BENIGN PROSTATIC HYPERPLASIA DEFINITION: Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland resulting from an increase

in the number of epithelial cells and stromal tissue. RISK FACTORS: Family history Environment Diet high in saturated fatty acids Obesity Physical activity Alcohol consumption. THEORIES POSTULATED TO DEVELOPMENT OF BPH: Hormonal mechanism : an increase in the level of dihydro testosterone (DHT) in the cells leads to stimulation of cell growth. Stem cell theory : by reactivation of the stem cells and benign enlargement of the prostatic gland Stroma-epithelial interaction : by growth factor which stimulates cell proliferation. PATHOPHYSIOLOGY: Endocrine changes associated with the aging process Possible causes include excessive accumulation of dihydroxytestosterone (the principal intraprostatic androgen), stimulation by estrogen, and local growth hormone action. BPH develops in the inner part of the prostate Enlargement gradually compresses the urethra, eventually leading to partial or complete obstruction CLINICAL MANIFESTATIONS: 1.Obstructive symptoms caused by prostate enlargement leads to urinary retention decrease in the caliber and force of the urinary stream difficulty in initiating voiding, intermittency dribbling at the end of urination. 2.Irritative symptoms Associated with inflammation or infection Increased urinary frequency Urgency Dysuria Bladder pain Nocturia Incontinence COMPLICATIONS: Acute urinary retention Urinary tract infection (UTI) and potentially sepsis secondary to UTI. Incomplete bladder emptying (partial obstruction) results in residual urine. Calculi in the bladder due to the alkalinization of the residual urine. Bladder stones are eight times more common Potential complications: Acute renal failure caused by hydronephrosis Pyelonephritis Bladder damage

Complications following surgery: Hemorrhage Bladder spasms Urinary incontinence Urinary infection DIAGNOSTIC STUDIES: History and physical examination Digital rectal examination (DRE)- estimate the size, symmetry, and consistency of the prostate gland. In BPH the prostate is symmetrically enlarged, firm, and smooth. Urinalysis with culture - presence of infection. or inflammation. Serum creatinine - renal insufficiency. Prostate-specific antigen (PSA) - prostate cancer. Postvoid residual - the degree of urine flow obstruction. Uroflowmetry - extent of urethral blockage Transrectal ultrasound (TRUS) - for accurate assessment of prostate Cystourethroscopy - allowing internal visualization of the urethra and bladder COLLABORATIVE THERAPY: Goals of collaborative care To restore bladder drainage Relieve the patient's symptoms Prevent or treat the complications of BPH Drug Therapy: 1. 5--Reductase inhibitors: reduces the size of the prostate gland. Finasteride blocks the enzyme 5-a-reductase, which is necessary for the conversion of testosterone to dihydroxytestosterone, the principal intraprostatic androgen. results in regression of hyperplastic tissue through suppression of androgens. 3 and 6 months to be effective Side effects of 5-a-reductase inhibitors include decreased libido, decreased volume of ejaculate, and erectile dysfunction. 2. - Adrenergic Receptor Blockers symptomatic relief of BPH, they do not treat hyperplasia promote smooth muscle relaxation in the prostate. - Adrenergic receptors are abundant in the prostate and are increased in hyperplastic prostate tissue. Relaxation of the smooth muscle ultimately facilitates urinary flow through the urethra. Improvement of symptoms occurs within 2 to 3 weeks. Side effects include orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion. Herbal Therapy: plant extracts, such as saw palmetto (Serenoa repens), have been used which improves urinary symptoms and urinary flow measures Surgical Therapy: Indications: decrease in urine flow persistent residual urine acute urinary retention because of obstruction with no reversible precipitating cause, or hydronephrosis.

Invasive Therapy Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP) Open prostatectomy Minimally Invasive Therapy Transurethral microwave thermotherapy (TUMT) Transurethral needle ablation (TUNA) Laser prostatectomy Transurethral electrovaporization of the prostate (TUVP) Intraprostatic urethral stents

LIST OF NURSING DIAGNOSES: 1. Acute pain related to bladder irritability, irrigations, and distention; presence of catheter; and surgical trauma evidenced by reports of pain; nonverbal signs of pain such as moaning, crying, legs drawn to abdomen. 2. Urge urinary incontinence related to bladder irritation and poor sphincter control as evidenced by involuntary leakage of urine. 3. Ineffective therapeutic regimen management related to lack of knowledge regarding need for follow-up care and activity restriction postoperatively as evidenced by questioning or inaccurate comments about postoperative activity. 4. Risk for infection related to an indwelling catheter, urinary stasis, or environmental pathogens Pain management: Teach patient non pharmacologic techniques to alleviate pain through a variety of methods. Explore the factors that relieve/worsen pain. Evaluate the effectiveness of the pain control measures used through ongoing assessment of the pain experience. Institute and modify pain-control measures on the basis of the patient's response. Tube Care: Urinary Maintain patency of urinary catheter system because clots cause obstruction of urine flow resulting in painful bladder spasms.

Urinary Elimination Management: Identify factors that contribute to incontinence episodes to plan appropriate interventions. Instruct patient to respond immediately to urge to void to prevent involuntary leakage.

Urinary Incontinence Care: Explain etiology of problem and rationale for actions to help patient plan appropriate interventions. Limit ingestion of bladder irritants to decrease urinary urgency. Limit fluids for 2-3 hours before bedtime to avoid nighttime urgency. Preoperative Care: Restoration of urinary drainage using a urethral catheter Insertion of catheter to pass the obstruction. Administration of Antibiotics Treatment of infection of the urinary tract Encouraging a high fluid intake Relief of anxiety through effective counselling Postoperative Care: 1. Bladder irrigation: either manually or continuous bladder irrigation is done to remove clotted blood from the bladder and ensure drainage of urine. urine drainage should be light pink without clots. inflow and outflow of irrigant must be continuously monitored. careful aseptic technique avoidance of Valsalva maneuver 2. Management of bladder spasms: catheter should be checked for clots and should be removed by irrigation antispasmodics along with relaxation techniques, are used to relieve the pain and decrease spasm. The patient should urinate within 6 hours after catheter removal. 3. Sphincter tone : can be strengthened by practicing Kegel exercises encouraged to practice starting and stopping the stream several times during urination. 4. Ambulatory and Home Care: caring for an indwelling managing urinary incontinence Maintaining oral fluids between 2000 and 3000 ml per day observing for signs and symptoms of urinary tract and wound infection Preventing constipation avoiding heavy lifting refraining from driving or intercourse after surgery as directed by the physician.