Benign Prostate

Hyperplasia (BPH)

Matrix : 1524
LEARNING OBJECTIVE
After end of case study I will able to;
 State the definition for benign prostate hyperplasia
(BPH).
 Explain the anatomy and physiology of prostate gland.
 Explain the pathophysiology of BPH.
 State the etiology of BPH.
 State the clinical manifestation.
 State the complication on BPH.
 Describe the investigation done on patient with BPH.
 How do show your understanding the implication for
medication and treatment used in care patient in BPH.
 Implement the nursing care plan.
 Appreciate the importance of giving health teaching to
patient in BPH to prevent further complication.
PATIENT BIODATA
Name: Mr. X

Consultant: Dr. L

MRN: xxxxxx

Date of birth: 13 June 1945

Age: 60 years old

Gender: Male

Marital status: Married

I/c no: 450613-xx-xxxx

Race: Chinese

Religion: Buddha
Religion: Buddha
Occupation: Businessman

Reason for admission: Complaint of difficulty passing

urine for 1 weeks

Diagnosis: Benign prostate hyperplasia

Medical history: Nil

Surgical: Nil

Family medical history: Mother had stroke

Current medication: Nil

Allergies: Norfloxacin and crab
ADMISSION

Mr. X was admitted to 4th floor in Puteri Specialist Hospital (PSH) on

02 December 2007 at 1330 pm with complaint of difficulty to
passing urine for 1 week.

Vita sign Mode of admission

Blood pressure: 140/80mmHg Wheel chair
Temperature:36.5º
Pulse: 80 beat per minutes Level of
consciousness
Respiration:23 breath per minutes conscious

Skin condition:
Normal and clean
ACTIVITY DAILY LIVING

BREATHING
Mr. X no complaint of difficulty in breathing, shortness of
breath (SOB) during admission.

COUGH
Mr. X no complaint of cough.

SMOKE
Mr. X is not active smoke only 3stick/day.

EATING AND DRINKING

Mr. X allergic to antibiotic (norfloxacin, and crab)

ELIMINATION
Mr. X did not complaint of constipation.
BLADDER
Mr. X had difficulty in passing urine in 1week.

SLEEPING
Mr. X has sleeping disturbance at night because nocturia.

MOBILITY
Ambulant

PERSONAL HYGIENE
Mr. X can do himself.

SAFE ENVIRONMENT
Put the side rails up all the time.
SPIRITUAL
Not applicable.

COMMUNICATION
Mr. X cans speech normally.

VISION AND HEARING

No complaint of blurred vision and hearing sound.

INTEREST
Like to reads news paper.
PHYSICAL EXAMINATION
Physical examination was done on patient from head toe.
Below is the information:

HEAD
Hair grey and black hair.
Clean head scalp and no swelling seen.

EYES
No conjunctivitis and no discharge.
Eyes appeared symmetrical.

NOSE
Nose shape is symmetrical.
Patient able to smell slight.
No discharge seen.
EAR
No discharge seen.
Ear shape is symmetrical.

NECK
No lymph node swelling or thyroid enlargement
detected.
No redness and scarring seen.

UPPER LIMB
ARM
No bruises, flexible joint.

WRIST
Have a vasocan at right hand.
FINGERS
Normal digitalis. Can move normally.

NAIL
No clubbing seen.

SKIN
Clean and warm.
BODY

CHEST
Symmetrical in shape.
No scarring.

ABDOMEN
Having slight distended, wound not detected.

LOWER LIMB
No swelling and redness.
Flexible joints.
No itchiness so is detected.
vasocan
ANATOMY AND PHYSIOLOGY

PROSTATE GLAND
Lies on pelvic cavity in front of rectum and behind
the symphysis pubis, surrounding the first part of
the urethra.

Consist of an outer fibrous covering , a layer of

smooth muscle and glandular substances
composed of columnar epithelial cells.

The prostate makes a fluid that becomes part of

semen. Semen is the white fluid that contains
sperm.
DEFINITION OF BENIGN PROSTATE HYPERPLASIA
(BPH)

An age related , non malignant enlargement of the prostate

gland , is a common disorder of the ageing male , the
prostate , very small at birth , grows at puberty , reaches
adult size around age 20.
(Medical surgical page 1537)

Definition 2
Benign prostatic hyperplasia is nonmalignant (non
cancerous)enlargement of the prostate gland, a common
occurrence in older men. It is also known as benign
prostatic hypertrophy and abbreviated as BPH
DEFINITION 3

The prostate gland starts to enlarge after middle age.When

the prostate becomes enlarged, the condition is called
benign prostatic hyperplasia (BPH), or benign prostatic
hypertrophy.
ETIOLOGY

 Unknown.

 The aging process

 Testosterone levels

 Dihydrotestosterone (DHT)
 PATHOPHYSIOLOGY

Aging
↓
Androgen that mediates prostatic growth at all
ages is Dihydrotestosterone (DHT) formed in
prostate from testosterone
↓
Androgen reduce in aging men and more sensitive
to DHT
↓
Estrogen produced in small amount in men,
sensitive the prostate gland to effects of DHT
↓
Increase estrogen level in aging related to
testosterone level
↓
Its begins as small nodules in periurethral
glands, inner layers prostate
↓
Prostate enlarge, formation and growth of
nodules and enlargement of glandular cell
↓
Benign prostate hyperplasia (BPH)
CLINICAL MANIFESTATION

More frequent urination

Bladder irritability
Nocturia
Urge incontinence
Dysuria
Urinary retention
COMPLICATION OF BENIGN PROSTATE
HYPERPLASIA (BPH)

Vesicoureteric reflux
Hydoureter
Hydronephrosis
INVESTIGATION

Chest x-ray

Blood test (pre operation) GP 78A or M19

Serology – Prostate Specific Antigen (PSA)

Electrocardiogram (ECG)

Uroflowmetry
PRE-OPERATIVE PROFILE (GP78A) @ M1
Date order: 3 January 2007
Date done: 3 January 2007

HAEMATOLOGY
Haemoglobin 14.7g/d 13.0 - 18.0

Platelet count 207 10/uL 150 – 450

BIOCHEMISTRY
Glucose 5.7mmol/L 3.9-6.1

Reference range: Random blood sugar : <7.8 mmol/L

(<140mg / dL)
Creatinine 63 umol/L 51 – 133
Urea 5.8 mmol/L 2.0 – 6.8
Sodium 141 mmol/L 135 – 155
Chloride 103 mmol/L 95 –
111

SEROLOGY
Prostate specific antigen (PSA) 4.97ng/mL <4.0

BLOOD GROUP

ABO group O
Rhesus group (D) positive
VDRL (RPR) non reactive non reactive

HIV I/II antigen /antibodies non reactive non reactive

HBs antigen
CHEST X RAY RESULTS

Date order: 3 January 2007

Date done: 3 January 2007

No focal lung lesion

Heart size is normal
No hilar or pleural abnormalities
The mediastinum is not widened.
No body abnormalities
ECG

Date order: 3 January 2007

Date done: 3 January 2007

Vent. Rate 72 bpm

PR int 196 ms
QRS dur 118 ms
QT / QTc intr 388 / 412 ms
P QRS / T axis 60 / 3 / 46º
RVS SV 1 amp 1.630 / 1.070 mv
RVS + SV 1 amp 2.700 mv
1100 sinus rhythm
1102 sinus arrhythmia
2320 non specific intraventricular conduction delay
9130 ** borderline ECG**
 Uroflowmetry

700

600

500

400 Flow ml/s

vol.mL
300

200

100

0
0 20 40 1:00 1:20
 Dev (male)
Max flow: 8.6 ml/s -42%
Averange flow: 3.5ml/s -67%
Voiding time: 1: 09. 2 sec -219%
Flow time: 58.6 sec
Time to peak flow: 6.0sec 42%
Voided vol: 207.8ml
Flow at 2 seconds: 7.1 ml/s
Acceleration: 1.2ml/s
Statistic of BPH in Puteri Specialist Hospital (PSH)

70

60

50

40 31- 40YRS
41-50YRS
51- 60YRS
30
>=61YRS

20

10

0
YEAR 2003 YEAR 2004 YEAR 2005 YEAR 2006
Medication in ward

Name of drug: Date on: Date off:

Tab tramal 50mg TDS 3/1/2007 5/1/2007

IV maxolon 10mg TDS/PRN 3/1/2007 3/1/2007
Tab zinnat 250mg BD 3/1/2007 continue at
home
IV pethidine 50mg STAT 3/1/2007 3/1/2007
IV phenergan 25mg STAT 3/1/2007 3/1/2007
Proscar 5mg OM 3/1/2007 continue at
home

Medication when discharge

Tab maxolon I/I TDS/PRN 3/7
Zinnat 250mg BD 3/7
Name Dose Freq Indct s/effct D/on D/off
IM 50 STAT Reduce Dizziness,s 3/1 3/1
pethidi mg pain weating,n
ne ause and
vomiting,d
ry mouth
IM 25 STAT control Tachycardi 3/1 3/1
phener mg nausea a,dizziness
gan and ,constipati
vomiting on
Tab 50 TDS/P Release Sweating, 3/1 5/1
tramal mg RN pain dizziness,
vomiting
dry mouth
Name Dose Freq Indct. s/effct D/on D/off
Zinnat 250 mg BD Prevent Headach 3/1 cntn. at
infection e, home
eosinopill
ia
Proscar 5mg OM Control Impotenc 3/1 Cntn.at
and e,decrea home
vomiting se libido
TREATMENT

CONSERVATIVE (usually for mild cases)

 Antibiotic therapy
 Hormone therapy
 Health education

SURGERY
TURP (Transurethral Resection of Prostate)
This is an instrument that’s used in TURP procedures.
 This is the way TURP was done to patient and
the end of the resectoscope have the electrode
cutting wire to cut the enlargement of prostate.
Doctors inserts the resectoscope through the penis
This photos shows that doctors cutting the prostate by using the electrode wire loop
ZINNAT

Group: Macrolides

Name of drug: Cefuroxime axetil

Indication: Broncholitis , pneumonia , upper respiratory tract , GUT ,

skin and soft tissue infection , pyelonephritis .

Dosage: 250mg BD

Contra indication: Hypersensitivity and cephalosporin’s.

Special precaution: Anaphylactic reaction to penicillin’s

Side effect:. I disturbances occasionally pseunomembranous colitis ,

hypersensitivity reactions . Eosinophillia .headache . super infection.
PROSCAR

Group: Genito urinary system

Name of drug: Finasteride

Indication: treatments and control benign

prostate hyperplasia to cause regression of
enlarged prostate, improve urinary flow and
symptom associated with benign prostate
hyperplasia.

Dosage: 5mg OM
Contra indication: women and peads patients

Special precaution: Large residual urine volume

and or severely diminished urinary flow (monitor
for obstructive uropathy ) exclude prostate
cancer . Generally baseline PSA further
evaluation and consideration of biopsy. Decrease
in serum PSA concentration even in the presence
of prostate cancer. BPH patient treated with
proscar with reduction of serum PSA level does
not rules out concomitant prostate cancer.

Side effect: Impotence, decrease libido and

volume of ejaculate.
TRAMAL

Group: Analgesic and antipyretic

Name of drug: Tramdol HCL

Indication: Moderate to severe acute chronic pain, painful

diagnostic measures and surgical pain.

Dosage: 50mg TDS

Contraindication: Analgesic or psychotropic. Narcotic

withdrawal treatments. Hypersensitivity
Special precaution: Reduce level of consciousness of unclear origin,
respiration disorder, increase intracranial pressure. Patient knows to
suffer from convulsion. Pregnancy and lactation. On long term use,
possibility of tolerance, psychic and physical dependence .Capacity
to drive or operate machines may be impaired, especially if taken
with alcohol.

Side effect: Sweating , dizziness , drowsiness , vomiting , dry mouth.

In rare cases , influence on CVS regulation , especially after IV
administration , headache , vomiting, constipation , GI irritation ,
skin reaction. In very cases, motorial weakness, appetite changes,
micturation disorder . Psychic side effect e.g. mood. Perception and
activity changes. In isolated cases, cerebral convulsion especially on
co –medication with neuroleptics . Allergies reaction and shocks
cannot definity be ruled out.

Drug interaction: Avoid concurrent administration of MOAIs. Co

medication with other centrally acting depressants include alcohol
may potentiate CNS effects.
PETHIDINE

Group: Analgesic and antipyretics

Indication: Pain relief of moderate to severe pains. As anaesthetic

adjust and for obstetric analgesia.

Dosage:50mg STAT

Contra Indication: Respiratory distress head injury increases ICP brain

tumor cardiac arrthymia eclampsia

Special Precautions: May impair ability to drive or operate machinery.

Elderly. Reduced renal and liver function.

Side Effect: Respiration depression dizziness, sedation, sweating,

nausea and vomiting,Tachycardian bradycardia, gangrene.

Drug Interaction: Barbituration CNS depresses increase the CNS

effects.
MAXOLON

Group: Antacids.

Name of drug: Metoclopramide.

Indication: Dyspepsia, flatulence, digestive disorders associated with

hiatus hernia, peptic ulcer ulceration, reflux oesophagitis, gastritis,
duodenitis.

Dosage: IV 10mg TDS.

Special precaution: Neuroleptics, anticholinergics, phyroplasty

pregnancy.

Side effect: rarely, extra pyramidal reaction, tacdive dry skinesia.

Drug interaction: Phenothiazines, anti cholinergic, narcotic

analgesics.
Special care

 Catheter bladder drainage (CBD)

 Continues bladder irrigation (CBI)

CBD

 Wash hand before and after handling the CBD.

 Ensure the urine is low with gravity.
 Maintain urine free flow all the time.
 Urine bag not touching the floor
 Ensure the catheter not kinking or blocked.
 Empty the urine bag 8hourly or PRN.
 Avoid patient to touch the urine catheter.
 Do not take the urine specimen from urine bag.
 Do the perineal care and ensure it is clean and
dry.
 Do not pull out the catheter
 Urine bag must be attach to the frame and must
be hanging at the bed.
CBI

 Solution as prescribed is normal saline

 Run the solution at rate prescribed fast in 1st 5hours.
 Check and record pulse and blood pressure.
 Reduce the rate when blood stained is reduce.
 Change the normal saline when empty immediately to
prevent air embolism.
 Ensure it is not blocked or kinking.
 Frequently observe the urine bag and empty if full
 Urine bag must be lower from bladder and not touch the
floor.
 Inform doctor if bleeding still persists.
NURSING CARE PLAN (NCP)

PRE OPERATION
1)Alteration in emotional status: anxiety related to pre
operation.

2) Alteration in emotional status: pain(dysuria) related to

constriction of urethre.

POST OPERATION

3)Alteration in comfort: pain related to post operation.

4)Potential hypovolemic shock related to excessive

bleeding.

5)Potential infection related to poor care of CBD.

NCP 1
Date:3 January 2007
Time:0730

Alteration in emotional status: anxiety related to pre operation.

Supporting data:
1)Patient facial expression look anxious.
2) Patient keep in asking question about the operation.

Goal: Patient will be reduce anxiety 1-2 hours after nursing

intervention given and during hospitalization.

Nursing intervention:
1) Assess patient general condition such as facial expression.
® Act as baseline data and plan appropriate nursing care.
I- I assess patient general condition during admission and
patient look anxious.
2) Monitor patient vital sign such as blood pressure, pulse ,
temperature and respiration.
® Patient anxious may indicated in high blood pressure.
I- I check patient vital sign and my patient blood pressure is
160/90 mmHg.

3) Re inforce doctors explaination about the procedure will

done to him.
® To reducing the anxiety level.
I- I re inforce doctors explaination to patient to him get a
picture about the operation.

4) Encourage patient to asking the question regarding the

operation.
® To ensure patient understand about the operation and
reducing anxiety.
I- I encourage him to asking question and give answer in
simple language.
5) Teach patient to do deep breathing exercise (DBE)
® For relaxation and divert patient mind.
I- I teach him to do DBE , inhaled and hold in 10 seconds
then exhale do in 5 to 10 minutes.

6) Encourage patient to rest in bed (RIB)

® To reduce anxiety and relaxation.
I- I advice him to rest and relax it is also can divert patient
mind.

7) Encourage family member to be with patient.

® To give moral support to him.
I- I encourage his wife to spend time with him.
8) Inform doctors if patient still anxious.
® To further treatment and intervention.
I- I not inform doctor because the anxiety is reducing and blood
pressure back to normal level.

Evaluation:
Patient reduce the anxiety level in 1hours after nursing
intervention given and during hospitalization.

Supporting data:
Patient look more calm and relax.
Patient blood pressure back to normal range 140-80 mmHg.

Date:3 January 2007

Time:0830
NCP 2
Date: 3 January 2007
Time:0930

Alteration in comfort: pain dysuria related to constriction of

the urether.

Supporting data:
1. Patient verbalize pain during passing urine.
2. Patient facial expression look pale.

Goal: Patient will be reduce the pain within 3-4 hours after
nursing intervention given during hospitalization.

Nursing intervention:
1) Assess patient general condition such as severity of pain by
using pain scale.
 Act as baseline data and plan appropriate nursing care.
I- I assess severity of pain by asking him how the pain it is.
2) Monitor patient vital sign such as blood pressure, pulse,
temperature and respiration.
 To detect any changes in vital sign especially in blood
pressure reading.
I- I do observation 4 hourly and blood pressure is 150/80
mmHg.

3) Encourage patient to do deep breathing exercise (DBE).

 To reduce the pain and relaxation.
I-I demonstrate to him how to do the DBE and ask patient
to demonstrate back to me.

4) Ensure patient in rest in bed (RIB)

 To reduce pain and minimize movement.
I- I ensure him to rest in bed for reduce pain it is also can
divert patient mind.
5) Serve medication as prescribed by doctors such as
antipyretic tramal 250 mg.
 To decreasing and stop the pain.
I- I serve tramal 250mg to him with supervise of staff
nurse.

6) provide divertional therapy

 TO divert patient mind and not thing of the pain.
I- I provide new strait time and switch on the televison.

7) inform dortors if the pain is not reduce.

 For futher treatment and investigation.
I- I did not inform to doctors because the pain is reduce.
Evaluation : Patient reduce the pain after 3 hours after
nursing intervention given and during hospitalization.

Supporting data:
Patient verbalize the pain is reducing.
Patient blood pressure is normal range 140/70mmHg.

Date: 3 January 2007

Time:1230
NCP 3

Date:3 January 2007

Time:1715

Alteration in comfort: pain related to post operation.

Supporting data:
Patient verbalize pain at the operation site.
Patient look pale.

Goal: Pain will reduce pain in 3-4hours after intervention given and
during
hospitalization.

Nursing intervention:
1) Asses patient pain by using pain scale 1-10, 10 consider is
severe pain.
® Act as baseline data and plan appropriate nursing care.
I- I asking patient how severe the pain for further treatment.
2) Monitor patient vital sign especially blood pressure.
® Increase blood pressure indicated patient in pain.
I- I do observation 4hourly and blood pressure is
150/80mmHg.

3) Position patient in patient desired (recumbent)

® To reduce pain and relaxation.
I- I position him in recumbent position as him desired.

4)Encourage patient to rest in bed (RIB)

® To minimize patient movement and relaxation.
I- I encourage him to RIB and explain to him it is also can
reducing the pain.

5) Encourage patient to do double breathing exercise (DBE)

® For release the pain and muscle relaxation.
I-I teach patient to do DBE , inhale and hold in 10second than
release.
6) Serve antipyretic drugs such as tramal 50mg TDS.
® To reduce and stop pain
I- I serve antipyretic drug tramal to patient with supervise
of staff nurse.

Evaluation: Patient reduce the pain in 3hours after nursing

intervention given during hospitalization.

Supporting data:
Patient verbalize the pain is reducing
Patient look more relax compare than before intervention
given.

Date: 3 January 2007

Time: 2015
NCP 4
Date: 3 January 2007
Time: 2030

Potential hypovolemic shock related to excessive bleeding.

Supporting data:
1. Patient post surgery ( TURP )
2. Patient back to ward with CBI.

Goal: Patient will be free from bleeding 2-3 hours after

nursing intervention given and during hospitalization.
Nursing intervention:
1) Assess patient site and severity of bleeding such as
amount and color of blood.
 Act as baseline data and plan appropriate nursing care.
I- I assess the site of surgery and check the amount blood in
the urine bag and how the color dark red or no.

2) Monitor patient vital sign such as blood pressure, pulse,

respiration and temperature.
 If patient is severe bleeding blood pressure will decrease
can lead to hypovolemic shock.
I- I do observation to patient 4 hourly and check the blood
pressure, pulse, temperature.

3) Observe sign and symptom of bleeding such as blood

pressure decrease, and rapid pulse.
 To prevent severe bleeding occurs.
I- I do observation especially blood pressure and pulse to
know any changes in patient vital sign.
4) Set up intravenous drip such as Hartman’s solution
 Hartman can increasing the blood pressure and reduce
the bleeding.
I- I assist the staff nurse to set up the intravenous line.

5) Position patient in the recumbent position.

 To reducing the bleeding.
I- I position him in recumbent position and encourage him
to relax.

6) Avoid to do hot compress

 Hot compress can dilate the blood vessel and can cause
severe bleeding.
I- I did not give hot compress to patient.
7)Avoid to serve anticoagulant drug such as wafarin,
heparin.
 If can cause more bleeding.
I- I did not serve the anticoagulant drug to patient.

Evaluation: Patient free from excessive bleeding after

nursing intervention given and during hospitalization.

Supporting data:
1. Patient blood pressure in normal range 140/70 mmHg
2. Patient facial expressions not pale.

Date: 3 January 2007

Time: 2210
NCP 5
Date: 4 January 2007
Time: 0830

Potential infection due to poor care of CBD.

Goal: Patient will free from infection after nursing

intervention given and during hospitalization.

Nursing intervention:

1) Assess patient general condition such as site of CBD.

® Act as baseline data and plan appropriate nursing care
to patient.
I- I check patient catheter and ensure it is clean and intact.
3) Maintain personal hygiene.
® To prevent getting infection.
I-I do perineal care to him for first hours after operation because
patient in RIB.

4) Ensure wash hand before and after handling patient with CBD.
® To prevent transmission of microorganism.

I-I wash hand before and after attend to patient.

5) Empty the CBD 8 hourly or PRN.

® To prevent retention of urine in the bladder.

I- I empting the urine bag when it is full and chart in intake and
output chart.

6) Avoid patient to touch the catheter.

® To prevent cross infection happened.
I- I advice to him do not necessary touch the catheter
2)Monitor patient vital sign such as blood pressure,
temperature, pulse and respiration.
® High temperature may indicate patient in infection.
I-I do observation to him and his not develop fever and the
temperature is 36.3º.

3) Maintain personal hygiene.

® To prevent getting infection.
I-I do perineal care to him for first hours after operation
because patient in RIB.

4) Ensure wash hand before and after handling patient

with CBD.
® To prevent transmission of microorganism.
I-I wash hand before and after attend to patient.
5) Empty the CBD 8 hourly or PRN.
® To prevent retention of urine in the bladder.
I- I empting the urine bag when it is full and chart in intake
and output chart.

6) Avoid patient to touch the catheter.

® To prevent cross infection happened.
I- I advice to him do not necessary touch the catheter.

7) Observe the sign and symptom of infection such as

itchiness and redness.
® To detect infection early.
I-I check the site if have redness and I asking him that he
feel itchy or no.
Evaluation: Patient free from infection after nursing
intervention given and during hospitalization.

Supporting data:
No redness and patient no complaint feel itchiness.
The area is clean and dry.

Date: 5 January 2007

Time: 1330
 Health education

 Diet
 Exercise
 Lifestyle
 Hygiene
 Medication
 Follow up
 DISCHARGE

My patient discharge on 5 January 2007 at 1330. I

told to him that the bill is ready and can settle
down at counter 38 on ground floor. I also told
him to take the medication at the nurses counter
in the ward. Staff nurse give explanation to him
regarding the medicine and lastly I off the
vasocan. The doctors was order the tab maxolon
I/I TDS/PRN x 3/7 , zinnat 250 mg BD x 3/7,
proscar 5 mg OM TDS/PRN x 3/7 .

I also remind him about the follow up on 18

January 2007.
 Follow up

My patient appointment on 18 January 2007 for

follows up and Dr.L order to do ultrasound
abdomen and do the ureflowmetry to check still
got the obstruction or no.

And the result show the patient not having the

obstruction.
 SUMMARY

Mr. X was admitted on 3rd January 2007 at O710am. He

was complaint of difficulty in passing urine for 1 week,
Dr. L diagnose him a Benign prostate hyperplasia (BPH)
and transurethral resection of prostate (TURP) was done
to patient on 3rd January 2007 at 1330pm. He was
hospitalized for 2 days and discharge on 5 January 2007.
There was no complaint of difficulty in passing urine
anymore. Health educations were given on regarding the
CBD and follow up appointment on 19 January 2007. Dr.
L was ordered maxolon and zinnat 250mg to him.
CONCLUSION

Thank you, to all staff in Puteri Specialist Hospital

(PSH) especially to Sister Marina who that guide
me to do and finish my case study. Not
forgotten to my collogue in guided me also
thank you so much. Not forgetting to my parents
support in do my case study. I choose this case
because it is interesting case and of course
common happen in male population in the
world.But not so worry because now we have
the treatment to treat it become enlarge the
treatment called transurethral resection of
prostate. Thank you so much once again to my
collogue and staff PSH may Allah bless u.
REFERENCE

Medical surgical nursing book 10th edition editor by Mark

Johnson page 1192,1195,1196,1958.
A Complete Hospital Manual of INSTRUMENT AND
PROCEDURES editor by MM Kapur New Delhi page 288, 289.
Operating room technique editor by Berry and Kohns page
709,710,711,712,713,714.
Benign prostate hyperplasia editor by Axeanders and Jane C.
Rothrock page 1020,1021,1022.
Watson’s clinical nursing and related sciences editor by Mike
Walsh page 980,981,985.
MIMS 99TH Edition 2004 page 13,73,128,177.
http://www.benignprostatehyperplasia.com/GUT
/urinary
system
http://www.TURPprocedures.com.my/treatment
http://www.anatomy&physiologyofprostategland
http://www.uroflowmetryprocedures.com.my
Any question ?
Thank you for your attenttion