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Benign Prostate Hypertrophy

Introduction
 Prostate gland is a walnut size gland that is situated below a
bladder of man.
 Prostate glands wrap around the urethra and formation fluid part of
semen and carry urine from blood.
 Benign prostate hyperplasia (BPH) is the most common urologist
problem in male adults.

Definition
 BPH is an enlargement of the prostate gland.
 BPH generally caused the urinary retention due to blockage of
male urethra.

Cause
 Unknown cause
 Older age above 50 years
 Family history
 Diabetes
 Chronic infection
 Heart disease
 Sedentary lifestyle
 Hormone alteration ( increase androgen )
 Prolonged obstruction
 Decrease testosterone level.

Sign and symptoms

 Decrease force of urinary stream

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 Burning and painful urination

 Urinary obstruction
 Retention of urine
 Dribbling air leaking after urination
 Dysuria and nocturia
 Incomplete bladder empty
 Urine incontinence
 Hesitancy
 Recurrent UTI
 Anorexia and fatigue
 Haematuria ( blood in urine )
 Renal failure
 Nausea and vomiting
 Feeling of bladder fullness
 Pelvic discomfort
 Urgency.

Pathophysiology
Cause and Etiology
↓
Hyperactivity of testosterone
↓
Overgrowth of prostate gland and tissues
↓
Prostatic urethra become narrow
↓
Prolonged obstruction
↓
BPH

Diagnostic examination
 History collection and physical examination.
 Urinalysis and urine culture test.

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 Serum test ( increase BUN )

 Digital rectal examination
 Serum prostate specific antigen ( PSA ) - Increase
 Trans rectal ultrasound ( TRUS )
 Serum creatinine - increase
 Cystoscopy
 USG.

Medical management
 Alpha adrenergic receptor blockers - used to relax smooth muscles
of the bladder.

 Tamaulosin, Alfuzosin.

 5 alpha - reduce inhibitors - reduce the size of the prostate gland.

 Antiandrogen agents - used to prevent hyperplasia of prostate
glands.
 Erectogenic drugs
 Herbal therapy.

Surgical management
 Transurethral resection of a prostate (TURP) - used to visualise
bladder cavity by inserting a telescope through an electroscope.
 Transporter incision of prostate (TUIP) - used to Incision into
prostate tissue to relieve obstructions.
 Prostatectomy
1. Surgery of choice of BPH.
2. Suprapubic prostatectomy
3. Retro pubic prostatectomy
4. Perineal prostatectomy.

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 Minimal invasive surgery

o Laser prostatectomy.
o Intra prostatic urethral stents.
o Transurethral electro vaporization of prostate (TUVP).
o Transurethral microwave thermotherapy (TUMT).
o Transurethral needle ablation (TUNA).

Complications
 Urinary tract infection ( UTI )
 Urinary retention
 Kidney damage and bladder damage
 Bladder stones.

Nursing management
 Monitor patient vital signs and physical examination.
 Monitor patient input and output charts.
 Assess frequency of urine stream and dribbling.
 Provide privacy for urination.
 Provide prescribed medication and IV fluids.
 Prepare the patient for surgical intervention.
 Nurse collects all surgical equipment at the side of the operative
table.
 Nurses follow the barrier of nursing to prevent infection.
 Nurses maintain hygiene conditions to prevent infection.
 Instruct patients to urinate every 2 - 3 hours, when they first feel an
urge.
 Provide health education.

Key Points

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1. Which gland wrap around the urethra - Prostate gland.

2. Most common urologic disorder in male - BPH.

3. Most common cause of BPH - Age (above 50 years old).

4. Mild to moderate BPH treat by - Medications.

5. Surgery of choice of BPH - Prostatectomy.

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