BENIGN PROSTATE HYPERTROPHY

What is BPH?

It is enlargement of prostate gland.

Definition:

BPH os characterized by proliferation of both stromal & epithelial elements with resultant enlargement of gland resulting in urinary obstruction.

Etiology & Risk factors:

• Age over 40 years & older
• Family history of BPH
• Obesity
• Cardiovascular disease
• Type 2 diabetes 
• Sedentary lifestyle
• Erectile dysfunction
• Decrease levels of testosterone in blood

Pathophysiology:

Development of multiple fibroadenomatous nodules in the periurethral region of prostate leads to narrowing of lumen of prostatic urethra leading obstruction in urinary flow causing diverticula& hypertrophy of bladder causing increase pressure with micturition leading to incomplete emptying of bladder causing infection & hydronephrosis.

Sign & Symptoms:

• Urinary hesitancy- difficulty initiating stream of urine due to pressure ob urethra & bladder neck
• Urinary frequency- Need to urinate frequently owing to pressure on bladder
• Urinary urgency
• Nocturia
• Decrease force of urine stream
• Dribbling of urine
• Hematuria
• UTI
• Bladder stones
• Pelvic discomfort
• Azotemia
• Abdominal straining

Medical & Nursing Management:

• Alpha 1 adrenergic blockers - doxazosin, tamsulosin
• 5 Alpha recductase inhibitors to reduce the size of prostate-finasteride, dutasteride
• Antimuscarinics such as  tolterodine 
• Phosphodiesterase-5 inhibitors such as tadalafil 
• Combination therapy of alpha blockers & 5 aplha reductase inhibitors.
• Monitor blood pressure as hypotension may be the side effect of alpha 1 blockers
• Monitor renal function
• Administer anti spasmodoics for patient experiencing bladder symptoms.
• Explain patient to avoid caffeine, alcohol, decongestants which may increase symptoms of BPH.
• Surgical treatment may be a choice to alliviate symptoms.
• Monitor postoperative patient's bladder irrigation:

1. 3 way port catheter
2. Monitor amount of fluid instilled & returned.
3. Subtract the amount of fluid instilled from amount of fluid returned to determine actual urine output.
4. Monitor bladder spasm as it may indicate blocked catheter drainage postoperatively
5. Document the color of urinary output post operatively.
6. Maintain record of cardinal signs.
7. Continuous bladder irrigation post operatively.

Distinctive facts:

• Ix: Prostate specific antigen [PSA], BUN & creatinine levels - elevated, Digital rectal examination 
• Sx: Transurethral Resection of Prostate [TURP], Transurethral Incision of prostate [TUIP].
• Main factor of cause: Dihydrotestosterone [DHT]
• More common in white & black men than in Asian men.
• Also called as benign prostate hyperplasia, adenofibromyomatous hyperplasia, benign prostatic hypertrophy,benign prostatic obstruction
• Complications include: Vesicourethral reflux, Cystolithiasis.
• May be caused by taking drugs such as beta blockers.

Prognosis:

Prognosis is often associated with surgical management. The prevalence rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years. Medical management can reduce the course of disease.