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bENIGN PROSTATICHYPERPLASIA(BPH)ISAAC AMANKWAA (MSc., BSc., RN)The Prostate Gland

Male sex gland Pear-shape,wt7-16gmSize of a walnutHelps control urine flow Produces fluid component of semenProduces Prostate Specific Antigen (PSA)

2Located in lower pelvis just below the bladder and in front of the rectumSurrounds the urethraprostate 4cm in diameter at broadest point

PSA is good indicator of activity of prostate PSA tests are used to diagnose PC along with a physical examination.

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 treatednnnn

What is Benign Prostatic Hyperplasia?3EtiologyAgeing Excessive accumulation of prostatic androgen [dihydroxytestosterone]Stimulation by estrogenLocal growth hormone action Risk factorsFamily history EnvironmentDiet [saturated fatty acids]Reduced exerciseAlcohol consumption

Clinical ManifestationsOBSTRUCTIVEIRRITATIVEReduced force of urine stream (weak stream)FrequencyDifficulty in initiating voidingUrgency Intermittency Dysuria Dribbling at the end of urination Bladder painHesitancy Nocturia Urinary retention

Incontinence Straining to pass urine (strangury)Inflammation/ infectionProlonged micturationwhat causes these symptoms?Prostate grows with age Pressure on the urethra restricts urine flow

nn7complicationsAcute urinary retentionUTI Incomplete bladder emptying residual urineStone formationHydronephrosis Pyelonephritis Bladder damage Diagnosis History & PEDigital Rectal examinationUrinalysis Urine c/sPSA [Prostate specific antigen]Transrectal ultrasoundMeasure Postvoidal residual urineCystourethroscopy enlarged prostate MedicationHeat therapiesSurgical approaches

treatment optionsnnn10MedicationTwo major types:Alpha-1-blocker - relax the prostate and provide a larger urethral opening e.g. prazosin,terazosin5-alpha reductase inhibitorShrink the prostate gland e.g.finasteride

n11Relaxation of these muscle bundles lessens the resistance to outflow during urination.Destroy prostate tissue with heatTissue is left in the body and is expelled over time (called sloughing)Transurethral Microwave Therapy (TUMT)Transurethral Needle Ablation (TUNA)Interstitial Laser Coagulation (ILC)Water Induced Thermotherapy (WIT)

heat therapiesnnnnnn12possible side effects of Urinary Tract InfectionImpotenceIncontinence

heat therapiesnnn13Medications address the desire we all have to find a cure to fix the problem. We all like a quick and easy solution.They can, however, become less effective over time.Studies have shown that people tend to become less careful about following directions regarding the dose and/or frequency of taking their medication.

Surgical treatment (prostatectomy)

14Until recently, the only option we could offer patients for treatment of their symptoms was either an open abdominal surgical procedure, or a trans-urethral resection of the prostate.SURGICAL PROCEDURESTypes of prostatectomyTransurethral prostatectomySuprapubic prostatectomyRetropubic prostatectomyPerineal prostatectomySURGICAL APPROACHESSeveral approaches can be used to remove the hypertrophied portion of the prostate gland: CLOSEDTransurethral resection of the prostate (TURP),Transurethral incision of the prostate (TUIP)OPENSuprapubic prostatectomy, Perineal prostatectomy, Retropubic prostatectomy, andSUPRAPUBIC 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

Gold Standard of care for BPHUses an electrical knife to surgically cut and remove excess prostate tissueEffective in relieving symptoms and restoring urine flow(transurethral resection of the prostate)nnn21Minimally invasive therapyTransurethral 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 prostatectomyVisual laser ablationInterstitial laser coagulationIntra prostatic urethral stents

PREOPERATIVE NURSING DIAGNOSISAnxiety related to unknown outcome of surgery and its outcomeImpaired Urinary Elimination: Urinary Retention related tomechanicalobstructionby enlarged prostateAcute pain related to bladder distention and mucosal irritationAnxiety 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 interventionsReducing patient anxietyAlways remain with thepatient. Establish trusting relationship with patient.Ask the patient what he knows about the procedure and its aftermathReinforce previous information patient has been givenClarify the nature of the operation and expected post-operative outcomesProvide privacy, and establish a trusting and professional relationshipEncourage the to discuss feelings and concernsOffer emotional supportPre-operative nursing interventionsReducing discomfort/ pain reliefAssess pain, noting location, intensity (scale of 010), duration Administer analgesicsTape drainage tube to thigh and catheter to the abdomen (if traction not required).Monitor voiding patterns; watch for bladder distensionInsert urinary catheter if bladder distension is presentProvide comfort measuressuch asback rub, helping patient assume position of comfort. Suggest use of relaxation and deep-breathing exercises, diversional activities.

Pre-operative nursing careBecause some types of prostectomy can result in impotence, it is important to arrange for sexual counseling to help the patient and his partner copeIf the patient is schedule for TURP, explain that this procedure often causes retrograde ejaculation but otherwise doesnt impair sexual functionPre-operative nursing carePhysical preparationShave and clean the surgical siteAdminister a cleansing enema

Post-operative careTURPa 3-way catheter is kept in position after surgeryOne way is connected to a continuous irrigation bag hanged above usually containing 0.9% normal salineSuprapubic prostatectomy2 different catheters are inserted with one in the bladder through the abdomen and the other in the urethraThe suprapubic catheter is connected to a continuousPost-operative careObservationMonitor the patients vital signs closely, looking for indications of possible hemorrahgeFrequently check the incision site (if present) for signs of infection and change dressings as neededRecord amount and nature of urine drainageWatch for catheter blockade from kinking or clot formation, and correct as necessaryMaintain the patency of suprapubic tube, if inserted

Post-operative careObservationObserve the colour of drainage, drainage should be amber or slightly blood tingedThe 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 careManagement of catheters/irrigationMaintain indwelling urinary catheter patency through intermittent or continuous irrigation as ordered.Secure catheters in positionEnsure that specially prepared sterile fluid or normal saline is used for irrigationEnsure that the rate of flow is regulated to specificationTHANKS