benign prosatatic hypertrophy

1. BENIGN PROSTATIC
HYPERTROPHY
(BPH)
This majorly means the enlargement of the prostate. It can also be referred to as prostatic hyperplasia.
The prostate is a wall nut shaped, bi-lobed gland, that surrounds the urethra at the neck of the
bladder, and borders the rectum posteriorly. (it is part of the lower urinary tract).
Its major role is to produce prostatic fluids that swim sperms.
It occurs mainly in the second stage of prostatic growth, i.e.: 21yrs on wards…………

2. Epidemiology
• By 60 years, 50% of the males world wide have BPH. 85years , 90%
have BPH. But, 50% of the people with BPH, develop symptoms that
require treatment.
• Although BPH rarely causes symptoms before the age of 40, the
occurrence of symptoms increase with age.

3. Warning signs
• Slowness in micturition
• Dribbling micturition
• Urgency of micturition
• Weak/interrupted urine stream
• Leaking micturition(urinary incontinence)
• Sudden need of micturition
• Nocturia
• Inability to completely empty the bladder
• Painful ejaculation
• Smelly, discoloured urine

4. Risk factors.
• age 40 years and older
• family history of benign prostatic hyperplasia
• medical conditions such as obesity, heart and circulatory disease,
and type 2 diabetes
• lack of physical exercise
• Mastabation

5. Cause of BPH
• BPH, has no clear cause but, it is linked to hormonal changes.
• With aging, testosterone levels fall/decrease
• Estrogen levels remain the same, and thus out compete the
testosterone for their receptors in the prostate. Due to estrogen̕s
growth effect to prostatic tissues, BPH occurs.
• Another male hormone essential for prostatic growth is
dihydrotestosterone (DHT). It continues to be secreted in aging males.
• Prostatic cells thus continue to grow, also due to its growth effect to
prostatic tissues.

6. Complications
• Acute/chronic urinary retention
• UTIs
• Blood in urine
• Bladder stones
• Bladder damage
• Kidney damage

7. Diagnosis
• Medical history review (personal and family)
• Physical examination (digital rectal examination)
• Cystoscopy
• Trans rectal ultrasound
• Urinalysis
• Blood_(prostate-specific antigen test) PSA

8. Diffretiantial diagnosis
• Over active bladder
• Bladder carcinoma
• Foreign bodies in the bladder(stones)
• Urethral strictures due to UTIs, STDs, and traumas

9. Management and treatment
• Life style changes: reduce alcohol intake, beverages, fizzy drinks,
exercising, reduced evening fluid intakes.
• Medications: alpha blockers to relax urethral smooth muscles,
phosphodietarase_5 inhibitors for erectile dysfunction, 5_alpha redutase
inhibitors to block DTH.
• Minimally invasive procedures: transurethral needle ablation, transurethral
microwave thermotherapy, water induced thermotherapy, prostatic stent
insertion.
• Surgeries: transurethral resection of the prostate (TURP), trans urethral
incision of the prostate (TUIP), transurethral electropolistaion, open
prostatectomy (retro-pubic, supra-pubic, perineal prostatectomy).

10. Complications of BPH treatment
• Irregular heart beats
• Painful erections that last even after hours of collapse
• Swelling in the body extremities
• Dizziness when standing up suddenly
• Blood in urine
• UTIs
• Chronic prostatitis
• Painful urination
• Infection
• Bleeding and blood clots
• Scar tissue
Associated with
the alpha
blockers and PD-
5 inhibitors
Associated with
the minimal
invasive &
surgical
procedures

11. Nursing care plan
DIAGNOSIS GOAL INTERVANSION RATIONALE
Urinary retention,
related to
mechanically
enlarged blader by
incontinence and in-
ability to empty
bladder completely.
To voiding sufficient
urine amounts with
in 2weeks time.
Administer alpha
blockers to relax
urethral smooth.
Catheterise for
residual urine and
leave indwelling
catheter.
Prevents urinary
retention.
Deficient fluid
volume related to
post obstructive
diuresis (over
distended bladder)
evidenced by
electrolyte
imbalance.
To maintain
adequate hydration
as evidenced by
stable vital signs
with in 6hrs.
Monitor electrolyte
levels especially
sodium.
Prevents the risk of
hyponatremia.
Acute pain related To relieve and Assess pain noting Relieves pain,