
b) Changes in the hormone estrogen balance - testosterone
In the aging process in men there is an increase in estrogen hormone and
decrease in testosterone resulting in stromal hyperplasia.
c) Stroma - epithelial interactions
Increased epidermal gorwth factor or fibroblast growth factor and decreased
transforming growth factor beta cause stromal and epithelial hyperplasia.
d) Reduced dead cells
Increased estrogen causes an increase in stromal and epithelial life of the
prostate gland.
e) Stem cell theory
Increased stem cells result in transit cell proliferation.
2.4 Pathophysiology
• Prostate enlargement process occurs slowly so that changes in the urinary tract
also occur slowly.
• Initial stage of BPH is the presence of retention in the jar neck and prostate
area increases as well as the occurrence of thickening and stretching of detrusor
muscles that lead to sakulasi or divertikel. This detrusor thickening phase is
called the compensation phase. If the condition continues this detrusor
becomes tired and eventually decompensated and unable to contract so that
urinary retention may subsequently lead to hydronephrosis and urinary tract
dysfunction.
2.5 Classification
With rectal toucher can be known degree from BPH, that is:
a) Degree I = weight of prostate  20 grams.
b) Degree II = prostate weight between 20-40 grams.
c) Degree III = weight of prostate  40 grams.
2.6 Clinical Symptoms
Clinical symptoms induced by Benigne Prostate Hyperplasia are referred to as
Syndroma Prostatisme. Syndroma Prostatisme is divided into two namely:
a) Obstructive symptoms are:
1) Hesitancy is the start of old urine and often accompanied by straining
caused by muscle destrussor jar takes some time to increase the pressure of
intravesikal to overcome the pressure in the urethra of prostatika.
2) Intermittent ie disjointed urine flow caused by the inability of destrussor
muscle in maintaining intra vesika pressure until the end of micturition.
3) Terminal dribling is dripping urine at the end of urine.
4) The weak emission: weakness of the power and the caliber of the
destrussor jet takes time to get beyond the pressure in the urethra.
5) Dissatisfaction after the end of urination and feel not satisfied.
b) Symptoms of Irritation are:
1) Urgency is the feeling of wanting to urinate that is difficult to hold.
 2) Frequency ie miksi patients more often than usual can occur at night
(Nocturia) and during the day.
3) Dysuria is pain in urine.
2.7 Physical Examination
a) Performed by examination of blood pressure, pulse and temperature. The
pulse may increase in morbidity in acute urinary retention, dehydration to shock
on urinary retention and urosepsis to shock-septic.
b) Abdominal examination is done by bimanual technique to know the
existence of hydronephrosis, and pyelonephrosis. In the supra-symfiser region
the retention state will be prominent. When palpation feels the ballotemen and
the client will feel like miksi. Percussion is done to determine the presence or
absence of residual urine.
c) Penis and urethra to detect possible stenose meatus, urethral stricture,
urethral stones, carcinoma or phimosis.
d) Scrotum examination to determine the presence of epididymitis 1) Rectal
touch is aimed at determining the consistency of the neural system of the
urethral vessel unit and the magnitude of the prostate.
e) Anamnesa Symptoms of BPH are known as LUTS (Lower Urinary Tract
Symptoms), among others: hesitancy, weak urine emission, intermittency,
dribbling terminals, feels there remain aftermath called symptoms of
obstruction and irritant symptoms can be urgency, frequency and dysuria.

2.8 Diagnostic / Support Check

a) Laboratory Examination
1) Complete blood examination, renal physiology, serum electrolytes and
sugar levels are used to obtain baseline data on the general state of the
client.
2) Complete urine examination and culture.
3) PSA (Prostatic Specific Antigen) is important to be examined as a
vigilance of malignancy.
 b) Uroflowmetric examination One symptom of BPH is the weakening of urine
emission. Objectively urine emission can be checked with uroflowmeter with
assessment:
1) Maximum flow rate  15 ml / s = non obstructive. 2) Maximum flow rate
10 - 15 ml / s = border line. 3) Maximum flow rate  10 ml / sec =
obstructive. c) Imaging and Rontgenological examination 1) BOF (Buik
Overzich) To see the presence of stones and metastases in bone.
2) Ultrasound (Ultrasonography) To check for consistency, the volume and
bulk of the prostate is also a state of the bladder including residual urine.
Examination can be done transrectally, transuretral and supra pubic.
3) IVP (Intravenous Pyelography) Used to see the function of renal
excretion and the presence of hydronephrosis.
4) Panendoskop Check To know the state
2.9 Therapy
a) Drugs:
1) Alpha 1-blocker For example doxazosin, prazosin, tamsulosin and
teralosin. These medications cause relaxation (relaxation) of the muscles in
the bladder so that patients more easily urinate.
2) Finasterid Finasterid causes reduced levels of prostate hormone thereby
decreasing the size of the prostate. These drugs also cause increased urinary
flow rate and reduce symptoms. But it takes about 3-6 months until a
significant improvement occurs. Side effects of finasterid are decreased
sexual arousal and impotence.
3) Other drugs To treat chronic prostatitis, which often accompanies BPH,
is given antibiotics.
b) Surgery: Surgery is usually performed on patients who have:
1) Urinary incontinence
2) Hematuria (blood in urine)
3) Urinary retention (urine stuck inside the bladder) Recurrent urinary tract
infections. The choice of surgical procedure usually depends on the severity
of the symptoms as well as the size and shape of the prostate gland. of the
urethra and jar.

a. TURP (trans-ureteral resection of the prostate) TURP is the most

frequently performed BPH surgery. Endoscopy is inserted through the penis
(urethra). The advantages of TURP are no incision so as to reduce the risk
of infection. 88% of patients undergoing TURP experience improvement
over 10-15 years. Impotence occurred in 13.6% of patients and 1% of
patients experienced urinary incontinence. b. TUIP (trans-ureteral incision
of the prostate) TUIP accompanies TURP, but is usually done in patients
who have relatively small prostate. In the prostate tissue is made a small
incision to dilate the urethral holes and holes in the bladder, resulting in
improved urinary flow rate and reduced symptoms. Complications that may
occur are bleeding, infection, urethral narrowing and impotence. c. Open
prostectomy An incision can be made in the abdomen (through the structure
behind the pubic / retropubic bone and above the pubic / suprapubic bone)
or in the perineum (pelvic floor covering the scrotum to the anus). The
current perenium approach is rarely used anymore because the incidence of
impotence after surgery is 50%. This surgery takes time and usually the
patient should be treated for 5-10 days. The complications that occur are
impotence (16-32%, depending on surgical approach) and urinary
incontinence (less than 1%). Other treatments of its effectiveness are still
under research are hypertremia, laser therapy and prostatic stents. If the
degree of blockage is minimal, the following actions may be taken:

1. Hot shower

2. Immediately urinate when the urge to urinate appears

3. Avoiding alcohol

4. Avoid excessive fluid intake (especially at night)

5. To reduce nocturia, should reduce fluid intake a few hours before bedtime
2.10 Management The purpose of therapy in patients with BPH
1. Medical
According Mansjoer (2000) and Urnomo (2000) management on BPH can
be done by:
1) Observation Reduce drinking after dinner, avoid decongstan medicine,
reduce coffee, avoid alcohol, every 3 months control complaints, residual
urine and rectal rectal.
2) Medikamentosa (Baradero et al 2007) - Inhibits adrenorecept a - Anti-
androgen drugs - Enzyme inhibitor a-2 reductase - physiotherapy
3) Bad Therapy The indications are that if repeated urinary retention,
haematuria, decreased renal function, urinary tract infection, hydroureter,
hydronephrosis, surgical type:
- TURP (Trans Uretral Resection Prostatectomy) That is the removal of part
or the whole of the prostate gland through a cytochoscope or a
resectoscope that is input through the urethra
- Retropubic prostatectomy That is the removal of the prostate gland
through the incision in the lower abdomen via the anterior fossa prostate
without entering the bladder.
- Suprapubic prostatectomy Namely removal of the prostate gland through
incisions in the lower abdomen via the radial prostate fossa through an
incision made in the bladder
- Peritoneal prostate That is the removal of the radical prostate gland
through an incision between the scrotum and rectum - Radical retropubic
prostate Namely removal of the prostate gland including the capsule,
seminal vesicles and adjacent tissue through an incision in the lower
abdomen, the urethra is insulted into the bladder neck of prostate cancer.
4) Minimally invasive therapy
- Trans uretral microwave the motheraphy (TUMT) That is the installation
of prostate dengn micro wave channeled to the prostate gland through the
antenna is installed through or at the end of the catheter.
- Trans uretral ultrasound guided laser induced proststectomy (TULIP)
- Trans uretral ballon dilatation (TUBD)
2. Nursing
1) Pre operation
- Full blood examination (minimum hg 10g / dl, blood type, CT, BT, AL)
- Examination of EGK, GDS remember most people with BPH
- Radiological examination: BNO, IVP, Rongen totax
- Preparation before BNO fasting at least 8 hours. Before the IVP examination
the patient is given a diet of soy sauce porridge, lavemen fasting at least 8
hours and reduce speech to minimize the entry of air.
2) Post operation
- Irrigation / spoling with Nacl
- Post operation day 0: 80 drops / m
- First day post operation: 60 drops / m
- Day 2 post operation: 40 drops / m
- Day 3 post operation: 20 drops / m
- Day 4 post operation: in clamp
- Day 5 post operation done aff irrigation if no problem (urine in clear catheter)
- Day 6 post operation performed aff drain when no problem (serohemoragis
fluid <50cc
- Infusions are given for maintenance and give an injection drug during the day,
if the patient has mmpu eat and take medicine with either injection drug rejected
by oral medication
- Bed rest during the first 24 hours of mobilization after 24 hours post op
- Conducted wound care and DC care 3 days post op with betadin
- Encourage drinking (2-3L / day)
- DC can be removed 10 days post op
- Check hb post op if less than 10 give transfuse
- If a bladder spasm occurs the patient may feel urge to urinate, feel pressure
or tightness in the bladder and urethral bleeding around the catheter.
Medications that can soften smooth muscle can help eliminate warm spasms in
the pubis can help eliminate spasm
- If the patient can move freely the patient is encouraged to walk but does not
sit too long because it can increase abdominal pressure / bleeding
- Perineal exercises are performed to help achieve urinary control
- Drainage below as pinkish urine is easily reddish then clear to slightly red red
easy within 24 hours after surgery
- Bright red bleeding with increased viscosity and a number of clots usually
indicates venous bleeding by placing traction on the catheter so that the balloon
holding the catheter in place puts pressure on the prostatic fossa
 BIBLIOGRAPHY

Bibliography
Wilkinson, M. J. (2012). Handbook of Nursing Diagnosis Nanda Diagnosis, NIC Intervention.
Jakarta: EGC.

Bibliography
Taylor.M.C and Ralph, S. (2010). Diagnosis of Nursing By Care Plan Edition 10. Jakarta: ECG.

Wilkinson, M. J. (2012). Handbook of Nursing Diagnosis Nanda Diagnosis, NIC Intervention.

Jakarta: EGC.