Benign Prostatic

Hyperplasia
Presented by:
2BSN2 - Group 6
INTRODUCTION
 The prostate is a walnut-sized gland that forms part of the male
reproductive system. The gland is made of two lobes, or regions,
enclosed by an outer layer of tissue. As the diagrams show, the
prostate is located in front of the rectum and just below the
bladder, where urine is stored. The prostate also surrounds the
urethra, the canal through which urine passes out of the body.
 Scientists do not know all the prostate's functions. One of its

main roles, though, is to squeeze fluid into the urethra as sperm

move through during sexual climax. This fluid, which helps make
up semen, energizes the sperm and makes the vaginal canal less
acidic.
 It is common for the prostate gland to become enlarged as a man

ages. Doctors call this condition benign prostatic hyperplasia

(BPH), or benign prostatic hypertrophy.
INTRODUCTION
 Normal urine flow.  Urine flow with BPH.
INTRODUCTION
 As a man matures, the prostate goes through two main periods of growth. The
first occurs early in puberty, when the prostate doubles in size. At around age 25,
the gland begins to grow again. This second growth phase often results, years
later, in BPH.
 Though the prostate continues to grow during most of a man's life, the
enlargement doesn't usually cause problems until late in life. BPH rarely causes
symptoms before age 40, but more than half of men in their sixties and as many
as 90 percent in their seventies and eighties have some symptoms of BPH.
 As the prostate enlarges, the layer of tissue surrounding it stops it from
expanding, causing the gland to press against the urethra like a clamp on a
garden hose. The bladder wall becomes thicker and irritable. The bladder begins
to contract even when it contains small amounts of urine, causing more frequent
urination. Eventually, the bladder weakens and loses the ability to empty itself, so
some of the urine remains in the bladder. The narrowing of the urethra and partial
emptying of the bladder cause many of the problems associated with BPH.
 Many people feel uncomfortable talking about the prostate, since the gland plays
a role in both sex and urination. Still, prostate enlargement is as common a part
of aging as gray hair. As life expectancy rises, so does the occurrence of BPH.
INTRODUCTION
 Cause of BPH
◦ Changes in hormone balance and cell-growth
factors
◦ Genetics
◦ Men older than 50 years old ( higher chance of
acquiring BPH)
INTRODUCTION
 Signs and symptoms:
◦ Related to bladder emptying:
 Difficulty starting a urine stream (hesitancy and straining)
 Decreased strength of the urine system (weak flow)
 Dribbling after urination
 Feeling that the bladder is not completely empty
 An urge to urinate again soon after urinating
◦ Related to bladder storage:
 Walking at night to urinate (nocturia)
 Frequent urination
 A sudden, uncontrollable urge to urinate
INTRODUCTION
 Complications
◦ The progression of symptoms in benign prostatic
hyperplasia (BPH) is typically very slow, and
additional symptoms, when they occur, often come
and go. Individual response to these symptoms also
varies widely. Some men can tolerate very
uncomfortable sensations of abnormal urination,
while other men seek relief from mild symptoms.
BPH does not appear to impair sexual function.
Problems with urination, however, can be very
distressing and severely affect quality of life in
some cases.
INTRODUCTION
 Complications
◦ Other problems can develop, but these problems affect
only a small number of men with BPH. Obstruction of urine
flow with retention of some urine in the bladder may
increase the pressure in the bladder and limit the flow of
urine from the kidneys, putting increased stress on the
kidneys. This increased pressure may impede kidney
function, although the effect is usually temporary if the
obstruction is relieved early. If obstruction is prolonged,
the bladder may overstretch, causing overflow incontinence
As the bladder stretches, small veins in the bladder and
urethra also stretch. These veins sometimes burst when
men strain to urinate, causing blood to enter the urine.
INTRODUCTION
 Complications
◦ Complete blockage of urine flow out of the bladder
(urinary retention) can develop, making urination
impossible and usually leading to a full feeling and
severe pain in the lower abdomen. However, occasionally
urinary retention can occur with few or even no
symptoms until retention is very severe. Urinary
retention can be triggered by the following conditions:
 Being immobile (for example, when put on bed rest)
 Being exposed to cold
 Delaying urination for a long time
 Using certain anesthetics, alcohol, amphetamines, cocaine,
opioids, or drugs with anticholinergic effects
INTRODUCTION
 Complications
◦ Bladder obstruction can also cause bladder stones,
blood in the urine, urinary tract infection, and
incontinence. It may also increase the risk for
chronic kidney disease. Unfortunately, no current
tests can accurately predict which men are at higher
risk for complications, although men with a weak
urine stream and larger prostates are at higher risk
for urinary retention.
SURGICAL PROCEDURE
 Transurethral resection of the prostate (also
known as TURP)
◦ TURP is a urological operation. It is used to treat benign
prostatic hyperplasia (BPH). As the name indicates, it is
performed by visualising the prostate through the
urethra and removing tissue by electrocautery or sharp
dissection. This is considered the most effective
treatment for BPH. This procedure is done with spinal or
general anesthetic. A large triple lumen catheter is
inserted through the urethra to irrigate and drain the
bladder after the surgical procedure is complete.
Outcome is considered excellent for 80-90% of BPH
patients.
SURGICAL PROCEDURE
 Indications
◦ BPH is normally initially treated medically. This is done
through alpha antagonists such as flomax or alpha-1
reducatase inhibitors such as proscar and avodart. If
medical treatment does not reduce a patient's urinary
symptoms, a TURP may be considered- following a
careful examination of the prostate/bladder through a
cystoscope. As medical management of BPH improves,
the numbers of TURPs have been decreasing. If TURP
is contraindicated a Urologist may consider: a simple
prostatectomy, in and out catheters, or a supra-pubic
catheter to help a patient void urine effectively.
SURGICAL PROCEDURE
 Procedure:
◦ To prepare for TURP, patients should:
◦ Select an experienced TURP surgeon to perform the
procedure.
◦ Purchase a mild natural bulk-forming laxative.
◦ Wear loose clothing on the morning of surgery.
◦ Ask friends or family to be available for assistance
after surgery.
◦ Schedule a week off from work.
◦ Get sufficient sleep on the night before surgery.
SURGICAL PROCEDURE
Aftercare

The initial recovery period lasts approximately one week, and includes
some pain and discomfort from the urinary catheter. Spastic convulsions
of the bladder and prostate are expected as they respond to the surgical
changes. The following medications are commonly prescribed after TURP:
◦B&O suppository (Belladonna and Opium). This medication has the dual purpose of
providing pain relief and reducing the ureteral and bladder spasms that follow TURP
surgery. It is a strong medication that must be used only as prescribed.
◦Bulk-forming laxative. Because of the surgical trauma and large quantities of liquids
that patients are required to drink, they may need some form of laxative to promote
normal bowel movements.
◦Detrol. This pain reliever is not as strong as B&O. There may be wide variations in its
effectiveness and the patient's response. It also controls involuntary bladder
contractions.
◦Macrobid. This antibiotic helps prevent urinary tract infections.
◦Pyridium. This medication offers symptomatic relief from pain, burning, urgency,
frequency, and other urinary tract discomfort.
SURGICAL PROCEDURE
 Aftercare
When discharged from the hospital, patients are
advised to:
◦ Refrain from alcoholic beverages.
◦ Avoid sexual activities for a few weeks.
◦ Avoid driving a car for a week or more.
◦ Keep domestic activities to a minimum.
◦ Avoid weight lifting or strenuous exercise.
◦ Check their temperature and report any fever to the
physician.
◦ Practice good hygiene, especially of the hands and penis.
◦ Drink plenty of liquids.
ANATOMY AND PHYSIOLOGY
 Prostate
◦ The prostate (from Greek προσ
τάτης - prostates, literally
"one who stands before",
"protector", "guardian") is a
compound
tubuloalveolar exocrine
gland of the malereproductive
system in most mammals. In
2002, female paraurethral
glands, or Skene's glands, were
officially renamed the female
prostate by the Federative
International Committee on
Anatomical Terminology.
ANATOMY AND PHYSIOLOGY
Function
 store and secrete a slightly alkaline fluid, milky or white in

appearance, that usually constitutes 20-30% of the volume of

the semen along with spermatozoa and seminal vesicle fluid.
◦ The alkalinity of semen helps neutralize the acidity of the vaginal
tract, prolonging the lifespan of sperm.
◦ The alkalinization of semen is primarily accomplished through
secretion from the seminal vesicles. 
◦ The prostatic fluid is expelled in the first ejaculate fractions,
together with most of the spermatozoa. In comparison with the few
spermatozoa expelled together with mainly seminal vesicular fluid,
those expelled in prostatic fluid have better motility, longer survival
and better protection of the genetic material (DNA).
 contains some smooth muscles that help expel semen during

ejaculation.
ANATOMY AND PHYSIOLOGY
Secretion
 Prostatic secretions vary among species. They are

generally composed of simple sugars and are

often slightly alkaline.
 In human prostatic secretions, the protein

content is less than 1% and includesproteolytic

enzymes, prostatic acid phosphatase,
and prostate-specific antigen. The secretions
also contain zinc with a concentration 500-1,000
times the concentration in blood.
  
ANATOMY AND PHYSIOLOGY
Regulation
 To work properly, the prostate needs

male hormones (androgens), which are

responsible for male sex characteristics.
 The main male hormone is testosterone,

which is produced mainly by the testicles.

Some male hormones are produced in small
amounts by the adrenal glands. However, it is
dihydrotestosterone that regulates the
prostate.
ANATOMY AND PHYSIOLOGY
Development
 The prostatic part of the urethra develops from the pelvic (middle)

part of the urogenital sinus (endodermal origin). 

 Endodermal outgrowths arise from the prostatic part of the urethra

and grow into the surrounding mesenchyme.

 The glandular epithelium of the prostate differentiates from these

endodermal cells, and the associated mesenchyme differentiates

into the dense stroma and the smooth muscle of the prostate. 
 The prostate glands represent the modified wall of the proximal

portion of the male urethra and arises by the 9th week of embryonic
life in the development of the reproductive system.
 Condensation of mesenchyme, urethra and Wolffian ducts gives rise

to the adult prostate gland, a composite organ made up of several

glandular and non-glandular components tightly fused within a
common capsule.
PATHOPHYSIOLOGY
NURSING ASSESSMENT
Personal History
 Mr. L. V. Lemos. is a 77 years old male, who resides at Los Banos

Laguna. His religious affiliation is Roman Catholic and is married to

Mrs. R.L. Mr. Lemos had previously worked at factory worker in
Canlubang. He lost his job last 2005 when his company went
bankrupt. Since then, he couldn’t find a job and just stayed in their
home. He usually sleeps at 10 in the evening and wakes up at around
4 in the morning. He usually spends time watching TV, dawdle in
front of their house, chatting with his neighbors and going to a market
via bicycle. His usual viand includes chicken, fish or meat and rice.
He also loves eating bread and drinking milk. Before, he used to love
eating tinapa, sardines, tocino and bagoong.
 He also smokes before and is able to consume 1 pack of cigarette per

day. He drinks alcohol beverages occasionally. Regarding the

finances about health he is using his PHILHEALTH card to compensate
the finances needed.
NURSING ASSESSMENT
Family Health and Illness History
 According to Mr. Lemos, the familial disease

that they have in the family is Diabetes

Mellitus. His mother has DM and died of
natural cause while his father died of stroke.
He has seven siblings and one died due to
stroke. He also added that he is the only
member in the family who has BPH.
NURSING ASSESSMENT
 History of Past and Present Illness
 It is the first time of Mr. Lemos to be confined in a hospital. But he
always goes to LBDH for his routine check-up. Last 3 years ago he
was diagnosed by Dr. De Guzman for having a problem in his prostate.
He was advised by the doctor to stop eating foods high in salt and
rich in preservatives. As for his present condition, he was admitted to
LBDH with a chief complaint of blood in the urine and black stool and
was diagnosed for having BPH or Benign Prostatic Hyperplasia based of
the diagnostic procedure he had underwent. One week prior to his
admission he experiences pain during urination and find a tinge of
blood in his urine. Last Wednesday, Feb 16, 2011 he was brought in
the hospital at around 10 in the evening due to black stool and
hematuria.
 Upon admission he had undergone some laboratory examination such
as CBC, CREA, BUN, HGT, and urinalysis. His initial medication is
Kepox.
Physical Examination
 Physical Assessment done by the attending physician reveals that patient is:
•Conscious and coherent
•Pink palpebral conjuctiva, anisteric sclera
•(-) cyanosis
•(+) pain
•afebrile
•(+) NABS
•non tender abdomen

 Vital Signs upon admission (Feb 16, 2011)

BP- 110/70 mmHg
RR-21 bpm
PR-80 bpm

Temp-36.7 oC
Physical Examination
Physical Assessment done by the student reveals that patient is;
•Pink palpebral conjunctiva
• (+) dry lips
•(+) dry skin
•decreased skin turgor
•(+) paleness
• (+) edema of hands and feet

Vital Signs upon admission (Feb 17, 2011)

BP- 110/60 mmHg
RR-21 bpm

PR-80 bpm

Temp-36.5 oC
DIAGNOSTIC AND LABORATORY
PROCEDURE
Complete Blood Count (CBC)
This is to determine blood components and the response to
inflammatory process or if there is a presence of infection.
Results:
Hct- 20.3 %
Platelet- 22.6
WBC- 24.4 g/l
Granulocytes- 3
Lympho/Mono- 17
Hgb- 67
Conclusion:
WBC is elevated based on the normal value of 4.3-10 g/l
which confirms the presence of infection
DIAGNOSTIC AND LABORATORY
PROCEDURE
Fasting Blood Sugar
This is to measure the blood glucose levels
Results: 107 mg/dl
Conclusion:
the result is within normal range based
on the normal value of < 126 mg/dl.
DIAGNOSTIC AND LABORATORY
PROCEDURE
BUN
This is an indicator of renal function and
perfusion, dietary intake of CHON and the
level of protein metabolism.
Results: 17.4 mg/dl
Conclusion:
the result is within normal range based on
the normal value of 7-21 mg/dl.
DIAGNOSTIC AND LABORATORY
PROCEDURE
Creatinine
In men with symptoms, blood tests are performed to
measure a substance called serum creatinine, which
is a marker for kidney trouble. Kidney problems exist
in an average of 13.6% of BPH patients. Studies have
reported rates as high as 30% and as low as 0.3%.

Results: 1.0mg/dl
Conclusions:
The result is within normal range based on the
normal value of 0.60-1.7 mg/dl.
DIAGNOSTIC AND LABORATORY
PROCEDURE
Urinalysis
A urinalysis may be performed to detect signs of bleeding or infection. A urinalysis
involves a physical and chemical examination of urine. In addition, the urine is
spun in a centrifuge to allow sediments containing blood cells, bacteria, and other
particles to collect. This sediment is then examined under a microscope. Although
urinary infection is uncommon in younger men, it occurs more frequently in older
men, particularly those with BPH. A urinalysis also helps rule out bladder cancer.

Results:
Color- yellow
Specific Gravity- 0.010
pH- 7.5
Appearance- turbid
Pus cells- 1-3 hpf
Red cells- 15-25 hpf

Conclusions:
The results are almost normal but there is a presence of pus cells in the urine
which indicates the presence of infection and presence of red cells that indicates
the presence of blood in the urine.
DRUG STUDY
Medical/ Surgical Management
Intravenous Rehydration
- When the fluid loss is severe or life threatening, IV fluids are used for
replacement.
Blood Transfusion

- It may be necessary for replacement of RBC to WBC, platelets or blood

proteins
Folley Catheter

- To facilitate accurate measurement of urinary output for critically ill clients

whose output need to be monitored hourly. It is also used to manage
incontinence when other measures have failed.
Lavage

- The process of washing out an organ, usually the bladder, bowel,

paranasal sinuses, or stomach for therapeutic purposes.
Watchful Waiting

- Watchful waiting involves lifestyle changes and an annual examination. It

should be noted that even when choosing watchful waiting, an initial
examination is critical to rule out other disorders.
Transurethral resection of the prostate (TURP)

- Involves surgical removal of the inner portion of the prostate where BPH
develops. It is the most common surgical procedure for BPH
DISCHARGE PLANNING
 M-Instructed the patient to continue medication as ordered
◦ Iberet 500 mg cap once a day (8am)
◦ Lanoxin 0.25 mg tab once a day (8am)
◦ Vastarel MR tab 2 x day (8am-1pm)
 E-Instructed the patient to do exercise as tolerated such as walking
 T-Instructed the patient to continue the medication
 H-

1. Encouraged patient to increase fluid intake

2. Encouraged patient to eat foods rich in Vitamin C and Nutritious
foods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest
 O- Instructed to come back for follow-up check-up
 D- Advised the patient to a diet as tolerated but preferably avoiding

salty and fatty foods