3. Objectivesā¢ At theend of session, thestudent will beableto
ā¢ DefineBPH
ā¢ Identify thepredominant location in theprostatewhereBPH
developsand describehow thisfact relatesto thesymptomsand
signsof BPH
ā¢ List thesymptomsBPH
ā¢ List theimportant componentsof thephysical exam of apatient
with BPH
ā¢ List themedical and surgical treatment optionsfor BPH.
3
5. ā¢ Walnut sized gland at
baseof malebladder
ā¢ Surroundstheurethra
ā¢ Producessemen that
transportssperm during
ejaculation
ā¢ Prostategrowsto its
5
What istheProstate
(Heidenreich, 2014)
6. Prostateā¦
ā¢ normal adult sizein amanāsearly 20s; it
beginsto grow again during themid-40s
6
(Heidenreich, 2014)
7. ā¢ Enlarged Prostate orBenign Prostatic Hyperplasia
(BPH)
ā¢ Prostatitis
ā¢ Prostate Cancer
ā¢ Eachco nditio n affects the pro state differently.
(Sosa, 2014)
7
What Can Happen to the
Prostate
8. What isBPH?
8
No rmal adult size = appro ximately 1 .5
inches in diameter
(Silva, 2014)
9. Normal vs. Enlarged Prostate
ā¢ Astheprostateenlarges,
pressurecan beput on
theurethracausing
urinary problems
(LUTS)
Corona, 2014
9
Normal Prostate Enlarged Prostate
(Corona,
2014)
10. Epidemiology
ā¢BPH affects50% of men over 50yrs
ā¢Affects40-50% of men ages51-60
ā¢Affects80%+ men over age80
ā¢Obesity, higher body mass index (BMI)
and lack of exercise may increase the risk
of BPH
(
Sosa, 2014) 10
11. ā¢ Causenot completely understood
ā¢ Elevated estrogen levels. BPH generally
occurs when men have elevated estrogen
levels and when prostate tissue becomes more
sensitivedueto aromataseenzyme.
(Getzenberg, 2014)
11
Etiologies
13. Etiologiesā¦
ā¢ Reduced activity level. A sedentary lifestyle
could also lead to thedevelopment of BPH.
ā¢ Western diet. A diet high in animal fat and
protein and refined carbohydrates while low in
fiber predisposesaman to BPH.
13
(Getzenberg, 2014)
14. ā¢ Resistance. BPH is a result of complex
interactions involving resistance in the prostatic
urethrato mechanical and spastic effects.
(Getzenberg, 2014)
14
Pathophysiology
15. Pathophysiology contā¦.
ā¢ Obstruction. The hypertrophied lobes of the
prostate may obstruct the bladder neck or urethra,
causing incomplete emptying of the bladder and
urinary retention.
ā¢ Dilation. Gradual dilation of the ureters and
kidneyscan occur.
15
(Getzenberg, 2014)
16. ā¢ Urinary frequency. Frequent trips to the
bathroom to urinate may be an early sign of a
developing BPH./ 3-5 timesper hrs/
ā¢ Urinary urgency. sudden and immediate
urgeto urinate.
ā¢ Nocturia. Urinating frequently at night.
16
Symptoms of BPH
(Silva, 2014)
17. Symptomsā¦
ā¢ Weak urinary stream.
Decreased and intermittent
forceof stream isasign of
BPH.
ā¢ Dribbling urine. Urine
dribblesout after urination.
ā¢ Straining. Thereispresence
of abdominal straining upon
urination.
17
(Silva, 2014)
18. ā¢ Digital rectal examination (DRE). A DRE often
reveals a large, rubbery,
and nontender prostate gland.
18
Diagnosis
(Silva, 2014), (Mottete, 2014)
19. Diagnosisā¦
ā¢ Prostate specific antigen levels.
- Elevated PSA levels may indicate an enlarged
prostate.
ā¢ Ā normally PSA level is under 4 (ng/mL) in the
blood
19
(Silva, 2014)
20. Diagnosisā¦
ā¢ BUN/Cr:Ā Elevated if renal function is
compromised.
Normal rangesBUN:
ā¢ adult men: 8 to 20 mg/dL
ā¢ adult women: 6 to 20 mg/dL
ā¢ children: 5 to 18 mg/dL
20
21. Diagnosisā¦
ā¢ WBC:Ā May bemorethan 11,000/mm3,
ā¢ Normal value= 4,500 to 11,000 white blood cells per
microliter (mcL).
ā¢ Uroflowmetry:Ā Assessesdegreeof bladder
obstruction.
21
(Silva, 2014)
27. Watchful Waiting and Behavioral
Modification
ā¢ is the preferred management technique in
patientswith mild symptoms
ā¢ 1/3 improveon own.
27
(Oelke, 2013)
28. Watchful Waiting and Behavioral
Modificationā¦.
ļDecrease caffeine, alcohol )diuretic effect(
ļAvoid taking large amounts of fluid over a short period
of time
ļVoid whenever the urge is present, every 2-3 hours
ļMaintain normal fluid intake, do not restrict fluid
28
(Oelke, 2013)
29. Watchful Waiting and Behavioral
Modificationā¦.
ļAvoid bladder irritants to include artificial
sweeteners, carbonated beverages
ļLimit nighttimefluid consumption
ļBPH symptomscan bevariable, intermittent
29
(Oelke, 2013)
31. ā¢ Nutritional supplements
ā Saw Palmetto
ā¢ Alphablockers
ā Doxazosin (Cardura)=Initial dose1mg
po/d for 1or 2wks
maxim dose1 to
8mg po/d
ā Terazosin (Hytrin)= Initial dose: 1 mg
orally onceaday at bedtime, Maintenance
dose: 1 to 5 mg orally onceaday.
Maximum dose: 20 mg per day. 4 to 6 weeks
( Margie, 2014) 31
Medical Management
32. Medical Managementā¦
ā Tamsulosin (Flomax)=initial doseo.4mg
po/d, maxim dose0.8mg po/d for 6-12 months
ā Alfuzosin (Uroxatral) = 10 mg orally oncea
day immediately after thesamemeal each day
for 2 to 3wks
Sideeffects: postural hypotension, dizziness,
fatigue
32
( Morgia, 2014)
33. Medical Managementā¦
ā¢ 5-alphareductaseinhibitors
ā Finasteride (Proscar)=5mg po/d for
3months, Dutasteride (Avodart)= 0.5 mg
orally onceaday for 6 - 12 months
ā Less effective for relief of BPH
symptoms than alpha blockers
33( Morgia, 2014)
34. Combination Therapy
ā¢ Concomitant use of alpha blockers and 5-alpha
reductaseinhibitors
ā Should be reserved for patients who are at
significant risk of progression and adverse
outcome
ā¢ Patient wantsto avoid surgery
ā¢ Significant cost associated with dual medications
(Morgia, 2014)
34
35. Surgical Management
ā¢ Transurethral needle ablation (TUNA). A
combined visual and surgical instrument
(cystoscope) is inserted and guides a pair of
tiny needles into the prostate tissue that is
pressing on theurethra.
35
(LEE, 2012)
36. Surgical Managementā¦
ā¢ TUNA useslow-level radio frequenciesĀ to
producelocalized heat that destroysprostate
tissuewhilesparing other tissues.
36
(LEE, 2012)
37. Surgical Managementā¦
ā¢ Open prostatectomy. Open prostatectomy
involves the surgical removal of the inner
portion of the prostate via a suprapubic,
retropubic, or perineal approach for large
prostateglands.
37
(LEE, 2012)
39. Surgical Managementā¦
ā¢ Patients who have developed complications of
BPH (i.e urinary retention, renal insufficiency,
recurrent UTI and obstructed urinary flow )
arebest treated surgically.
39
(LEE, 2012)
40. Complicationsof BPH
ā¢ Urinary retention
ā¢ UTI
ā¢ Sepsissecondary to UTI
ā¢ Residual urine
ā¢ Calculi
ā¢ Renal failure
ā¢ Hematuria
40
(Speakman, 2014)
42. Nursing Assessment
Isbaseon health history
ā¢ Health history. The health history focuses on
the urinary tract, previous surgical procedures,
general health issues, family history of
prostate diseases, and fitness for possible
surgery.
ā¢ Physical assessment. Physical assessment
includesdigital rectal examination.
42
43. Nursing Diagnosis
ā¢ Based on the assessment data, the appropriate
nursing diagnosesfor apatient with BPH are:
ā¢ Urinary retention related to obstruction in the
bladder neck or urethra.
ā¢ Acute painrelated to bladder distention.
ā¢ Anxiety related to thesurgical procedure.
43
44. Thegoalsfor apatient with BPH include:
ā¢ Relieveacuteurinary retention.
ā¢ Promotecomfort.
ā¢ Prevent complications.
ā¢ Help patient deal with psychosocial concerns.
ā¢ Provideinformation about disease
process/prognosisand treatment needs.
44
Nursing Care Planning &Goals
45. Nursing Interventions
ā¢ Nursing Interventions
ā¢ Preoperativeand postoperativenursing
interventionsfor apatient with BPH areasfollows:
ā¢ Reduce anxiety. Thenurseshould familiarizethe
patient with thepreoperativeand postoperative
routinesand initiatemeasuresto reduceanxiety.
ā¢ Relieve discomfort. Bed rest and analgesicsare
prescribed if apatient experiencesdiscomfort.
45
46. Nursing interventionsā¦
ā¢ Provide instruction. Beforethesurgery, the
nursereviewswith thepatient theanatomy of
theaffected structuresand their function in
relation to theurinary and reproductive
systems.
ā¢ Maintain fluid balance. Fluid balanceshould
berestored to normal.
46
48. Take-Home Messages
ā¢ Aging Population= More BPH
ā¢ Not all Male LUTS=BPH
ā¢ Not all BPH=LUTS
ā¢ Consider Combination Therapy
ā¢ Quality of life issues
48
49. References
1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU
guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with
curative intentāupdate 2013. European urology. 2014;65(1):124-37.
2. Hambrock T, Hoeks C, Hulsbergen-van de Kaa C, Scheenen T, FĆ¼tterer J, Bouwense S, et
al. Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-
weighted magnetic resonance imagingāguided biopsies versus a systematic 10-core
transrectal ultrasound prostate biopsy cohort. European urology. 2012;61(1):177-84.
3. Sosa MS, Bragado P, Aguirre-Ghiso JA. Mechanisms of disseminated cancer cell
dormancy: an awakening field. Nature Reviews Cancer. 2014;14(9):611-22.
4. Silva J, Silva CM, Cruz F. Current medical treatment of lower urinary tract
symptoms/BPH: do we have a standard? Current opinion in urology. 2014;24(1):21-8.
49
50. Referenceā¦
5. Corona G, Vignozzi L, Rastrelli G, Lotti F, Cipriani S, Maggi M. Benign prostatic
hyperplasia: a new metabolic disease of the aging male and its correlation with
sexual dysfunctions. International journal of endocrinology. 2014;2014.
6. Getzenberg RH, Kulkarni P. Etiology and pathogenesis. Male Lower Urinary Tract
Symptoms and Benign Prostatic Hyperplasia. 2014:218.
7. Mottet N, Bastian P, Bellmunt J, Van den Bergh R, Bolla M, Van Casteren N, et al.
Guidelines on prostate cancer. Eur Urol. 2014;65(1):124-37.
8. Abrams P, Chapple C, Khoury S, Roehrborn C, De la Rosette J. Evaluation and
treatment of lower urinary tract symptoms in older men. The Journal of urology.
2013;189(1):S93-S101.
50
51. Referenceā¦
9. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU
guidelines on the treatment and follow-up of non-neurogenic male lower urinary
tract symptoms including benign prostatic obstruction. European urology.
2013;64(1):118-40.
10. Morgia G, Russo GI, Voce S, Palmieri F, Gentile M, Giannantoni A, et al. Serenoa
repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH.
An Italian multicenter double-blinded randomized study between single or
combination therapy (PROCOMB trial). The Prostate. 2014;74(15):1471-80.
11. Lee NG, Xue H, Lerner LB. Trends and attitudes in surgical management of benign
prostatic hyperplasia. The Canadian journal of urology. 2012;19(2):6170-5.
51
52. Referenceā¦
12. Speakman MJ, Cheng X. Management of the complications of BPH/BOO. Indian
Journal of Urology. 2014;30(2):208.
13. Jain P, Neveu B, Fradet Y, Pouliot F. Moderated Posters 8: Prostate (Cancer/BPH)
July 1, 2014, 0730-0915. CUAJ. 2014;8:5-6Suppl3.
52