BENIGN PROSTATIC
HYPERPLASIA (BPH)
Adult Nursing / Practical
Supervisor
Dr. Haider Ali
written by
Ali Rajeh
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH), also known as benign
prostatic hypertrophy, is a histologic diagnosis characterized by
proliferation of the cellular elements of the prostate, leading to an
enlarged prostate gland. Chronic bladder outlet obstruction
(BOO) secondary to BPH may lead to urinary retention, impaired
kidney function, recurrent urinary tract infections, gross
hematuria, and bladder calculi.
Anatomical view of the prostate
The prostate is a walnut-sized gland that forms part of the male
reproductive system. It is located anterior to the rectum and just
distal to the urinary bladder. It is in continuum with the urinary
tract and connects directly with the penile urethra. It is therefore
a conduit between the bladder and the urethra.
The gland is composed of several zones or lobes that are enclosed
by an outer layer of tissue (capsule). These include the peripheral,
central, anterior fibromuscular stroma, and transition zones. BPH
originates in the transition zone, which surrounds the urethra.
Causes
The actual cause of prostate enlargement is unknown.
Factors linked to aging and changes in the cells of the
testicles may have a role in the growth of the gland, as well
as testosterone levels. Men who have had their testicles
removed at a young age (for example, as a result of
testicular cancer) do not develop BPH.
Risk factors
Risk factors for prostate gland enlargement include:
 Aging. Prostate gland enlargement rarely causes signs
and symptoms in men younger than age 40. About onethird of men experience moderate to severe symptoms by
age 60, and about half do so by age 80.
 Family history. Having a blood relative, such as a father
or a brother, with prostate problems means you're more
likely to have problems.
 Diabetes and heart disease. Studies show that 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.
Signs and symptoms
When the prostate enlarges, it may constrict the flow of urine.
Nerves within the prostate and bladder may also play a role in
causing the following common symptoms:
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Urinary frequency
Urinary urgency
Nocturia
Incomplete bladder emptying
Dribbling
Diagnosis
 Digital rectal examination
 Laboratory studies
 Urinalysis
 Urine culture
 Prostate-specific antigen (PSA)
 Electrolytes
 blood urea nitrogen (BUN),
 creatinine
 Ultrasonography
 Endoscopy of the lower urinary tract
Complications
Complications of an enlarged prostate can include:
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Sudden inability to urinate (urinary retention).
Urinary tract infections (UTIs).
Bladder stones.
Bladder damage.
Kidney damage.
Treatment of BPH
Drugs
Drugs are usually tried first. Alpha-adrenergic blockers relax
certain muscles of the prostate and bladder outlet and may
improve the flow of urine.
Men who also have erectile dysfunction (impotence) may be
treated with daily tadalafil because this drug may help relieve
both erectile dysfunction and BPH.
Surgery
If drugs are ineffective, surgery can be done. Surgery offers the
greatest relief of symptoms but may cause complications.
There are several types of minimally invasive or surgical
therapies.
 Transurethral resection of the prostate (TURP)
A lighted scope is inserted into your urethra, and the surgeon
removes all but the outer part of the prostate. TURP generally
relieves symptoms quickly, and most men have a stronger urine flow
soon after the procedure.
 Transurethral incision of the prostate (TUIP)
A lighted scope is inserted into your urethra, and the surgeon makes
one or two small cuts in the prostate gland — making it easier for
urine to pass through the urethra.
 Transurethral microwave thermotherapy (TUMT)
The doctor inserts a special electrode through your urethra into your
prostate area. Microwave energy from the electrode destroys the
inner portion of the enlarged prostate gland, shrinking it and easing
urine flow. TUMT might only partially relieve your symptoms, and
it might take some time before you notice results.
 Transurethral needle ablation (TUNA)
In this procedure, a scope is passed into your urethra, allowing
doctor to place needles into your prostate gland. Radio waves pass
through the needles, heating and destroying excess prostate tissue
that's blocking urine flow. TUNA may be an option in select cases,
but the procedure is rarely used any longer.
Nursing Management
A. Facilitating Urinary Elimination
1. Provide privacy for the patient and allow enough time for
voiding.
2. Palpate/percuss suprapubic area to check for bladder
distention.
3. Encourage to increase oral fluid intake up to 2-4L of water
as tolerated.
4. Assist with the catheter insertion as indicated.
 Monitor vital signs and input and output.
 Maintain patency of the catheter.
5. Administer medications as ordered and provide health
teaching on how to check for the side-effects.
 Alpha-adrenergic blockers – orthostatic hypotension,
syncope, blurred vision, impotence, rebound
hypertension if discontinued suddenly
 Finasteride (Proscar) – impotence, hepatic dysfunction,
interference with PSA testing
B. Relieving of pain
1. Assess pain, noting location, intensity, and duration. Use the
scale of pain.
2. Provide a calm and quiet environment.
3. Encourage to use hot sitz baths.
4. Provide rest periods.