Benign Prostate Hyperplasia
Benign Prostate Hyperplasia
 Enlargement of prostate gland
resulting from increase in number of
epithelial cells and stromal tissue
 Most common urologic problem in
males
2
Benign Prostate Hyperplasia
 Occurs in 50% of men over 50 and
90% of men over 80
 Approximately 25% will require
treatment by age 80.
 Does not predispose to
development of prostate cancer
3
Etiology and Pathophysiology
 Possible causes
• Excessive accumulation of
dihydroxytestosterone
• Stimulation by estrogen
• Local growth hormone action
 Typically develops in inner part of
prostate while prostate cancer is
most likely to develop in outer part.
4
Etiology and Pathophysiology
 Possible risk factors
• Family history
• Obesity
• Increased waist circumference
• Physical activity level
• Alcohol consumption, smoking
• Diabetes
5
Etiology and Pathophysiology
 Enlargement gradually compresses
urethra.
• Partial or complete obstruction
 Compression leads to clinical
symptoms.
6
Benign Prostate Hyperplasia
Fig. 55-2. Benign prostatic hyperplasia. The enlarged prostate compresses the urethra.
7
Clinical Manifestations
 Symptoms are usually gradual in
onset.
 Early symptoms are usually minimal
because bladder can compensate.
 Worsen as obstruction increases
8
Clinical Manifestations
 Symptoms categorized into two
groups
• Obstructive symptoms
• Irritative symptoms
9
Clinical Manifestations
 Obstructive symptoms
• Symptoms due to urinary retention
• Decrease in caliber of force of urinary
stream
• Difficulty in initiating urination
• Intermittency
• Dribbling at end of voiding
10
Clinical Manifestations
 Irritative symptoms
• Symptoms associated with
inflammation or infection
• Urinary frequency and urgency
• Dysuria
• Bladder pain
• Nocturia
• Incontinence
11
Complications
 Related to urinary obstruction
• Acute urinary retention: complication
with sudden, painful inability to
urinate
• Treatment involves catheter insertion
and possible surgery.
12
Complications
 UTI and sepsis
• Incomplete bladder emptying with
residual urine provides medium for
bacterial growth.
13
Complications
 Calculi may develop in bladder
because of alkalinization of residual
urine.
 Renal failure: caused by
hydronephrosis
 Pyelonephritis
 Bladder damage
14
Diagnostic Studies
 History and PE
 DRE (Digital Rectal Exam)
 Urinalysis with culture
 PSA level
 Serum creatinine
15
Diagnostic Studies
 TRUS scan
 Uroflometry
 Cystoscopy
16
Collaborative Care
 Goals
• Restore bladder drainage.
• Relieve symptoms.
• Prevent/treat complications.
 Watchful waiting
 Dietary changes
 Timed voiding schedule
17
Collaborative Care
 Drug therapy offers symptomatic
relief of BPH
• 5α-Reductase inhibitors
• Example: finasteride (Proscar)
• ↓ size of prostate gland
• Takes 3 to 6 months for improvement
• Side effects: decreased libido, decreased
volume of ejaculation, ED
18
Collaborative Care
• α-Adrenergic receptor blockers
• Examples: tamsulosin (Flomax),
Promotes smooth muscle relaxation in
prostate; facilitates urinary flow
• Improvement in 2 to 3 weeks
• Side effects: orthostatic hypotension and
dizziness, retrograde ejaculation, nasal
congestion
19
Collaborative Care
 Transurethral microwave therapy
https://youtu.be/zuN-yXqH-TI?si=50hmkGjezj_EmzIv&t=5
• Outpatient procedure: delivers
microwaves directly to prostate
through a transurethral probe
• Heat causes death of tissue and relief
of obstruction.
20
Collaborative Care
 Transurethral microwave therapy
(cont’d)
 Postop urinary retention is common
• Patient sent home with catheter 2 to 7
days
• Antibiotics, pain medication, and
bladder antispasmodic medications
given
21
Collaborative Care
 Transurethral microwave therapy
(cont’d)
• Not appropriate therapy when rectal
problems exist
• Side effects: bladder spasm,
hematuria, dysuria, and retention
22
Collaborative Care
 Transurethral needle ablation
(TUNA)
• ↑ temperature of prostate tissue for
localized necrosis
• Low-wave frequency used
• Only tissue in contact with needle
affected
23
Collaborative Care
 Transurethral needle ablation
(cont’d)
• Majority of patients show
improvement in symptoms.
• Outpatient uses local anesthesia and
sedation.
• Lasts 30 minutes with little pain and
quick recovery
24
Collaborative Care
 Transurethral needle ablation
(cont’d)
• Complications include urinary
retention, UTI, and irritative voiding
symptoms.
• Some patients require a catheter.
• Hematuria up to a week
25
Collaborative Care
 Laser prostatectomy
• Delivers a laser beam transurethrally
to cut or destroy parts of the prostate
• Common procedure: visual laser
ablation of the prostate (VLAP)
• Takes several weeks to reach optimal
results
• Urinary catheter inserted
26
Collaborative Care
 Laser prostatectomy (cont’d)
• Contact laser techniques
• Minimal bleeding during and after
procedure
• Fast recovery time
• Patients may take anticoagulants.
• Photovaporization of the prostate
27
Collaborative Care
 Invasive therapy indicated when
• Decrease in urine flow sufficient to
cause discomfort
• Persistent residual urine
• Acute urinary retention
• Intermittent catheterization can
reduce symptoms and bypass
obstruction
28
Collaborative Care
 Transurethral resection (TURP)
• Removal of obstructing prostate
tissue using resectoscope inserted
through urethra
• Outcome for 80% to 90% is excellent.
• Relatively low risk
• Performed under spinal or general
anesthesia and requires hospital stay
29
https://youtu.be/aBelQBJNDNM?si=n7E1xcpbOfEcMjYH&t
=21
Fig. 55-3. Transurethral resection of the prostate.
30
Collaborative Care
 Transurethral resection (cont’d)
• Bladder irrigated for first 24 hours to
prevent mucous and blood clots
• https://youtu.be/9wGZ7YjuaFA?si=mOZJtrtqTe0Sn17G&t=29
• Complications include bleeding, clot
retention, dilutional hyponatremia,
retrograde ejaculation.
31
Nursing Implementation
Preoperative care
 Use aseptic technique when using
urinary catheter.
 Administer antibiotics
preoperatively.
32
Nursing Implementation
Preoperative care
 Provide patient opportunity to
express concerns over alterations in
sexual function.
 Inform patient of possible
complications of procedures.
33
Planning
 Goals for postoperative care
• No complications
• Restoration of urinary control
• Complete bladder emptying
• Satisfactory sexual expression
34
Nursing Implementation
Postoperative care
 Postop bladder irrigation to remove
blood clots and ensure drainage or
urine
 Administer antispasmodics.
 Teach Kegel exercises.
35
Nursing Implementation
Postoperative care
 Observe patient for signs of
infection.
 Dietary intervention-high fiber
 Stool softeners to prevent straining
36
Nursing Implementation
 Focus: early detection and
treatment
 Yearly physical exam and DRE for
men over 50
 Educate patients that alcohol,
caffeine, and cold and cough meds
can increase symptoms.
37
Nursing Implementation
 Discharge instructions on indwelling
catheter
 Managing incontinence
 2 to 3 L fluids per day
 Signs and symptoms of UTI, wound
infection
38
Nursing Implementation
 Preventing constipation
 Avoiding heavy lifting
 Refraining from driving, intercourse
after surgery as directed
39
Nursing Implementation
 Sexual counseling if erectile
dysfunction becomes a problem
 Avoiding bladder irritants
 Yearly digital rectal examination
(DRE)
40
Student Response Question
A patient with benign prostatic hyperplasia is scheduled
for a transurethral resection of the prostate (TURP). The
nurse assesses the patient’s knowledge of the procedure
and its effects on reproductive function, and determines a
need for further teaching when the patient says,
1. “It is possible that I’ll be sterile following this
procedure.”
2. “It is likely that I will become impotent from this
procedure.”
3. “I understand that some retrograde ejaculation may
occur.”
4. “I will have a catheter for a couple of days to keep my
urinary system open.”
41