Conditions of prostate

This includes the disease conditions related to prostate

1. Prostate: Inflammation,
Infection, Hypertrophy,
Tumour
MS.ALISHA TALWAR

2. Benign Prostate
Hyperplasia

3. Benign Prostate Hyperplasia
It is a condition progressive enlargement of
prostate gland, resulting from an increase in the
number of size of epithelial cells and stromal
tissue.

5. Epidemiology/
Incidence

6. Etiology
Ageing
Excessive accumulation of prostaticandrogen
Family history
Diet increase animal fat and saturated fatyacids
Reduced exercise and alcoholconsumption

7. Etiology
Recent studies have identified smoking (both
current and formersmoking),heavy alcohol
consumption, hypotension,heart disease and
diabetes mellitus as risk factors associated with
BPH.

8. Pathophysiology
The causeofBPH is uncertain, butstudies
suggest that estradiollevels may have a
relationship to prostate size among men with
testosterone levels above themedian.
Recent studies have identified smoking both
current and former, heavy alcohol
consumption, hypertension, heart disease and
diabetes as risk factors ofBPH.

9. Pathophysiology
The hypertrophied lobes of prostate may
obstruct the vesicalneck or prostatic urethra,
causing incomplete emptying of the bladder and
urinaryretention.
As a result. A gradual dilation of the ureters
(hydroureter) andkidneys(hydronephrosis)can
occur. Urinary tract infections may result from
urinary stasis. Urine remaining in the urinary
tract serves as a medium for infectve
organisms.

10. Pathophysiology

11. Clinical Manifestations
Obstructive
Reduced force of urinestream
Difficulty in initiating voiding
Intermittency
Dribbling at the end ofurination

12. Clinical Manifestations
Irritative
Frequency
Urgency
Dysuria
Bladderpain
Nocturia(excessive urination at night)
Incontinence

13. Continue
Inflammation and infection
Decrease volume and force of the urinary
stream
Sensation of incompleteemptying

14. Continue
Generalized symptomsinclude
Fatigue
Anorexia
Nausea andvomiting
Epigastricdiscomfort

16. Complications
Acute urinaryretention
Urinary tract infections(UTI)
Renal stone (kidneystone)/ Bladder stone
Bladderdamage/ decompensation
Hydronephrosis
Pyelonephritis
Sexual Dysfunction
Urinary incontinence

17. Assessment and Diagnostic
Tools
History-H/o surgical procedure (genitourinary),
hematuria, UTIs, DM. Current Medications
(anticholinergics-which impair bladder contractions
or sympathomimetics-that increase outflow
resistance, Use of voiding dairy)
Physical examination-Digital rectal examination to
detect enlarged prostate, to evaluate anal sphincter
tone, to rule out any neurological problems.
Urinary outflow resistance
can be estimated,
provided the bladder
pressure, equivalent exit
pressure, and the urinary
flow rate are measured
simultaneously

18. Assessment and Diagnostic
Tools
Urinanlysis-to rule out UTIs & hematuria
Urine culture and sensitivity
Serum Creatinine-to evaluate LUTS
Prostate Specific Antigen (PSA)-can help to rule out
prostatic carcinoma
TransrectalUltrasound-to rule out enlargement
Uroflowmetry& Urodynamics-to evaluate the flow-rate
It is electric recording
of urine flow-rate
throughout course of
micturition.

19. Assessment and Diagnostic
Tools
Post-voidalresidual urine-to measure residual
urine. It ranges b/w 0.09-2.24 ml.
Pressure flow studies-to distinguish uretheral
obstruction and impaired detrusor contractility.
>15ml/sec flow rate suggests bladder dysfunction.
Filling Cystometry-Invasiveurodynamic procedure
to determine bladder capacity & compliance

20. Assessment and Diagnostic
Tools
Cystourethoscopy-to visualise the prostatic urethera
and bladder.
Complete blood studies are performed because
hemorrhageis a major complication of prostate
surgery, all clotting defects must be corrected. A high
percentage of patients with BPH have cardiac or
respiratory complications, or both because of their age
therefore cardiac and respiratory function also
assessed.

21. Medical Management
The main goals of medical management are-
Restore bladder function
Relieve signs and symptoms
Prevent and treat complications

22. Contd..
The treatment Plan depends on the cause of
BPH, the severity oftheobstruction, and the
patient’s general healthconditions.
If the patient is admitted on an emergency
basis because he can not void, he is
immediatelycatheterized.

23. Dietary Management
Decrease amount of intake caffeine and
artificialsweetners, limit spicy and acidic foods
andalcohol.

24. Pharmacological Management
Alfa-adrenergic blockers such as doxazosin,
tamsulosin(relaxes smooth muscles of bladder neck
and prostate to facilitate voiding).
5-alfa reductaseinhibitors such as finasterideand
dutasteride(exert anti-androgen effect on prostatic
cells and can reverse or prevent hyperplasia).
Aromatase Inhibitors
Symptomatic Management

25. Surgical Management
Several approaches or methods depends on size of
gland, severity of obstruction, age, health of client
& prostatic disease.
Surgery is primary intervention for BPH.
During surgery prostate gland is left intact and
adenomatous soft tissue is removed by one of four
surgical routes.
Transuretheral, Suprapubic, Retropubic, Perineal

26. Contd…
2 newer approaches balloon dilatation of prostate
under endoscopy and TUIP.
Indications-
Acute urinary retention
Recurrent infection
Recurrent hematuria
Azotemia

27. Closed Surgical Procedures
TURP (Transurethral resection of theprostate)
TUIP (Transurethral incisionof the prostate)
TUMT (Transurethral Microwave therapy)
TUNA (Transurethral Needle ablation)

28. Open Surgical Procedures
SuprapubicProstatectomy
PerinealProstatectomy
RetropubicProstatectomy

29. Others
•Newer treatments include balloon urethroplasty,
laser therapy, and intraurethralstents
•Other minimally invasive surgical techniques
include: ◗Transurethral needle ablation to burn
away well-defined regions of the prostate, thereby
improving urine flow with less risk

30. TURP
Removal of prostate tissue using a
resectoscopeis inserted through the tip of
penis and into the tube that carries urine from
bladder (urethra) under spinal or general
anaesthesia.

31. TUIP
A combined visual and surgical instrument
(resectoscope) is inserted through the tip of penis
into the tube that carries urine from bladder
(urethra). The prostate surrounds the urethra. The
surgeon cuts one or two small grooves in the area
where the prostate and the bladder are connected
(bladder neck) to open the urinary channel and
allow urine to pass through more easily.

32. TUMT
A small microwave antenna is inserted through the
tip of penis into the tube that carries urine from
bladder (urethra)

33. TUNA
Radiofrequency ablation, is a minimally invasive
treatment option used to treat benign prostatic
hyperplasia. During theprocedure, radiofrequency
needles are placed through the urethra into the
area of the prostate that is pressing on the urethra.

34. SuprapubicProstatectomy
SuprapubicProstatectomy is one method of
removing the enlarged gland through an
abdominal incision . An incision is made into the
bladder and the prostate gland is removed from
above.

36. Perinealprostatectomy
Perinealprostatectomy involves removing the
gland through an incision in the perineum. (This
method is practical when other methods or
approaches are notpossible.

37. Retropubicprostatectomy
Retropubicprostatectomy is a another
technique, is more common than suprapubic
approach. Incision made on low abdominal
between prostate gland and pubic arch and the
bladder without entering thebladder.

38. Cancer of Prostate

39. Cancer of Prostate
Abnormal proliferation of cells of prostate.
Most common carcinoma in men over 65 years.
Etiologyis UNKNOWN. Increased risk if family
history, influences of dietary intake, S. testosterone
levels are under investigation.

40. Clinical Manifestation
May be asymptomatic at early stage.
Symptoms due to obstruction of urinary flow:
Hesitancy & straining on voiding
Frequency
Nocturia
Diminution in size & force of urinary stream.

41. Clinical Manifestation
Symptoms due to metastasis:
Pain in lumbosacral area radiating to hips &
down legs.
Perineal& rectal discomfort.

42. Clinical Manifestation
Anemia, weight loss, weakness, nausea, oliguria,
hematuria
Lower extremities edemaoccurs when pelvic node
metastasis compromise venous return.

43. Investigations
Digital rectal examination (Hard nodule may be felt)
Needle biopsy for Histological study
Trans-rectal USG
PSA (4-10 ng/ml-suspect and > 10 ng/ml indicate
cancer)

44. Medical Management
Periodic PSA determination & examination for
evidence of metastasis
Symptomatic management
Analgesics & Narcotics to relieve pain
TURP to relieve obstruction
Suprapubiccystostomy

45. Surgical Management
Radical Prostatectomy-entire prostate gland,
capsule, seminal vesicle and pelvic lymph nodes
are removed.
Cryosurgery of prostate freezes prostatic tissue
killing tumorcells without removing gland.

46. Radiation
External beam radiation-focused on prostate.
Interstitial radiation (Brachytherapy)
Complications-Radiation cystitis (frequency,
urgency, nocturia), Uretheralstricture, Radiation
enteritis (diarrhoea, anorexia, nausea), Radiation
Prostatitis (diarrhoea, rectal bleeding), Impotence.

48. Hormonal therapy (Palliative)
Aim is to deprive tumorcells & its by-product.
Bilateral orchidectomy(removal of testes)
Luteinizing hormone releasing hormone analogues
Antiandrogendrugs
Complications-hot flushes, N/V, gynaecomastica,
sexual dysfunction.

49. Nursing Management
The goals of nursingmanagement
Restoration of urinarydrainage
Treatment of urinary tractinfections
Understanding theprocedure

50. Nursing Diagnosis
•Impaired urinary elimination related to obstruction of
urethra
•Risk for infection related to surgical incision, urinary
catheter
•Anxiety related to urinary incontinence, difficulty
voiding.

51. Pre-operative Interventions
Avoid alcohol andcaffeine
Advise to urinate every 2-3hours
Normal fluid intake should be maintain and
avoid over fluid intake and volume over land.
Antibiotics before any Invasiveprocedure

52. Post-Operative Care
Assess the patient’sconditions.
Main complications is hemorrhage, bladder
spasm, urinary Incontinence andinfections.
Bladderirrigation
Cathetercare
Avoid activities that increase abdominal
pressure.

53. Post-Operative Care
To Relive bladder spasms use Antispasmodics
After removing catheter, patient should urinate
within 6hours.
Patient should practice pelvic floor exercise ( kegel
exercise)
Encourage to practice straining and stopingthe
streamduringurination.

54. Post-Operative Care
Dietary advice or management including
fiberand easily digestibalefood
Adminsterstool softners, avoid heavy alcohol
intake, weighting, and sexual intercourse.

55. Prostatitis

56. Prostatitis
An inflammation of the prostate gland.
Prostatitis is most common prostate problem in
men under the age of 50.
It is classified as-
Bacterial Prostatitis
Non-bacterial Prostatitis

57. Bacterial Prostatitis
There are 4 types of bacterial prostatitis
Type I-acute bacterial caused by GI or sexually
transmitted bacteria
Type II-chronic bacterial caused by GI (gram
negative ) organisms
Type III-chronic pelvic pain syndrome
Type IV-asymptomatic inflammatory prostatitis

58. Pathophysiology & Etiology
Acute bacterial invasion of prostate from reflux of
infected urine into ejaculatory & prostatic duct or
secondary to urethritis or rectal examination when
bacteria are present. It is often caused by gram
negative bacteria-pseudomonas, gram positive
cocci-streptococcus, staphylococcus.

59. Contd…
Chronic bacterial prostatitis: Ascending infection
from urethera. Due to gram negative bacteria-
E.Coli, proteus, klebsiella, pneumonia&
pseudomonas aeruginosa.
Non-bacterial prostatitis: May be complication of
urethritis.

60. Clinical Management
Sudden chills & fever with body aches with acute
prostatitis.
More subtle symptoms with chronic prostatitis.
Bladder irritability, frequency, dysuria, nocturia,
urgency, hematuria
Pain in perineum, rectum, lower back and lower
abdomen & penile head.
Pain after ejaculation, symptoms of uretheral
obstruction.

61. Investigations
Culture & Sensitivity test for urine
Rectal examination-tender, painful swollen
prostate, warm to touch in acute cases.
Elevated leucocytes (leucocytosis)

62. Management
Antimicrobial therapy-10-14 days
Suprapubiccystostomy. Avoid uretheral
catherization
Antipyretics

63. Chronic bacterial prostatitis
Antimicrobial-4 weeks (Ciprofloxacin, Norfloxacin,
Sulfonamides)
Oral antispasmodic agents to relieve urinary
frequency, urgency.

64. Non bacterial prostatitis
Antimicrobial 2 weeks (Doxycycline, Erythromycin)
Symptomatic relief
Anti-cholinergicsto relieve spasms
Anti-inflammatory
Hot sitzbath

65. Nursing Considerations
History of previous LUTS/STDs
Recent voiding patterns
Genital examination-uretheraldischarge
Rectal examination except acute bacterial
prostatitis
Urine culture & sensitivity

66. Nursing Diagnosis &
Interventions
Ineffective thermoregulation related to infection/
Hyperthermia related to infection
Monitor vitals
Cooling measures
Hydration status
Oral/Parenteral fluids
Antipyretics as prescribed.

67. Nursing Diagnosis &
Interventions
Pain & discomfort related to inflammation
Bed rest
Warm sitzbath to relieve pain & promote
muscular relaxation of pelvic floor
Stool softeners, high fibersdiet to prevent
constipation
Anti-inflammatory & Analgesics as prescribed