LESSON PLAN

ON
BENIGN PROSTATIC HYPERPLASIA

EXTERNAL EXAMINER SIGNATURE INTERNAL EXAMINER SIGNATURE

 STUDENT PROFILE

HALL TICKET NUMBER : 19501400001

COURSE : M.SC(N) 1ST YEAR

SUBJECT : NURSING EDUCATION

TOPIC : BENIGN PROSTATIC HYPERPLASIA

METHOD OF TEACHING : LECTURE CUM DISCUSSION

GROUP : B.SC(N) 2ND YEAR

DATE : 25-03-2021

DURATION : 20 MINUTES

A.V AIDS : BLACK BOARD- INTRODUCTION

OHP- DEFINITIONS
PPT- SIGNSS AND SYMPTOMS
CHART- PATHOPHYSIOLOGY
HANDOUTS- DIAGNOSTIV EVALUATIONS
 OBJECTIVES
General Objectives
By the end of the Lesson plan the group will be able to gain in-depth knowledge regarding Benign Prostate Hypertrophy

Specific Objectives
By the end of the seminar group will be able to
 Explain the anatomy and physiology of male reproductive system.
 Define Benign prostatic hyperplasia.
 List down the incidence of BPH
 Discuss the etiology of BPH
 Explain the pathophysiology
 Discuss the clinical manifestations
 Describe diagnostic evaluations
 Explain indetail about medical and surgical management
 Describe the nursing management
 Discuss health educati

S.NO SPECIFIC TIME CONTENT TEACHING AV EVALUATION

 OBJECTIVES AND AIDS
LEARNING
ACTIVITY
1. Introduce the 1 min Introduction: Lecture Black what is the
cum Board introduction of
Topic Benign Benign prostatic hyperplasia (BPH) is a benign discussion the topic BPH?
prostatic enlargement of the prostate gland. In many patients older
Hyperplasia. than 50 years, the prostate gland enlarges, extending
upward into the bladder and obstructing the outflow of
urine by encroaching on the vesical orifice.
This condition is known as benign prostatic hyperplasia
(BPH), the enlargement, or hypertrophy, of the prostate.
BPH is one of the most common pathologic conditions in
older men (McConnell, 1998). It is the most common
urologic problem in male adults.

2. Discuss the 2 min Anatomy and Physiology of Male Reproductive Lecture PPT What is the
method anatomy and
Anatomy and
System: The three primary roles of the male physiology of
Physiology of male
reproductive system are: reproductive
Male
 Production and transportation of sperm system?
Reproductive
 System  Deposition of sperm in the female reproductive
tract
 Secretion of hormones.
The primary reproductive organs in the male are the
 Testes
 Secondary reproductive organs include Ducts
(epididymis, ductus deferens, ejaculatory duct, and
urethra)
 Sex glands (prostate gland, Cowper’s glands, and
seminal vesicles)
Define
Benign Definition:
3. 1 min Lecture OHP What is the
prostatic  According to Blacks and Hawks, Benign prostatic
method definition of
hyperplasia (BPH), is a non-cancerous enlargement
hyperplasia. BPH?
of the prostate, a small gland that encircle the
urethra in males.

 BPH is defined as the prostate gland enlarges,

extending upward into the bladder and obstructing
the outflow of urine by encroaching on the vesical
orifice.
-Brunner.
 BPH is defined as benign enlargement or
 hyperplasia of the prostate gland.
-Lewis.

Incidence:
List down the  Globally BPH, affects 210 million males as of 2019 Lecture PPT Listout the
incidence (6% of the population). method incidence of
4. 1min BPH?
 For a symptom free man of 46 years, the risk of
developing BPH over the next 30 years is 45%.
 Incidence rates increases from 3 cases per 1000
male population by the age of 75-79 years.
 Prevalence rate is 2.7%.

Etiology:
Discuss the  Age 50 years and above
5. etiology of  Family history ppt
BPH. 1min Lecture What is the
 Hormonal factors: testosterone and estrogen; late method etiology?
activation of cell growth
 Diabetes mellitus
 Diet-obesity.
 Pathophysiology
As men ages the enzyme aromatase and 5 alpha reductase
Explain the
increase in activity
pathophysiol
Lecture Chart What is the
6. ogy of BPH. 2 method pathophysiolog
mins y of BPH?
These enzymes are responsible for converting androgen
hormones into estrogen and dihydrotestosterone
respectively.

This metabolism of androgen hormones leads to a

decrease in testosterone but increased levels of DHT and
oestrogen.
Both grandular epithelial cells and the stromal cells
(including muscular fibres) undergo hyperplasia in BPH
 Enlargement of the prostate.

Obstruction of the urine flow.

Signs and symptoms:
Discuss the  Urinary hesitancy (slowed or delayed start of the
signs and urinary stream)
What are the
symptoms  Weak urine stream Lecture PPT signs and
7. and clinical 2  Nocturia (needing to urinate 2 to 3 times or more method symptoms of
mins BPH?
manifestation per night)
s of BPH.  Pain with urination
 Bloody urine
 Urinary retention (difficulty urinating)
 Increased urinary frequency.
 Strong and sudden urge to urinate (urinary
urgency)
 Incontinence.
 Clinical Manifestations
 Examination reveals a prostate gland that is large,
rubbery, and nontender.
 Fatigue,
 Anorexia,
 Nausea,
 Vomiting, and
 Epigastric discomfort.
Other disorders producing similar symptoms includes:
 Urethral stricture,
 Prostate cancer,
 Neurogenic bladder, and
 Urinary bladder stones.

Explain the
diagnostic Diagnostic Evaluations
evaluations of  History and physical examination.
8. BPH. 4  Digital rectal examination (DRE). Lecture Hand Explain the
mins  Uroflowmetry method outs diagnostic
evaluation?
 Urinalysis with culture
 Serum creatinine
 Prostate specific antigen(PSA): 4.0 ng/ml
 Transrectal ultrasound (TRUS)
 Cystouretheroscopy
History collection and physical examination:
The primary methods used to diagnose BPH include:
 History
 Physical Examination.
A physical exam any help to diagnose BPH. During a
physical exam, a health care provider most often
examines patient body, which can include checking for:
 Discharge from urethra
 Enlarged or tender lymph nodes in the groin
 Swollen or tender rectum.
Digital rectal exam
A digital rectal exam, or rectal exam, is a physical exam
of the prostate.
 To perform the exam, the health care provider asks
the man to bend over a table or lie on his side,
while holding his knees close to his chest. Patient
may feel slight discomfort during the rectal exam.
 Inserts a gloved finger into the rectum and feel the
part of the prostate next to rectum.
 The prostate can be palpated by digital rectal
examination (DRE) to estimate its size, symmetry,
and consistency.
 In BPH, the prostate is symmetrically enlarged,
firm, and smooth.
Uroflowmetry:
 Uroflowmetry is a simple, diagnostic screening
procedure used to calculate the flow rate of urine
over time.
 The test is non-invasive (the skin is not pierced)
and may be used to assess bladder and sphincter
 function.
 Uroflowmetry is performed by having a person
urinate into a special funnel that is connected to a
measuring instrument.
 The measuring instrument calculates the amount of
urine, rate of flow in seconds, and length of time
until completion of the void.
 This information is converted into a graph.
 The information helps evaluate function of the
lower urinary tract or help determine if there is an
obstruction of normal urine outflow.

Cystoscopy
 Cystoscopy can reveal a narrowing of the urethra
where it passes through the prostate gland,
indicating an enlarged prostate (benign prostatic
hyperplasia).

Urine test:
 Analysing a sample of urine can help rule out an
 infection or other conditions that can cause similar
symptoms.

Prostate-specific antigen (PSA) blood test:

 PSA is a substance produced in prostate. PSA
levels increase when there is an enlarged prostate.
However, elevated PSA levels can also be due to
recent procedures, infection, surgery or prostate
cancer.
Transrectal ultrasound:
 An ultrasound probe is inserted into rectum to
measure and evaluate prostate.
Prostate biopsy:
 Transrectal ultrasound guides needles used to take

tissue samples (biopsies) of the prostate.

Examining the tissue can help diagnose or rule out
prostate cancer.
Management:
 The goals are to:
 Restore bladder drainage.
 Relieve the patient’s symptom.
 Prevent or treat the complications of BPH.
Discuss
indetail about Medical Management
the medical Non-Pharmacological Management:
The approaches include: Lecture Ppt Explain the
and surgical
9. 2 method management ?
Management mins  Life-style modifications
of BPH.  Catheterization
 Double void
Life-style modification:
Life-style alterations to address the symptoms of BPH
include:
 Physical activity
 Decreasing fluid intake before bedtime.
 Moderating the consumption of alcohol and
caffeine containing products
 Following a timed voiding schedule.
Catheterization
 The treatment plan depends on the cause of BPH,
the severity of the obstruction and the patient’s
condition.
Double void:
 These means urine is passed twice in succession
first empty the bladder normally in a relaxed way,
wait for few minutes, and try to void again, do not
strain or push to empty.
PHARMACOLOGICAL MANAGEMENT
Drugs that have been used to treat BPH with variable
degrees of success include:
 Alpha blockers.
 5 alpha-reductase inhibitors and
 Combination treatment
Alpha blockers:
 These medications relax bladder neck muscles and
muscle fibers in the prostate, making urination
 easier. Alpha blockers which include alfuzosin
(Uroxatral), doxazosin (Cardura), tamsulosin
(Flomax) and silodosin (Rapaflo) usually work
quickly in men with relatively small prostates.
 Side effects might include dizziness and a harmless
condition in which semen goes back into the
bladder instead of out the tip of the penis
(retrograde ejaculation).

5-alpha reductase inhibitors:

 These medications shrink prostate by preventing

hormonal changes that cause prostate growth.
 Medications which include finasteride (Proscar)
and dutasteride (Avodart) for six months to be
effective.
 Side effects include retrograde ejaculation.

Combination drug therapy:

 Taking an alpha blocker and a 5-alpha reductase
 inhibitor at the same time if either medication alone
isn't effective.
MINIMALLY INVASIVE THERAPIES
Many minimally invasive therapies have outcomes
comparable to those of invasive techniques. It includes:
Transurethral resection of the prostate (TURP)
 Transurethral resection of the prostate (TURP) is a
surgery used to treat urinary problems that are
caused by an enlarged prostate.
 An instrument called a resectoscope is inserted
through the tip of the penis and into the tube that
carries urine from your bladder (urethra). The
resectoscope helps to visualize and trim away
excess prostate tissue that's blocking urine flow.
Transurethral incision of the prostate (TUIP)
 Transurethral incision of the prostate (TUIP) is a
procedure to treat urinary symptoms caused by an
enlarged prostate. It's generally used for men with
 small- to moderated-sized prostates.
 A combined visual and surgical instrument
(resectoscope) is inserted through the tip of the
penis into the tube that carries urine from your
bladder (urethra).
 The prostate surrounds the urethra. Incision of 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.

Transurethral microwave thermotherapy:

 A small microwave antenna is inserted through the
tip of the penis into the tube that carries urine from
your bladder (urethra).
 Extending the antenna until it reaches the area of
the urethra surrounded by the prostate.
 The antenna emits a dose of microwave energy that
heats and destroys excess prostate tissue blocking
 urine flow.
Transurethral needle ablation (TUNA)
 Transurethral needle ablation (TUNA) also known
as radiofrequency ablation. It is an outpatient
procedure to treat urinary symptoms caused by an
enlarged prostate.
 A combined visual and surgical instrument
(cystoscope) is inserted through the tip of the penis
into the tube that carries urine from your bladder
(urethra). The prostate surrounds the urethra. Using
the cystoscope, guides a pair of tiny needles into
the prostate tissue that is pressing on the urethra.
 Radio waves are then passed through the needles,

generating heat that creates scar tissue. Special

shields protect the urethra from the heat. The
scarring shrinks prostate tissue, allowing urine to
flow more easily.
NURSING MANAGEMENT:
  Health promotion
 Acute intervention
 Ambulatory and home care.
1. Health promotion:
 Early detection and treatment
Explain the  Reducing intake of caffeine and alcohol
nursing  Avoid compounds found in cough and cold
management preparations.
of BPH  Avoid the risk of urinary stasis and urinary Lecture ppt What is the
9. 2 method cum nursing
retention.
mins discussion management ?
2. Acute intervention:
 Preoperative care
 Post-operative care.
Preoperative care:
 Urinary drainage restored before surgery
 Antibiotics administered
 Allow to express sexual concerns.
Post-operative care:
 Complications if any are noted
 Remove clotted blood from the bladder
 Inflow & out flow of irrigant are strictly monitored.
 Prevent uretheral irritation and baldder infection.
 Reduce the bleeding site of the prostate by
applying counter pressure
 Avoid bladder spasms
 Practice pelvic floor exercises
 Straining during bowel movements avoided
3. Ambulatory and Home care
 Care of catheter
 Managing urinary in-continence.
 Intake of oral fluids 2000-3000ml /day
 Observing for urinary tract and wound infection
Prevent constipation.
 Avoid heavy lifting.
 Refraining from driving and intercourse as directed
by the physician.
 SUMMARY: Benign prostatic hyperplasia (BPH) also
called prostate gland enlargement is a common condition
as men get older. An enlarged prostate gland can cause
uncomfortable urinary symptoms, such as blocking the
Summarize flow of urine out of the bladder. It can also cause bladder,
the topic urinary tract or kidney problems.
benign There are several effective treatments for prostate gland
prostatic enlargement, including medications, minimally invasive
hyperplasia therapies and surgery. The nursing management is also
1
mins plays a major role in caring the patient with BPH.

CONCLUSION:
Thus, BPH is a disease affecting older adults which leads
to minor symptoms like urinary retention to major
symptoms like renal failure. Early treatment and
appropriate management show’s good prognosis.
BIBLIOGRAPHY
1. Toratora text book of Anatomy and physiology,
volume –II, 7th edition, page no. 1144-1169
2. Lewis, textbook of medical surgical nursing,
volume-I, 3rd edition, Elsevier publication, page no.
1375-1383
3. Suzanne C Smeltzers, textbook of medical surgical
nursing, 7th edition, Lippiciont publication, page
no. 350-364
4. Brunner and Suddharth, text book of medical
surgical nursing, 11th edition, Lippinciont
publication, page no. 2052-2061.
5. https://www.mayoclinic.org/tests-procedures/tuna-
ablation/about/pac-20384883
6. https://www.slideshare.net/SachinDwivedi15/benig
n-prostate-hyperplasia-bph-154142839