Benign Prostate HyperplasiaSlide 2Benign Prostate HyperplasiaSlide 4Etiology and PathophysiologySlide 6Slide 7Slide 8Clinical ManifestationsSlide 10Slide 11Slide 12ComplicationsSlide 14Diagnostic StudiesCollaborative CareSlide 17Slide 18Slide 19Slide 20Slide 21Slide 22Transurethral Resection of ProstateSlide 24Nursing AssessmentSlide 26Slide 27Slide 28Nursing DiagnosesPlanningSlide 31Nursing ImplementationNursing ImplementationSlide 34Slide 35Slide 36Slide 37Slide 38Slide 39Slide 40EvaluationEvaluationCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Spring 2011Focus onFocus onCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissueMost common urologic problem in malesCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Occurs in 50% of men over 50 and 90% of men over 80Approximately 25% will require treatment by age 80Does not predispose to development of prostate cancerCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Not completely understoodThought to result from endocrine changes from aging processTypically develops in inner part of prostateCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Enlargement gradually compresses urethra◦Partial or complete obstructionCompression leads to clinical symptomsNo direct relationship between prostate size and obstruction Location of enlargement determines obstructive symptomsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Fig. 55-2Fig. 55-2Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Risk factors◦Family history◦Environment◦ObesityIncreased waist circumference◦DietPolyunsaturated fatty acidsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Symptoms categorized into two groups◦Obstructive symptoms◦Irritative symptomsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Obstructive symptoms◦Symptoms due to urinary retentionDecrease in caliber of force of urinary streamDifficulty in initiating urinationIntermittencyDribbling at end of voidingCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Irritative symptoms◦Symptoms associated with inflammation or infectionUrinary frequency and urgencyDysuriaBladder painNocturiaIncontinenceCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Related to urinary obstructionAcute urinary retention: Common complication is indication for surgical interventionUTI and sepsis◦Incomplete bladder emptying with residual urine provides medium for bacterial growthCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Calculi may develop in bladder because of alkalinization of residual urine Renal failure: caused by hydronephrosisPyelonephritisBladder damageCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.History and Physical ExamDigital Rectal Examination [DRE]Urinalysis with culture & sensitivityPSA level [Prostate Specific Antigen]Serum creatinineTRUS scan [Trans Rectal Ultrasound]Uroflometry CystourethroscopyCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Goals◦Restore bladder drainage ◦Relieve symptoms◦Prevent/treat complicationsWatchful waitingDietary changesTimed voiding scheduleCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Drug therapy: Offers symptomatic relief of BPH◦↓ Size of prostate gland◦Promotes smooth muscle relaxation in prostate; facilitates urinary flow◦Side effects: Decreased libido, decreased volume of ejaculation, erectile dysfunction, orthostatic hypotension and dizziness, retrograde ejaculation, nasal congestionCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Herbal therapy◦Saw palmettoMay alleviate nocturia, improve urinary flow, reduce residual bladder volume Side effects: Mainly GI, may increase BP, increase risk of bleedingLong-term effectiveness and ability to prevent complications unknownCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Invasive therapy indicated when◦Decrease in urine flow sufficient to cause discomfort◦Persistent residual urine◦Acute urinary retention◦Intermittent catheterization can reduce symptoms and bypass obstructionCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Long-term catheter use contraindicated because of risk for infectionChoice of treatment depends on size and location of prostatic enlargement as well as age and surgical riskCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Transurethral Resection of Prostate (TURP)◦Removal of obstructing prostate tissue using resectoscope inserted through urethra◦Outcome for 80% to 90% is excellent◦Relatively low risk◦Performed under spinal or general anesthesia and requires hospital stayCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.TURP (cont’d)◦Bladder irrigated for first 24 hours to prevent mucus and blood clots◦Complications include bleeding, clot retention, dilutional hyponatremia, retrograde ejaculation◦Patients must stop anticoagulants before surgeryCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Fig. 55-3Fig. 55-3Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Other options:◦Transurethral microwave therapy (TUMT)◦Transurethral needle ablation◦Laser ProstatectomyCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Medications◦Estrogen or testosterone supplementationSurgery or previous treatment for BPHKnowledge of conditionVoluntary fluid restrictionNocturiaCopyright ©