Bph

Benigh Prostrate Hyperplasia Disease condition for Nursing Students

1. Ratheesh.R SLMGNC BENIGN PROSTATIC HYPERPLASIA (BPH)

2. The Prostate Gland Male sex gland Pear-shape,wt7-16gm Size of a walnut Helps control urine flow Produces fluid component of semen Produces Prostate Specific Antigen (PSA)

3. Cont…. Benign prostatic hyperplasia (BPH) is the condition that occurs when the prostate gland is increasing in size without there being any malignant cause. As the prostate enlarges it leads to compression and then obstruction of the urethra, which in turn affects urinary flow. This condition becomes increasingly common with age and has an impact on the quality of life for a considerable number of men aged over fifty years.

4. Four Areas of the Prostate Transition Zone Peripheral Zone Anterior Zone Central Zone

5. Definition: It is an enlargement of portion of Prostate, enlarges, Extending upward into the bladder obstructing the outflow of urine.

6. Causes: Unknown Heriditary Race Hormonal alteration with endocrine changes (Testicular Antrogen ) Stimulation of Oestrogen Aging Mal function of testis Diet Life style issues Excessive accumulation of dihydro testosterone.

7. Pathophysiology : Due to etiological factor Enlarged nodules tissues of the Prostate Gland Compress the urethra Obstruction of the Urethra Hypertrophy and bands of the bladder muscles

8. Cont…. Increased Trabaculation of the bladder wall Bladder capacity decreases and muscle tone decreases Bladder can’t expel the urine on voiding Urinary Retention Urine become Alkaline for Bacterial growth Urinary Obstruction and Irritation

9. Clinical Manifestation: Fatigue Anorexia Nausea & Vomiting Epigastric Discomfort Acute urinary retension Recurrent UTI Anemia Prostatism (obstructive and Irritative symptoms) Hesistancy in starting urination Haematuria Hydronephrosis Pylonephrosis Renal failure Azotemianitrogen - (nitrogen containing compounds in the blood) Sensation of incomplete emptying of bladder. Terminal Dribbling Nocturia Abdominal Staining

10. Cont…. Increased frequency of Urination Dysuria Urgency Loss of muscle tone in the bladder Change in the angle of the bladder neck.

11. Common symptoms Decrease in the urinary stream Dribbling or leaking after urination Intermittency Hesitancy Pain or burning during urination Feeling that the bladder never completely empties n n n n n n

12. Diagnostic Evaluation: History collection Physical Examination Rectal Examination (Digital) – It shows the smooth, firm, symmetric enlargement of the prostate Urine Analysis Serum creatnine and blood urea nitrogen Serum prostate and specific Antigen – It is a blood test to estimate the volume of prostate. Urodynamic Flow Studies ( Cystourethrography ) - Measures peak urine flow rate, voiding time and volume, status of the bladder’s ability to effectively contract.

13. Cont…. viii) Trans Rectal Ultrasound/catheterization – It is done to measure of post void residual time. ix) Cystourethroscopy - To determine the urethra, bladder and evaluate prostatic size. x) Cystoscopy - It is done to know the size and force of urinary string. xi) Electro Mylography (EMG) - It is done to detect any defect in sphincter of muscle xii) Prostatic Fluid Examination - The fluid is examinated to determine the infection xiii) CBC

14. When should BPH be treated? BPH needs to be treated ONLY IF: The symptoms are severe enough to bother patient and affect the quality of life Renal insufficiency Frequent urinary tract infections n n n

15. Enlarged prostate Medication Heat therapies Surgical approaches Treatment options n n n

16. Medication First line of defense against bother some urinary symptoms Manage the condition - don’t fix it Two major types: (Alpha-1-blocker) - relax the prostate and provide a larger urethral opening ( prazosin , terazosin ) Shrink the prostate gland (5-alpha reductase inhibitor) ( finasteride ) n n n n n

17. Cont…. Antibiotic Therapy Alpha-Adrenergic Blockers – To relax smooth muscle of bladder base and prostate to facilitate voiding. Catheterization Prostatic massage – It is done to reduce the symptoms and size of prostate. Phyto therapy – Herbal medicine extracted from plant.

18. Possible side effects of Impotence Dizziness Headache Fatigue Loss of sexual drive Medication n n n n n

19. Destroy prostate tissue with heat Tissue 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 therapies n n n n n n

20. Possible side effects of Urinary Tract Infection Impotence Incontinence heat therapies n n n

21. Surgical treatment

22. SURGICAL PROCEDURES TURP (Trans urethral Prostectomy ): => It is performed by inserting resectoscope through the urethra and visualize the inside of the bladder. Supra Pubic Prostectomy : => It involve a lower abdominal incision => Incision is made into the bladder and then enlarged tissue is enucleated by blunt dissection.

23. Cont.... “ Gold Standard ” of care for BPH Uses an electrical “knife” to surgically cut and remove excess prostate tissue Effective in relieving symptoms and restoring urine flow Transurethral resection of the prostate: n n n

24. Cont…. Retro-Pubic Prostectomy : => It approaches the prostate through a low abdominal incision without entry into the bladder. Prostatectomy: => To remove hypertrophied portion of the prostate gland. Perineal Prostectomy : => An incision is made into the perinium between the anus and the scrotum. => Patient must be in the Lithotomy position and contraindicated for patient with Arthritis and Cardio pulmonary disease.

25. Cont…. Trans Urethral Incision of the Prostate(TUIP): => It is option for men with a small prostate the is causing outlet obstruction. => Incision are made into the prostatic tissue to enlarge the lumen of the prostatic urethra. Trans Urethral Balloon Dilation of the Prostate: => It is done to relax smooth muscle of bladder neck and prostate. => Small catheter is inserted into the urethra and balloon is positioned with in the prostatic urethra and is inflamed for 15mts.

26. Cont…. Trans Urethral Ultrasound-Guided Incision of Prostate: => A Laser is used to make the incision into the prostate and it usually done in an Ambulatory or Outpatient setting. Visual Laser Ablation of the Prostate: => Neodynium - Yttrium Aluminum Garnet(YAG) is the medium that produces to destroy tissue through a special endoscope. => Sloughing of tissue may be delayed and blood loss is minimal.

27. Cont…. Microwave Thermotherapy: => It done to relieve necrosis and slough. Trans Urethral Needle Ablation: => It uses Radiofrequency energy to destroy Prostatic tissue and it is done without anesthesia. Prostatic Stent: => It is done to patient with extremely poor operative risk and mesh like tube can be inserted through and endoscope into the prostatic urethra to open Mechanically.

28. Complication: Hydronephrosis Hydroureter Gross Hematuria UTI Acute Urinary Retension .

29. Nursing Diagnosis: Impaired urinary elimination r/t obstruction of urethra. Pain r/t surgical incision. Risk for infection r/t Incision, Presence of catheter. Risk for fluid volume deficit r/t fluid replacement needs. Potential for sexual dysfunction r/t prostatectomy and UTI.

30. Nursing Mgt. Pre - operative care: Inform about the procedure and the expected post operative care including catheter drainage, Irrigation. Complication of surgery should be discussed with the patient. Prophylactic Antibiotic are ordered. Bowel preparation is given or the patient is instructed in home administration and fasting after midnight. Optimal cardiac, respiratory and circulatory status should be achieved to decreased risk of complication. Restoring urine drainage and encouraging high fluid intake are also helpful in managing the infection.

31. Cont…. Post - operative care: Maintain patency of catheter system. Monitor patient for signs of water after TURP. Instruct patient not to try to void around catheter, explain feeling of needing to void from pressure of catheter. Avoid use of enemas and rectal thermometers. Give prescribed medication. Change dressing frequently around suprapubic wounds. Give patient opportunities to discuss feelings about sexuality and possible incontinence.

32. Cont…. Encourage increased fluid and voiding. Avoid vigorous exercise, heavy lifting and sexual intercourse at least 3 weeks. Avoid straining with defecation using stool softeners or mild laxatives if needed. Advise to take high diet fiber facilitates the passage of stool. Avoid driving for 2 weeks.

33. THANKS