Benign

Bladder Bladder

prostatic
hyperplasia
(BPH)
Normal
Enlarged
Eman Shaker 20182348 prostate
prostate
Objectives

• Define BENIGN PROSTATIC HYPERPLASIA (BPH).

• Analyze the incidence of BPH in worldwide.

• Discuss the risk factors of BPH.

• Explain the pathophysiology of BPH.

Introduction

Male
reproductive
anatomy
 Bladder

Definition

Benign prostatic hyperplasia (BPH) is one of the

most common diseases in aging men. It is
noncancerous enlargement or hypertrophy of Enlarged
prostate
prostate gland.
The hypertrophied lobes of the prostate may obstruct the bladder neck
or urethra, causing incomplete emptying of the bladder and urinary
retention.

Bladder
Urinary retention may result in UTIs
because urine that remains in the
urinary tract serves as a medium for
infective organisms.
Incidence

BPH typically occurs in men older than 40 years of

age. By the time they reach 60 years of age, 50% of
men have BPH. It affects as many as 90% of men by
85 years of age. BPH is the second most common
cause of surgical intervention in men older than 60
years of age.
Risk factors
• Family history (first degree relatives).

• Smoking.

• heavy alcohol consumption.

• Obesity.

• reduced activity level.

• hypertension, heart disease, diabetes.

• Western diet (high in animal fat and protein and refined

carbohydrates, low in fiber).
Pathophysiology

The cause of BPH is not well understood, but testicular androgens have
been implicated. Dihydrotestosterone (DHT), a metabolite of testosterone,
is a critical mediator of prostatic growth.
Estrogens may also play a role in the cause of BPH; BPH generally occurs
when men have elevated estrogen levels and when prostate tissue
becomes more sensitive to estrogens and less responsive to DHT.

Dihydrotestosterone is an endogenous androgen sex

steroid and hormone.
BPH develops over a prolonged period; changes in the urinary tract
are slow and insidious. BPH is a result of complex interactions
involving :

• Resistance in the prostatic urethra

to mechanical and spastic effects.
• Bladder pressure during voiding.
• Detrusor muscle strength.
• Neurologic functioning, and general
physical health.
Test your self

1. What is BPH ?
2. Mention 3 risk factor for BPH.
3. From your understanding what is the POSSIBLE causes
for BPH ?
Summary

- The Definition of BPH.

- The incidence of BPH.
- The risk factor of BPH.

- The pathophysiology of BPH.

Benign Prostatic Hyperplasia

( Enlarged Prostate )

Hawra sayed abbas

20182191
Objectives:

1- Discuss the clinical manifestations of BPH.

2- Identify the assessment and diagnostic

findings related to BPH.
Clinical manifestations :
BPH may or may not lead to lower urinary
tract symptoms, if the symptoms occur they
may range from mild to severe.

The severity of symptoms increase with age.

Half of men report having moderate to
severe symptoms.
Obstructive and irritative symptoms include:

• Urinary • Urgency
frequency

• Dribbling
• Nocturia

• Hesitancy
in starting
urination
 Obstructive and irritative symptoms include:

• Complications
• Abdominal
of acute
straining
• Decrease and • Decrease urinary
with
intermittent in volume retention and
urination
force of stream and force recurrent UTI
and the of urinary
sensation of stream
incomplete
bladder
emptying
Normally,
Residual urine amount is more than 50
ml in middle-aged adult.
And less than 50 to 100 ml in older
adult.

Chronic urinary retention and large

residual volumes can lead to
azotemia and kidney failure.
General symptoms:

• Nausea • Pelvic
• Fatigue • Anorexia and discomfort
vomiting
Disorders produce similar symptoms:

• Urethral • Prostate
stricture cancer

• Neurogenic • Urinary
bladder bladder
stones
List 3 general symptoms for BPH…

True/False : The normal residual

amount of urine in middle-aged adult
is 65 ml…
Assessment and Diagnostic Findings :
 Patient voiding diary: used to record
voiding frequency and urine volume.

 DRE: reveals a large, rubbery, and

nontender prostate gland.

 Urinalysis: recommended to screen for

hematuria and UTI .

 PSA level : obtained if the patient is

without a terminal disease for whom
knowledge of the presence of prostate
cancer would change management.
Other diagnostic tests:

 Recording urinary  Measurement of postvoid

flow rate residual urine.

Others:

Urodynamic studies
Urethrocystoscopy
Ultrasound
List 2 assessment or diagnostic test
used for BPH…

What called the test that used to

record voiding frequency and urine
volume?
 Assessment and
Clinical
diagnostic
manifestations
findings
Any question..
Benign Prostatic Hyperplasia
(Enlarged prostate)

Done by : Zainab Salman Ali Alhendi.

Student ID : 20182197
Objectives :

• Identify the goals of medical management for Benign

Prostatic Hyperplasia .

• Discuss the pharmacological therapy for Benign

Prostatic Hyperplasia.
The goals of medical
management
Improve quality of life Relieve obstruction

Minimize complications

Improve urine flow Prevent disease progression

Management depends on :

• Severity

• Cause

• Condition of patient
Emergency management
 • Immediate Catheterization

Straight catheter Retention catheter

Stylet
• Supra Pubic Cystostomy
No complications watchful waiting
Pharmacological therapy
 • alpha adrenergic blockers

alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin

(Cardura) , tamsulosin .
 Side effects :

Dizziness Headache Fatigue

Postural hypotension Rhinitis Sexual dysfunction

 • 5 alpha reductase inhibitors

Finasteride (Proscar) and dutasteride (Avodart).

 Side effects :

Decrease libido Ejaculatory dysfunction

Erectile dysfunction

Gynecomastia
flushing
(breast enlargement)
+ = BPH
 Not recommended to use alternative and complementary
phytotherapeutic agents and other dietary supplements

Because :

• interfering with the conversion of

testosterone to DHT.
• may directly block the ability of DHT to
stimulate prostate cell growth.
List two goals of medical management for BPH .

List two of side effects of alpha adrenergic blockers .

True / False :

Its recommended to use alternative and complementary

phytotherapeutic agents ( )

With all BPH patient we use catheter ( )

 Summary

• Goals of medical • Pharmacological

management therapy
BENIGN PROSTATIC
HYPERPLASIA
(Enlarged Prostate)
Surgical Management

Done by: Marwa Abdulhadi

Student ID: 20184638
 Objective:

Discuss the complication of the BPH.

Explain the minimally invasive therapy may be used
to treat BPH:
• Transurethral Microwave Thermotherapy [ TUMT ]
• Transurethral Needle Ablation [ TUNA ]
* Complication of BPH

~ Hydroureters ~ Acute urinary retention

~ Hydronephrosis
~ Recurrent urinary
tract infection (UTI)
~ Pyelonephritis

~ Gross
hematuria
~ Renal & cystolithiasis
~ Bladder obstruction
and damage

~ Renal failure
 Transurethral Microwave Thermotherapy [ TUMT ]
• Involves the application of heat to prostatic tissue.

High-energy
TUMT devices: low-energy
TUMT devices:
 CoreTherm
 Prostatron  TherMatrx
 Targis
 Transurethral Microwave Thermotherapy [ TUMT ]
 Transurethral Microwave Thermotherapy [ TUMT ]

• A transurethral probe is inserted into the urethra,

and microwaves are directed to the prostate tissue.
• The targeted tissue becomes necrotic and sloughs.
• Some systems have a water-cooling apparatus:
1. To minimize damage to the urethra.
2.Decrease the discomfort from the procedure.
 Transurethral Needle Ablation [TUNA]
  Transurethral Needle Ablation [TUNA]

• Involve radiofrequency energy and the UroLume stent.

• TUNA uses low level radio frequencies delivered by thin
needles placed in the prostate gland to produce
localized heat that destroys prostate tissue while
sparing other tissues.
• The body then reabsorbs the dead tissue.
 Prostatic stents

Used only for patients

with urinary retention
and in patients who
are poor surgical risks.

Encrustation Infection Chronic

Pain
 SUMMARY 
Complication of BPH

Transurethral Microwave Thermotherapy [ TUMT ]

Transurethral Needle Ablation [ TUNA ]

Benign prostatic
hyperplasia
(BPH)

KAWTHER SAYED HUSAIN

SAEED
20174571
▪ explain the surgical management of
Benign prostatic hyperplasia
▪ Discus preoperative nursing intervention
▪ discus post operative management and
complication
▪ Formulate health education plan for patient
after surgery
Surgical resection of prostate gland

Is another option for :

▪Patients with moderate to sever lower
urinary tract symptoms of BPH .

▪Patients with acute urinary retention

and other complication .
 The specific
surgical approach
( open or endoscopy)

 the energy source

( electrocautery vs laser )
Based on
Surgeon’s experience
Size of prostate gland
The presence of other medical disorders
The patient preference
Transurethral resection of the prostate (TURP)

remain the benchmark for surgical treatment for BPH

it involves the surgical removal of the inner portion of

the prostate through endoscopic inserted through
urethra ( no external skin incision is made )

It can performed with ultrasound guidance

 The treated vaporizes or becomes necrotic
and sloughs
tissue either

The procedure is performed in the outpatient setting

Usually results in less postoperative bleeding than

traditional surgical prostatectomy
 True or false
Transurethral resection of the
prostate (TURP) Usually results in
more postoperative bleeding than
traditional surgical prostatectomy
Other surgical options for BPH
Transurethral incision of the prostate (TUIP)

Transurethral electro-vaporization

Laser therapy

Open prostatectomy
Transurethral incision of the prostate (TUIP)

Used to treat
The procedure is performed in the outpatient setting smaller
prostates

One or two cuts are made in the prostate and prostate

capsule

 To reduce constriction of the urethra

 Decrease resistance to flow urine out of the bladder

No tissue is removed
What is the purpose of
Transurethral incision of
the prostate (TUIP)
surgery?
open prostatectomy

Surgical removal for the inner portion of the

prostate via suprapubic , retropubic , or perineal
(rare) approach for large prostate gland

Prostatectomy may also be performed

laparoscopically or by robotic assisted
laparoscopy .
robotic assisted laparoscopy .
 True or false
Open prostatectomy involves the
surgical removal of the inner portion
of the prostate through endoscopic
inserted through urethra ( no external
skin incision is made )
Preoperative nursing intervention

Reduce anxiety

Relieving discomfort

Providing instruction

Preparing the patient

If surgery is to be performed :

All clotting defects must be corrected and

medications for anticoagulation withheld

Because bleeding is potential

complication of prostate surgery
post operative management

General post operative management:

• Maintain fluid balance

• Relieve pain
• Catheter care & continuous bladder
irrigation
• Monitoring and managing complication
Post operative complication

• Hemorrhage
• Bladder spasm
• Obstructed catheter
• Urinary
• Infection incontinence

• DVT • Sexual dysfunction

write 2 Postoperative
complication for BPH
surgery
Health education

▪ Physical activity

▪ Sexuality

▪ Driving

▪ Elimination
Summary

▪ surgical management of Benign

prostatic hyperplasia
▪ preoperative nursing intervention
▪ post operative management and
complication
▪ health education plan for patient after
surgery