As a part of my M.Sc. Nursing course, I have prepared PPT on Bengin Prostate Hyperplasia, which is an important topic from clinical as well as exam point of view. I hope this material will be helpful to the prospect nursing student. However, refer books for the better understanding of the topic.

1. BENIGN
PROSTATIC
HYPERPLASIA
PRESENTER:
ROLL NO. 2473

2. Introduction
– Histologic evidence of prostrate enlargement begins about the third decade of life
and increases proportionally with aging.
– Specifically, about 43% of men in their 40s
– 50% of men in their 50s,
– 75% to 88% in their 80s, and

3. – Nearly 100% of men reaching the ninth decade of life.
– European and African Americans have similar prevalence rates of BPH,
– but Asian Americans tend to have lower rates of BPH.
– The incidence of BPH is lowest among immigrants, however, and it increases
with subsequent generations, suggesting environmental as well as possible racial
differences.

4. Definition
The prostrate is the genital organ most commonly affected by benign and
malignant neoplasms.
Benign enlargement of the prostate gland is an extremely common process
that occurs in nearly all men with functioning testes.

5. -The term benign prostatic hyperplasia or hypertrophy (BPH) is used to describe
the disorder that occurs when the prostate growth sufficiently obstructs the urethral
outlet resulting in bothersome
lower urinary tract symptoms (LUTS), urinary tract infection (UTI),
hematuria, or compromised upper urinary tract function.

6. It is defined as
– “Noncancerous increase in size of prostate gland which involves
hyperplasia in Prostatic stromal and epithelial cell
– resulting in formation of large, fairly discrete nodules, in
transitional zone of prostate,
– Which push on and narrow the urethra resulting in an increase
resistance to flow of urine from the bladder.”

8. ETIOLOGY AND RISK FACTORS
– It is arrested following bilateral orchiectomy.
– Androgens, and particularly testosterone, are not direct causes of
BPH, their presence is critical to the normal growth and
development of the prostate as well as BPH
– Within the prostate, testosterone is converted to
dihyrotestosterone (DHT) under the influence of an enzyme called
5-alpha reductase.

9. – DHT is active form of testosterone that supports prostate growth
and development throughout life, and the prostate remains
sensitive to androgen production throughout life to maintain both
prostate size and function.

10. Additional factors associated
– Defect in local substances that regulate the programmed cellular death
(apoptosis)
– Imbalances of local growth factors,
– Local inflammation, and
– Genetic factor
– Frequent use of alpha-adrenergic agonists commonly found in over-the-
counter cold medications or diet pills increases the severity of
bothersome LUTS

11. Multiple possible risk factors for
BPH
– Dietary factors have been examined, and lycopene in cooked tomatoes,
green and yellow vegetables, and other elements of a traditional
Japanese diet appear to provide some protection against BPH
– Smoking has been hypothesized to exert a protective effect on BPH
because it reduces serum testosterone levels
– Heavy alcohol use and cirrhosis of the liver impede prostate
enlargement.

12. Obesity
– Particularly an increased abdominal girth may increase the risk for BPH,
– diabetes mellitus appears to exert only a modest affect on the incidence
of BPH or its severity.

13. PATHOPHYSIOLOGY

14. CLINICAL MANIFESTATIONS

15. Complications of benign prostate
enlargement.
– Compromised renal function or renal failure.
– Urinary tract infection and hematuria also may be associated with
BPH
– Urinary retention and obstruction

16. – International Prostate Symptom Score Index (IPSS)
– is a short questionnaire commonly used by urologists to
assess the client´s opinion about the severity of these
manifestations
– This instrument provides a reliable and valid description
of bothersome LUTS associated with BPH,
– but it fails to differentiate LUTS caused by BPH from
those caused by other, non-obstructive etiologies.

17. – A DIGITAL RECTAL EXAMINATION (DRE) is performed to
assess prostate size and to differentiate BPH from
prostate enlargement
– BPH reveals a symmetrically enlarged prostate with an
obliterated central sulcus.
– Prostatic infection (prostatitis) is associated with
symmetric enlargement, a boggy consistency, and
discomfort on palpation.
– Adenocarcinoma of the prostate is associated with
asymmetric enlargement, hardened nodules, or
induration

18. – Urinalysis and blood tests for kidney function (urea nitrogen or
blood urea nitrogen (BUN) and Creatinine)
– Urine culture or prostate-specific antigen (PSA) to assess for
cancer
– Chemistry panels, such as electrolyte, liver function, and blood
coagulation studies, may be added if surgery is being considered.

19. – Uroflowmetry may be completed to assess the voiding pattern
and measure maximum and average flow rates.
– A man starts this test with a full bladder, voids into a specific
toilet or container, and empties his bladder to the best of his
ability.
– Residual urine is determined after the urine flow either by
catheterization or by ultrasonography
– A maximum urinary flow of 12 ml/sec or greater in a man
aged 55 years or older greatly reduces the likelihood of
urethral obstruction associated with BPH

20. MEDICAL MANAGEMENT
Alpha blockers:
– These medications relax bladder neck muscles and muscle fibers
in the prostate, making urination easier.
– Alpha blockers — which include alfuzosin (Uroxatral), doxazosin
(Cardura), tamsulosin (Flomax), and silodosin (Rapaflo) — usually
work quickly in men with relatively small prostates.

21. 5-alpha reductase inhibitors:
– These medications shrink prostate by preventing hormonal
changes that cause prostate growth. These medications — which
include finasteride (Proscar) and dutasteride (Avodart) — might
take up to six months to be effective.

22. Combination drug therapy
– Doctor might recommend taking an alpha blocker and a 5-alpha
reductase inhibitor at the same time if either medication alone
isn't effective.
– Tadalafil (Cialis). Studies suggest this medication, which is often
used to treat erectile dysfunction, can also treat prostate
enlargement

23. PHYTOTHERAPEUTIC
AGENTS
– Use of herbs for healing purposes to manage BPH.
– The most widely used agent is Serenoa repens (saw palmetto).
– Saw palmetto is derived from a dwarf palm tree that grows in the
southwest United States;
– It contains a mixture of fatty acids, sterols (alcohol-based steroid),
and flavonoids.
– Its principal action in relationship to BPH appears to be inhibition
of 5-alpha reductase enzyme activities similar to the action

24. NURSING DIAGNOSIS

25. Ineffective Therapeutic Regimen
Management.
– Provide Teaching About BPH
– Encourage Fluids
– Explain Medications.

26. DIAGNOSIS: IMPAIRED
URINARY ELIMINATION.
– Monitor the Urine Output
– Catheterize

27. SURGICAL MANAGEMENT
INVASIVE SUGERIES
PROSTATECTOMY :
The part of the gland causing the obstruction is removed in a
procedure called a prostatectomy.
1. Transurethral Resection Of The Prostate
2. Suprapubic Prostatectomy:
3. Retropubic Prostatectomy:
4. Perineal Prostatectomy:

29. OPERATIVE
TECHNIQUE
TRANSURETHRAL RESECTION OF THE PROSTATE
widely used technique for managing BPH, and it continues
to be the ``gold standard`` against which all other
procedures are measured
Resectoscope is inserted through the urethra
The surgeon visualizes the inside of the bladder by inserting
a cystoscope (telescopic lens) through the resectoscope.

30. SUPRAPUBIC
PROSTATECTO
MY:– Suprapubic prostatectomy is a surgical approach
that involves a lower abdominal incision
– Prostate is too large
– A bladder abnormality needs correction
– An abnormal surgical exploration is necessary

31. RETROPUBIC
PROSTATECTOMY:
– The surgeon approaches the prostate through a low abdominal
incision without entry into the bladder.
– This is the operation of choice when the prostate is very large and
a severe urethral stricture is present.

32. PERINEAL
PROSTATECTOMY:An incision is made into the perineum
between the anus and the scrotum.
This operation is rarely used for treating BPH
because of the great potential for erectile
dysfunction.

33. MINIMALLY INVASIVE
THERAPIES:
1. LASER-ASSISTED PROCEDURES:
2. Prostatic Stent
3. Hyperthermia And Thermal Therapy
4. Transurethral Electrovaporization
Transurethral Incision Of The Prostate

34. LASER-ASSISTED PROCEDURES:
– Transurethral ultrasound-guided laser incision of the prostate
(TULIP) is a minimally invasive procedure in which a laser is used to
make the incision into the prostate

35. Laser ablation of prostatic tissue
– Its use subsequently declined because of the need for prolonged
catheterization following the procedure and the length of time
required to resect enough prostatic tissue to effectively relieve
bladder outlet obstruction.

36. Holmium laser enucleation of the prostate (HoLEP)
and photoselective vaporization of the prostate (
Green Light Laser)

38. HYPERTHERMIA AND THERMAL
THERAPY:
– Hyperthermia refers to the administration of temperature below
45’C; thermal therapy
– Three techniques- microwaves, radiofrequency, or high-intensity
ultrasound waves-may be used to heat the prostate and destroy
prostate tissue
– Temperature probe is placed in the rectum, and water is circulated
through the system to prevent urethral or rectal heat injury

39. The transurethral needle
ablation (TUNA) system
– Uses radiofrequency energy to destroy prostatic tissue.
– Special needles are placed into the prostate, and radiofrequency
energy is used to provoke tissue coagulation and necrosis.

40. PROSTATIC STENT:
– Prostatic stent insertion is indicated for clients who are extremely
poor operative risks.
– The mesh-like tube ( a coil-shaped device has also been used) can
be inserted through a endoscope into the prostatic urethra, where
it holds the urethra open mechanically.
– Over time, usually about 3-6 months, epithelial cells grow over the
stent, which is permanent in most cases

41. NURSING MANAGEMENT OF
SURGICAL CLIENT

42. Risk for injury related to presence of urinary
catheters, hematuria, irrigation, or
suprapubic drains
INTERVENTION
– Maintain irrigation.
– Monitor For Bleeding:
– PREVENT CATHETER DISLODGEMENT:
– Monitor For Retention:

43. Acute pain related to surgery and
bladder spasms.
– Ensure that the drainage system is not blocked
– Antispasmodic medications, such as belladonna and opium (B&O)
suppositories, propantheline bromide (Pro-Banthine)

44. SELF CARE
– Provide Teaching
– Teach Pelvic Rehabilitation

45. Treat Erectile Dysfunction:
– Sildenafil (Viagra) may be given to post-prostatectomy
– prevent or reverse apoptosis (programmed cellular death