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