JMJ
MARIST BROTHER
NOTRE DAME OF DADIANGAS UNIVERSITY
COLLEGE OF NURSING
WARD
CLASS
(BENIGN PROSTATIC
HYPERPLASIA)
Presented by: Kimberly N. Alberca BSN-3C Group 1
Presented to: Leila G. Garcia, RN, MAN
December 18, 2010
BENIGN PROSTATIC HYPERPLASIA
-Benign enlargement of prostate commonly occurring in men over 50 yrs.
- It is a gradual enlargement of the prostate gland with the hypertrophy and
hyperplasia of normal tissue.
Causes:
Age 50 y/o and above
Family history
Hormonal factors: testosterone and estrogen; late activation of cell
growth
Diabetes mellitus
Diet-obesity
Signs and symptoms:
urinary hesitancy (slowed or delayed start of the urinary stream)
weak urine stream
nocturia (needing to urinate 2 to 3 times or more per night)
pain with urination
bloody urine
urinary retention (difficulty urinating)
increased urinary frequency
strong and sudden urge to urinate (urinary urgency)
incontinence
Diagnostic Tools
1. International Prostate Symptom Score (IPSS) or AUA Symptom Index
— a short questionnaire that asks about specific urinary symptoms
associated with BPH or enlarged prostate and how often they occur.
2. Digital Rectal Examination (DRE) — during the physical examination,
the doctor inserts a gloved and lubricated finger into the rectum to feel
the prostate. This examination allows the doctor to get a general idea of
the size and condition of your prostate.
3. Prostate-Specific Antigen (PSA) blood test — used to rule out prostate
cancer as the cause of your symptoms. PSA is a protein produced by
cells in the prostate, and the level of this protein is elevated in the
blood in men who have prostate cancer or BPH.
4. Urinalysis — a laboratory test of your urine performed to rule out the
presence of an infection or condition that may produce similar
symptoms.
If the results of these tests suggest that you may have BPH or enlarged prostate,
your doctor will probably perform additional examinations to help confirm the
diagnosis and determine the severity of the condition.
Such tests may include:
a. Urinary flow study — measures the strength and amount of your urine flow.
b. Imaging tests — ultrasound may be performed to estimate the size of the
prostate and may also be used to look for prostate stones, kidney stones or
obstructions, or a tumor.
c. Cystoscopy — a cystoscope (a thin tube containing a lens with a light system)
is inserted into the urethra so the doctor can detect problems, including
prostate enlargement or the development of stones in your bladder.
d. Urodynamic studies — your doctor may recommend a series of tests to
measure bladder pressure and function if he or she suspects your symptoms
might be related to a bladder problem or a neurological problem, and not
BPH or enlarged prostate.
e. Post-void residual volume test — ultrasound imaging is used to determine if
you can empty your bladder.
Management:
Surgical
1. Transurethral Resection of the Prostate (TURP)
2. Suprapubic Prostatecatomy
3. Retropubic Prostatectomy
4. Perineal Prostatectomy
Medication
1. Alpha-blockers, including doxazosin (Cardura) and terazosin
(Hytrin), relieve symptoms within a few weeks but do not stop
the process of prostate enlargement.
2. 5-alpha reductase inhibitors, such as dutasteride (Avodart) or
finasteride (Proscar), may reduce the size of an enlarged
prostate but may take 6 months or more to show any effect on
symptoms.
3. Using a combination of an alpha-blocker with a 5-alpha
reductase inhibitor may help your symptoms more than either
medicine alone
4. Anti androgen agents (fenaSTERIDE and dutaSTERIDE)
Medical
1. Intravenous Rehydration. When the fluid loss is severe or life
threatening, IV fluids are used for replacement.
2. Blood Transfusion. It may be necessary for replacement of RBC to
WBC, platelets or blood proteins.
3. 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.
4. Lavage. The process of washing out an organ, usually the bladder,
bowel, paranasal sinuses, or stomach for therapeutic purposes.
5. 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.
Nursing Priorities
1. Relieve acute urinary retention.
2. Promote comfort.
3. Prevent complications.
4. Help patient deal with psychosocial concerns.
5. Provide information about disease process/prognosis and treatment
needs.
