BENIGN PROSTATIC

HYPERPLASIA
(BPH)

ISAAC AMANKWAA (MSc., BSc., RN)

The Prostate Gland

Male sex gland
Pear-shape,wt7-16gm
Size of a walnut
Helps control urine
flow
Produces fluid
component of semen
Produces Prostate
Specific Antigen (PSA)

Clip

What is Benign Prostatic Hyperplasia?

n

BPH is part of the natural

aging process (increase in
androgen receptor)

Dihydrotestosterone (DHT)
may play a role

BPH cannot be prevented

BPH can be treated

Etiology
Ageing
Excessive

accumulation of
prostatic androgen
[dihydroxytestosterone]
Stimulation by estrogen
Local growth hormone action

Risk factors
Family

history
Environment
Diet [saturated fatty acids]
Reduced exercise
Alcohol consumption

Clinical Manifestations
OBSTRUCTIVE

IRRITATIVE

Reduced force of urine stream

(weak stream)

Frequency

Difficulty in initiating voiding

Urgency

Intermittency

Dysuria

Dribbling at the end of

urination

Bladder pain

Hesitancy

Nocturia

Urinary retention

Incontinence

Straining to pass urine

(strangury)

Inflammation/ infection

Prolonged micturation

what causes these

symptoms?

n Prostate

grows with age

n Pressure

on the urethra restricts urin

flow

complications
Acute

urinary retention

UTI
Incomplete

bladder emptying
residual urine
Stone formation
Hydronephrosis
Pyelonephritis
Bladder damage

Diagnosis
History

& PE
Digital Rectal examination
Urinalysis
Urine c/s
PSA [Prostate specific antigen]
Transrectal ultrasound
Measure Postvoidal residual urine
Cystourethroscopy

enlarged prostate

treatment
options
n

Medication

Heat therapies

Surgical approaches

Medication
n

Two major types:

1.

Alpha-1-blocker - relax
the

prostate and provide a larger

urethral opening e.g.
prazosin,terazosin

1.5-alpha

inhibitor

reductase

Shrink the prostate gland

e.g.finasteride

heat therapies
n
n

Destroy prostate tissue with heat

Tissue is left in the body and is
expelled over time (called
nsloughing)
n
n
n

Transurethral Microwave Therapy (TUMT)

Transurethral Needle Ablation (TUNA)
Interstitial Laser Coagulation (ILC)
Water Induced Thermotherapy (WIT)

possible side effects

of
heat therapies
n

Urinary Tract Infection

Impotence

Incontinence

Surgical treatment (prostatectomy)

SURGICAL PROCEDURES
Types

of prostatectomy

Transurethral prostatectomy
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy

SURGICAL APPROACHES
Several approaches can be used to remove
the hypertrophied portion of the prostate
gland:
CLOSED
Transurethral resection of the prostate
(TURP),
Transurethral incision of the prostate (TUIP)
OPEN
Suprapubic prostatectomy,
Perineal prostatectomy,
Retropubic prostatectomy, and

SUPRAPUBIC PROSTATECTOMY
Suprapubic prostatectomy is one
method of removing the gland
through an abdominal incision. An
incision is made into the bladder,
and the prostate gland is removed
from above.

PERINEAL PROSTATECTOMY
Perineal
prostatectomy
involves removing the gland
through an incision in the
perineum. This approach is
practical when other approaches
are not possible and is useful for
an open biopsy.

RETROPUBIC PROSTATECTOMY
More

common than the

suprapubic approach.
The surgeon makes a low
abdominal incision and
approaches the prostate gland
between the pubic arch and the
bladder without entering the
bladder

Transurethral resection of the prostate(TURP)

Removal

of prostate tissue using a

resectoscope inserted through the
urethra (excision and cauterisation)
under spinal or general anaesthesia

TURP

(transurethral resection of the

prostate)

Gold Standard of care for BPH

Uses an electrical knife to

surgically cut and remove excess
prostate tissue

Effective in relieving symptoms

Minimally invasive
therapy
Transurethral

microwave
thermotherapy (TUMT)

An outpatient procedure of delivery

microwaves directly to the prostate
through a transurethral probe. (113F/
45C)
Transurethral
needle
ablation
(TUNA)
Low wave radio frequency is used to
heat prostate gland with the help of a
needle providing greater precision.

OTHER..
Laser

prostatectomy
Visual laser ablation
Interstitial laser coagulation
Intra prostatic urethral stents

PREOPERATIVE NURSING
DIAGNOSIS
1.
2.

3.
4.
5.

Anxiety related to unknown outcome of

surgery and its outcome
Impaired Urinary Elimination: Urinary
Retention related
tomechanicalobstructionby enlarged
prostate
Acute pain related to bladder distention and
mucosal irritation
Anxiety related to change in health status,
the possibility of surgical procedures.
Knowledge Deficit related to lack of
information about the disease process.

Pre-operative nursing
interventions
Reducing

patient anxiety
Always remain with thepatient. Establish trusting
relationship with patient.
Ask the patient what he knows about the
procedure and its aftermath
Reinforce previous information patient has been
given
Clarify the nature of the operation and expected
post-operative outcomes
Provide privacy, and establish a trusting and
professional relationship
Encourage the to discuss feelings and concerns
Offer emotional support

Pre-operative nursing
interventions
Reducing

discomfort/ pain relief

Assess pain, noting location, intensity (scale of 0

10), duration
Administer analgesics
Tape drainage tube to thigh and catheter to the
abdomen (if traction not required).
Monitor voiding patterns; watch for bladder
distension
Insert urinary catheter if bladder distension is
present
Provide comfort measuressuch asback rub, helping
patient assume position of comfort.
Suggest use of relaxation and deep-breathing
exercises, diversional activities.

Pre-operative nursing care

Because

some types of
prostectomy can result in
impotence, it is important to
arrange for sexual counseling to
help the patient and his partner
cope
If the patient is schedule for
TURP, explain that this
procedure often causes
retrograde ejaculation but
otherwise doesnt impair sexual

Pre-operative nursing care

Physical

preparation

Shave and clean the surgical site

Administer a cleansing enema

Post-operative care
TURP
a 3-way catheter is kept in position after
surgery
One way is connected to a continuous
irrigation bag hanged above usually
containing 0.9% normal saline

Suprapubic prostatectomy
2 different catheters are inserted with
one in the bladder through the abdomen
and the other in the urethra
The suprapubic catheter is connected to
a continuous

Post-operative care
Observation

Monitor the patients vital signs closely,

looking for indications of possible
hemorrahge
Frequently check the incision site (if present)
for signs of infection and change dressings
as needed
Record amount and nature of urine drainage
Watch for catheter blockade from kinking or
clot formation, and correct as necessary
Maintain the patency of suprapubic tube, if
inserted

Post-operative care
Observation

Observe the colour of drainage,

drainage should be amber or slightly
blood tinged
The urine output and the amount of
fluid used for irrigation must be closely
monitored to determine if irrigation
fluid is being retained and to ensure an
adequate urine output.
The patient also is monitored for
electrolyte imbalances.

Post-operative care
Management

of
catheters/irrigation
Maintain indwelling urinary catheter
patency through intermittent or
continuous irrigation as ordered.
Secure catheters in position
Ensure that specially prepared sterile
fluid or normal saline is used for
irrigation
Ensure that the rate of flow is
regulated to specification

THANKS