BENIGN PROSTATIC HYPERPLASIA

GROUP ONE

INTRODUCTION

• Hyperplasia is the increase in the amount of organic tissue that results in cell proliferation. It may lead to gross enlargement of an organ
• Most men experience prostate gland enlargement as they age. This is a condition called benign prostatic hyperplasia (BPH).
• The prostate gland is underneath the bladder. When it gets bigger, it can block the flow of urine through the urethra, which is the tube that carries urine from the bladder out through the penis. This can cause problems with urination. Experts theorize that the prostate gland grows as men age as a result of changes in hormonal balance. If treatment are not followed, it can cause bladder, urinary tract, or kidney problems.
• The complications of BPH can be serious, but BPH isn’t prostate cancer. Having BPH doesn’t mean you have an increased risk of prostate cancer. The prostate tissue growth associated with BPH begins around the inner prostate, which is a ring of tissue around the urethra, and continues growing inward. Prostate cancer begins growing on the outer part of the prostate and grows outward.
• Benign prostatic hyperplasia, also called benign enlargement of the prostate is a noncancerous increase in the size of the prostate. It involves hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the transition zone of the prostate.

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RISK FACTORS FOR BENIGN PROSTATIC HYPERPLASIA

• Changes in Hormonal balance
• Diet. A diet high in animal fat and protein and refined carbohydrates while low in fiber predisposes a man to BPH.
• Age
• Excessive alcohol intake
• Smoking. Smoking increases the risk of acquiring BPH.
• Reduced activity level. A sedentary lifestyle could also lead to the development of BPH.

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PATHOPHYSIOLOGY�

• As men age, the enzymes aromatase and 5-alpha reductase increase in activity. These enzymes are responsible for converting androgen hormones into estrogen and dihydrotestosterone (DHT) respectively. This metabolism of androgen hormones leads to a decrease in testosterone but raised levels of dihydrotestosterone and estrogen. Estrogen has a key role in the growth of cells in the prostate and DHT is an anabolic hormone many times more potent than testosterone that when combined, causes both the glandular epithelial cells and the stromal cells (including muscular fibers) in the prostate to undergo hyperplasia.

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SIGNS AND SYMPTOMS�

• Urine retention
• Urine urgency
• Nocturia
• Urine incontinence
• Urinary intermittency
• The need to urinate frequently
• Sensation of incomplete emptying
• Dysuria
• Abdominal pains
• Straining to void
• Dribbling at the end of urination

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DIAGNOSES�

• Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and nontender prostate gland.
• Urinalysis
• Urine cytology: To rule out bladder cancer
• IVP with post voiding film: Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticula, and abnormal thickening of bladder muscle.
• Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes.
• Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.
• Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulu
• Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.

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MEDICAL MANAGEMENT�

• MEDICAL MANAGEMENT

The two main classes of medication for BPH management are;

• Alpha-adrenergic blockers (eg, alfuzosin, terazosin), which relax the smooth muscle of the bladder neck and prostate
• 5alpha reductase inhibitors (eg. Finasteride and dutasteride) which will decreases the size of the prostate and prevents the conversion of testosterone to dihydrotestosterone

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SURGICAL MANAGEMENT�

• Transurethral microwave thermotherapy. This involves the insertion of a special electrode that releases microwave energy through your urethra into the prostate area to destroy the inner portion of the enlarged prostate gland, shrinking it and easing urine flow.
• Transurethral needle ablation (TUNA). TUNA uses low-level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues.
• Transurethral resection of the prostate (TURP). TURP involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra.
• Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostate glands.

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NURSING MANAGEMENT�

• Educate patient on condition and reassure to allay anxiety and fears
• Encourage moderate fluids to satisfy thirst and to ensure maintenance of effective drug levels in urine
• Instruct patient to avoids foods or drinks that increase prostatic secretions or have diuretic action, such as alcohol, coffee, chocolate, cola
• Recommend comfort measures, including analgesics, sitz baths for 10 to 20 minutes several times daily
• Advise patient to avoid sitting for long periods to minimize discomfort
• Administer antibiotics as prescribed
• Instruct patient to complete prescribed course of antibiotics
• Instruct patient to avoid sexual arousal and intercourse during periods of acute inflammation
• Educate patient to follow a healthy diet

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SOME NURSING DIAGNOSIS�

• Based on the assessment data, the appropriate nursing diagnoses for a patient with BPH are:
• Urinary retention related to obstruction in the bladder neck or urethra.
• Acute pain related to bladder distention.
• Anxiety related to the surgical procedure.
• The goals for a patient with BPH include:
• Relieve acute urinary retention.
• Promote comfort.
• Prevent complications.
• Help patient deal with psychosocial concerns.
• Provide information about disease process/prognosis and treatment needs.

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Nursing Interventions�

• Preoperative and postoperative nursing interventions for a patient with BPH are as follows:
• Reduce anxiety. The nurse should familiarize the patient with the preoperative and postoperative routines and initiate measures to reduce anxiety.
• Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort.
• Provide instruction. Before the surgery, the nurse reviews with the patient the anatomy of the affected structures and their function in relation to the urinary and reproductive systems.
• Maintain fluid balance. Fluid balance should be restored to normal.

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COMPLICATIONS�

• Complications of enlarged prostate can include:
• Sudden inability to urinate (urinary retention). You might need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
• Urinary tract infections (UTIs). Inability to fully empty the bladder can increase the risk of infection in your urinary tract. If UTIs occur frequently, you might need surgery to remove part of the prostate.
• Bladder stones. These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
• Bladder damage. A bladder that hasn't emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.
• Kidney damage. Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

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REFFERENCES

• MCVARY KT, ROEHRBORN CG, AVINS AL, ET AL. UPDATE ON AUA GUIDELINE ON THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA. J
• ∙ CHAPPLE CR. PHARMACOLOGICAL THERAPY OF BENIGN PROSTATIC HYPERPLASIA/LOWER URINARY TRACT SYMPTOMS: AN OVERVIEW FOR THE PRACTISING CLINICIAN.
• ∙ BURNETT AL, WEIN AJ. BENIGN PROSTATIC HYPERPLASIA IN PRIMARY CARE: WHAT YOU NEED TO KNOW.
• ∙ OELKE M, BACHMANN A, DESCAZEAUD A, ET AL. EAU GUIDELINES ON THE TREATMENT AND FOLLOW-UP OF NON-NEUROGENIC MALE LOWER URINARY TRACT SYMPTOMS INCLUDING BENIGN PROSTATIC OBSTRUCTION.
• ∙ DE JONG Y, PINCKAERS JH, TEN BRINCK RM, ET AL. URINATING STANDING VERSUS SITTING: POSITION IS OF INFLUENCE IN MEN WITH PROSTATE ENLARGEMENT. A SYSTEMATIC REVIEW AND META-ANALYSIS.
• ∙ BROWN CT, YAP T, CROMWELL DA, ET AL. SELF MANAGEMENT FOR MEN WITH LOWER URINARY TRACT SYMPTOMS: RANDOMISED CONTROLLED TRIAL.

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