By.

Ms Simranpreet kaur
M.Sc (N)

BENIGN PROSTRATIC HYPERPLASIA

DEFINITION

It is the enlargement of the prostate gland resulting

from an increase in the number of epithelial cells
and prostate tissue
CAUSES
 Family history particularly involving first degree relatives,
environment history like exposure to environmental
allergens and diet history like consumption of increased
saturated fatty acids like butter, beef.
 Age over 80 years associated with endocrine changes.
 Increased alcohol intake
 Obesity
 Excessive accumulation of dihydroxytestosterone
hormone
PATHOPHYSIOLOGY
Due to endocrine changes in ageing

Stimulation of estrogen and local growth hormone

Increased production of 5-α reductase

Conversion of testosterone to dihydroxytestosterone

Excessive accumulation of dihydroxytestosterone

Enlargement of prostate tissue

Compression of the urethra

Obstruction of urinary outflow

Hydroureter & hydronephrosis

CLINICAL MANIFESTATIONS
 Obstructive symptoms:
decrease in the force of urinary stream
difficulty in initiating voiding
intermittency (stopping and starting stream many times
while voiding)
dribbling at the end of urination
 Irritative symptoms:
urinary frequency, urgency, dysuria
bladder pain, nocturia & incontinence.
DIAGNOSTIC FINDINGS
 Digital rectal examination to evaluate the size, symmetry and
consistency of prostate gland.
 Urine analysis to determine the presence of infection.
 Prostate specific antigen test to rule out prostate cancer
 Trans rectal ultrasound to detect the prostate size
 Uroflowmetry to study the volume of urine expelled from the
bladder per second help in determining the extent of uretheral
blockage.
 Post voidal residual urine volume to determine the degree of urine
outflow obstruction
 Cystourethroscopy to allow visualisation of the urethra and bladder.
MANAGEMENT
 Dietary modifications like decrease caeffine, artificial sweeteners, spicy
and alcoholic foods.
 Avoid medications like decongesants and anticholinergics and restrict
evening fluid intake to reduce irritative symptoms.
 Drug therapy :
5 α reductase inhibitors like finasteride & dutasteride to block the
conversion of testosterone to di-hydroxy testosterone.
α- adrenergic receptor blockers like alfuzosin, doxazosin, terazosin to
promote the smooth muscle relaxation in the prostate and facilitate
urinary outflow through the urethra.
herbal therapy like saw palmetto for management of urinary symptoms.
SURGICAL MANAGEMENT
 Trans urethral resection of prostate(TURP):
This involves removal of prostate tissue using resectoscope inserted
through the urethra.
 Trans urethral incision of prostate (TUIP): this involves making

transurethral slits or incisions in to the prostate tissue to relieve

obstruction.
 Trans urethral microwave thermotherapy:

this involves a use of microwave radiating heat to produce

coagulative necrosis to the prostate.
 Trans urethral needle ablation (TUNA): this uses a low wave

radiofrequency to heat the prostate causing necrosis.

CONTD…..
 Open Prostatectomy: this is the surgery of choice
for men with large prostates which involves the
surgical excision of the prostate tissue.
 Laser Prostatectomy: this procedure uses a laser
beam to cut or destroy the part of the prostate.
The destroyed prostate tissue gradually sloughs in
the urinary stream.
NURSING MANAGEMENT
 Urinary drainage must be established with the catheter
before surgery
 Bladder irrigation is done either intermittently or
continuously to remove clotted blood from the bladder.
 Careful aseptic technique should be used when irrigating
the bladder to prevent possible infections
 Activities that increase abdominal pressure like sitting or
standing for long periods and straining during defecation
should be avoided.