Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

• Kristen G. Barbee, RN, BSN
• MSN Student
• East Carolina University

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Prostate Gland

• Walnut-sized gland
• Lies just below neck of bladder
• Surrounds urethra
• Produces a secretion chemically and
  physiologically suited for sustaining spermatozoa

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If women controlled medicine
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BPH
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BPH

• Prostate enlargement
• According to NIH, BPH affects 50 of men 60
  years of age
• Affects 90 of men over 70 years of age
• Men who have undergone bilateral orchiectomies do
  not develop BPH

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BPH Risk Factors

• All men will likely develop some degree of BPH as
  they age
• Due to hormonal changes
• Dihydrotestosterone (DHT)-a derivative of
  testosterone
• DHT may accumulate and cause hyperplasia of
  prostate cells

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Clinical Manifestations

• Prostatism
• Increased frequency of urination
• Nocturia
• Urinary urgency
• Hesitancy in starting urination
• Abdominal straining with urination
• Dribbling after urination
• Decrease in volume and force of stream
• Interruption of urinary stream

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Clinical Manifestations

• Sensation of not completely emptying bladder
• Acute urinary retention
• Recurrent UTIs
• Generalized symptoms
• Malaise
• Fatigue
• Anorexia
• N/V
• Azotemia-what blood test?
• Renal failure-Why?

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Diagnostic Findings

• DRE-large, rubbery, nontender
• PSA may be elevated
• UA
• Urodynamic studies assess urine flow
• IVP
• Rectal ultrasound
• Renal function tests
• CBC/Coagulation studies

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Relax, its only a DRE! http//www.yananow.net/
troopc.htm
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Medical Management

• Watchful waiting
• Medications
• 5-alpha reductase inhibitors
• Inhibit production of DHT
• Finasteride (Proscar)
• Dutasteride (Avodart)
• Alpha blockers
• Dilate smooth blood vessels and relax smooth
  muscles in prostate and bladder neck
• Tamsulosin (Flomax)
• Terazosin (Hytrin)
• Doxazosin (Cardura)
• Combination therapy proven superior in treatment
  of BPH and is now recommended by American
  Urologic Association.

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Surgical Treatment

• Transurethral resection of prostate (TURP)
• Gold standard
• Surgical procedure requiring spinal or general
  anesthesia
• Resectoscope inserted through urethra
• Gland removed in small chips by electrical
  cutting loop
• Inpatient hospitalization required

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TURP Postop

• Foley catheter
• Traction
• 3-way Foley
• Continuous bladder irrigations (CBI) or Murphy
  drip
• Avoid Valsalva or straining

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TURP Complications

• Bleeding
• DVT
• Hyponatremia
• TURP syndrome
• Infection
• Urethral Strictures
• Need for repeated surgeries
• Retrograde ejaculation
• Rarely causes erectile dysfunction or incontinence

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TURP Postop

• May be d/c home with catheter
• Large post-void residual
• Inability to void after catheter removed
• Leg bag instruction
• If client has hematuria
• Possibly being too active
• Drink a glass of water and rest
• Next voiding should be clear
• If not, call physician

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Other BPH Surgical Management

• TUIP (transurethral incision of prostate)
• TUMT (transurethral microwave therapy)

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Other BPH Surgical Management

• Laser therapy
• TUNA (transurethral needle ablation)
• Open prostatectomy
• Balloon dilatation
• Prostatic stents
• TUVP (transurethral vaporization)