BENIGN PROSTATE HYPERTROPHY
ORBENIGN PROSTATE
HYPERPLASCIA
ENLARGEMENT OF THE PROSTATE GLAND RESULTING FROM AN INCREASE IN THE NUMBER OR SIZE OF EPITHELIAL CELLS AND STROMAL TISSUE
50% MEN OVER 50YRS90% MEN OVER 80YRS
ETIOLOGY
Ageing Excessive accumulation of prostatic
androgen [dihydroxytestosterone] Stimulation by estrogen Local growth hormone action
RISK FACTORS
Family history Environment Diet [saturated fatty acids] Reduced exercise Alcohol consumption
S/M
OBSTRUCTIVE IRRITATIVE
Reduced force of urine stream Frequency
Difficulty in initiating voiding Urgency
Intermittency Dysuria
Dribbling at the end of urination
Bladder pain
Nocturia
Incontinence
Inflammation/ infection
COMPLICATIONS
Acute urinary retention UTI & Sepsis secondary to UTI Incomplete bladder emptying – residual
urine Stone formation Hydronephrosis Pyelonephritis Bladder damage
DIAGNOSTICS
History & PE Digital Rectal examinaton Urinalysis Urine c/s PSA [Prostate specific antigen] Transrectal ultrasound Uroflowmetry Measure Postvoidal residual urine Cystourethroscopy
MANAGEMENT
GOALS Restore bladder drainage Relieve s/s Prevent / treat complications
CONSERVATIVE MODE
Wait – and – see approachDietary changes Decrease caffeine and artifical sweetners Limit spicy and acidic foodsAvoiding medications Decongestant AnticholinergicsRestrict evening fluid intake
MEDICATION
5 α reductase inhibitor – finasteride α adrenergic receptor blockers –
doxazosin Herbal therapy – saw palmetto
SURGICAL APPROACHES
Several approaches can be used to remove the hypertrophied portion of the prostate gland:
CLOSED Transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP)OPEN Suprapubic prostatectomy, Perineal prostatectomy, Retropubic prostatectomy, and
SUPRAPUBIC PROSTATECTOMY
Suprapubic prostatectomy is one method of removing the gland through an abdominal incision. An incision is made into the bladder, and the prostate gland is removed from above.
PERINEAL PROSTATECTOMY
Perineal prostatectomy involves removing the gland through an incision in the perineum. This approach is practical when other approaches are not possible and is useful for an open biopsy.
RETROPUBIC PROSTATECTOMY
Retropubic prostatectomy, another technique, is more common than the suprapubic approach. The surgeon makes a low abdominal incision and approaches the prostate gland between the pubic arch and the bladder without entering the bladder
TRANSURETHRAL RESECTION OF THE PROSTATE(TURP)
Removal of prostate tissue using a resectoscope inserted through the urethra (excision and cauterisation) under spinal or general anaesthesia
TRANSURETHRAL INCISION OF THE PROSTATE(TUIP)
Done under LA. Indicated for men with moderate s/s with small enlargement and who are poor surgical candidates
MINIMALLY INVASIVE THERAPY
Transurethral microwave thermotherapy (TUMT)
An outpatient procedure of delivery microwaves directly to the prostate through a transurethral probe. (113°F/ 45°C)
Transurethral needle ablation (TUNA)
Low wave radio frequency is used to heat prostate gland with the help of a needle providing greater precision.
OTHER…..
Laser prostatectomy Visual laser ablation Interstitial laser coagulation Intra prostatic urethral stents
NURSING MANAGEMENT
GOALS Restoration of urinary drainage Treatment of UTI Understanding of procedures
PREOPERATIVE INTERVENTIONS
Avoid alcohol and caffeine Avoid cold as it causes smooth muscle contraction Advise to urinate in every 2-3 hrs Normal fluid intake to avoid fluid intake &
volume overload. Catheterisation Antibiotic before any invasive procedures
POSTOPERATIVE
main complications- hemorrhage, bladder spasms, urinary incontinence, infections
Bladder irrigations with normal saline [pink, no clots]
Monitor inflow & outflow of irrigant Catheter care avoid activities that increase the abdominal
pressure To relieve bladder spasms- opium suppositories,
antispasmodics with relaxation techniques.
After catheter removal, patient should urinate within 6hrs
Patient should practice pelvic floor muscle technique (Kegel exercise)
Encourage to practice starting and stopping the stream during urination
Dietary management – fiber and easily digestible food Stool softners Avoid straining during defecation Avoid heavy weightlifting Sexual counseling