BENIGN

PROSTATIC
HYPERPLASIA
 Objectiv
e of the class the student will be able to-
At the end

Define benign prostate hyperplasia.

• Enlist risk factor and causes of benign prostate hyperplasia.

• List down the clinical manifestation of benign prostate hyperplasia.

• Explain the stages of benign prostate hyperplasia.

• Enumerate diagnostic evaluation the benign prostate hyperplasia.

• Explain the management of benign prostate hyperplasia.

• Level of prostate specific antigen
• Normal 4-8 nmol/ml
• BPH 9-10 nmol/ml
• Less than 4 nmol/ml
• Diagnostic for BPH & suggestible for CA
• More than 10 nmol/ml
Suggestive for CA Prostate.
Control of urine semen flow
• The prostate acts as a kind of valve, preventing urine flow during the
ejaculation and or permitting urine flow in between.
Control of urine semen flow
• The prostate acts as a kind of valve, preventing urine flow during the
ejaculation and or permitting urine flow in between
 Definition:

Prostate is a fibro muscular glandular

structure situated between the neck of the
bladder and external urethral sphincter
and surround the prostatic urethra.

• iconical in shape
 SURFAC
E
It has 3 surfaces
1. Anterior
2. posterior
3.Two inferior-
lateral
LOBES
it has 5 lobes
1.Anterior
2.Posterior
3.Median
4.Two Lateral
Size
• About 3cm vertically, 4cm Transversally at base and about 2cm antero-
posteriorly.
Weight
• 15-20 gm
Physiology of prostate gland
• Prostate also secretes a glycol proteinious fluid which is
known as PSA, The PSA actually liquefies the semen
and allows the sperm to swim freely, and it is the best
tumour marker for Ca prostate.
Prostate secretion
• The prostatic fluid is thin, slightly acidic (pH 6.4) and forms about 20%
of semen volume.
• It contains spermine (for the motility of sperms), spermidine,
prostate glandins (for uterus stimulation), zinc (affects testosterone
metabolism of the prostate), citric acid (buffer), immunoglobulins,
phosphatases and proteases.
DEFINITI
ON
IT IS COMMON DISEASE IN AGING MEN.
Is a non cancerous enlargement or
hypertrophy of the prostate
gland.
When prostate enlarges, then it
can squeeze down on urethra and
impede (slow) the flow of urine.
It is also known as benign prostatic
hyperplasia and abbreviated as
BPH.
 RISK
• Aging >40 YR FACTOR
• Family history.
• Ethnic background. Prostate enlargement is less common in
Asian men than in white and black men.
• Diabetes and heart disease. Diabetes, as well as heart disease
and use of beta blockers, might increase the risk of BPH.
• Lifestyle. Obesity increases the risk of BPH,
while exercise can lower your risk.
• CAUSES: UNKNOWN
(IDIOPATHIC)
Clinical
manifestation
Less common signs and symptoms include
• Blood in the urine
• Fatigue
• Anorexia
• Nausea and vomiting
• Pelvic discomfort
Diagnostic evaluation
• HISTORY COLLECTION
Past health history
Present health history
• Physical examination
• Urinary blood test to screen for benign
prostate hyperplasia
• Ultrasound of the prostate
• prostate-specific antigen (PSA) test: PSA is a protein made
only by the prostate gland. PSA level above 4.0 ng/mL.
• Transrectal ultrasound-guided biopsy):biopsy of the
prostate done through the rectum using an ultrasound to guide.
A DIGITAL RECTAL EXAM (DRE): During the examination, the
gently puts a lubricated, gloved finger of one hand into the rectum
use the other hand to press on the lower belly or pelvic area.
 The main aim is to:
• improve the quality of life,
• improve urine flow,
• relieve obstruction,
• prevent disease progressive and minimize complication.
Treatment depend on the severity of disease, symptoms, causes of
disease, and patient condition.
 Immediate catheterization.
Lifestyle
Decreasing fluid intake before bedtime.
Avoid alcohol, smoking, consumption.
Voiding position
Voiding position when urinating may influence urodynamic parameters
(urinary flow rate, voiding time, and post-void residual volume)
There is no differences between the standing and sitting positions for
healthy males, but that, for elderly males with lower urinary tract
symptoms, voiding in the sitting position:
• post void residual volume was decreased
• maximum urinary flow was increased,
• voiding time was decreased
• This urodynamic profile is associated with a lower risk of
urologic complications, such as cystitis and bladder stones
 Medical management

.
• The two main medication classes for BPH management are alpha adrenergic
blockers and 5α-reductase inhibitors.
• alpha adrenergic blockers: it is most common choice for
initial therapy like alfuzosin, doxazosin.
• Alpha blockers relax smooth muscle in the prostate and the bladder neck,
thus decreasing the blockage of urine flow.
• 5α-Reductase inhibitors: finasteride and dutasteride are used for BPH.
These medications inhibit the 5α-reductase enzyme, which, in turn, inhibits
production of DHT {dihydrotestosterone or androstanol one}, a hormone
responsible for enlarging the prostate.
Surgical management
Surgical management
If medical treatment is not effective:
Surgery for bph include:
 Transurethral incision of the prostate (TUIP}
 Transurethral Resection of the Prostate–TURP
 Photo selective Vaporization of the Prostate (Laser PVP)
 Transurethral microwave therapy (TUMT)
 Transurethral needle ablation (TUNA)--radiofrequency ablation
Transurethral incision of the prostate (TUIP}
A combined visual and surgical instrument (resectoscope) is inserted through the
tip of the penis into the tube that carries urine from your bladder (urethra).
prostate that surrounds the urethra, cuts one or two small grooves in the area
where the prostate and the bladder are connected (bladder neck) to open the
urinary channel and allow urine to pass through more easily.
• TURP – Transurethral Resection of the Prostate:
Transurethral Resection of the Prostate (TURP) is a procedure to
remove excessive growth of the prostate gland, resulting from Benign
Prostatic Hyperplasia (BPH).
• Laser PVP (Photo selective Vaporization of the Prostate)
During laser PVP surgery, a tube with an imaging system (cystoscope) is
inserted into the penis. A surgeon places a laser through the cystoscope to burn
away (vaporize) excess tissue that is blocking urine flow through the prostate.
Transurethral microwave therapy (TUMT)
It's generally used for men with small- to moderate-sized prostates.
A small microwave antenna is inserted through tip of the penis into the bladder
(urethra).
The antenna emits a dose of microwave energy that heats and destroys excess
prostate tissue blocking urine flow.
• Transurethral needle ablation (TUNA)--radiofrequency ablation
• A combined visual and surgical instrument(resectoscope) is inserted
through the tip of the penis.
• the cystoscope, doctor guides a pair of tiny needles into the
prostate tissue that is pressing on the urethra.
Radio waves are then passed through the needles, generating heat that
creates scar tissue. Special shields protect the urethra from the heat.
The scarring shrinks prostate tissue, allowing urine to flow more easily.
Nursing management
Acute pain related to bladder distension as evidence by patient
verbalization.
GOAL: To reduce pain
Intervention:
• Maintain patient comfort.
• Assess the location, intensity duration of pain.
• Provide comfort measures such as back rub, helping patient assume
position of comfort. Suggest use of relaxation and deep-breathing
exercises, diversional activities.
• Urinary Retention related to mechanical obstruction or enlarged
prostate as evidence by frequency of urination .
GOAL: Void in sufficient amounts
INTERVENTION:
• Encourage patient to void every 2–4 hr and when urge is noted
• Observe urinary stream, noting gravity and force.
• Administer medications as indicated
RISK OF deficient fluid volume related to
renal dysfunction.
Goal: reduce the risk of fluid volume.
Intervention
• Monitor output carefully. Note outputs of 100–200 mL per hr.
• Encourage increased oral intake based on individual needs.
• Monitor BP, pulse. Evaluate capillary refill and oral mucous
membranes.
• Monitor electrolyte levels, especially sodium.