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.

4.
Epidemiology/
Incidence

5.
Etiology
 Ageing
 Excessive accumulation of prostaticandrogen
 Family history
 Diet increase animal fat and saturated faty acids
 Reduced exercise and alcoholconsumption

6.
Etiology
 Recent studies have identified smoking (both
current and former smoking), heavy alcohol
consumption, hypotension, heart disease and
diabetes mellitus as risk factors associated with
BPH.

7.
Pathophysiology
 The cause of BPH is uncertain, but studies
suggest that estradiol levels may have a
relationship to prostate size among men with
testosterone levels above the median.
 Recent studies have identified smoking both
current and former, heavy alcohol
consumption, hypertension, heart disease and
diabetes as risk factors of BPH.

8.
Pathophysiology
 The hypertrophied lobes of prostate may
obstruct the vesical neck or prostatic urethra,
causing incomplete emptying of the bladder and
urinary retention.
 As a result. A gradual dilation of the ureters
(hydroureter) and kidneys (hydronephrosis)can
occur. Urinary tract infections may result from
urinary stasis. Urine remaining in the urinary
tract serves as a medium for infectve
organisms.

9.
Pathophysiology

10.
Clinical Manifestations
 Obstructive
Reduced force of urine stream
Difficulty in initiating voiding
Intermittency
Dribbling at the end of urination

11.
Clinical Manifestations
 Irritative
Frequency
Urgency
Dysuria
Bladder pain
Nocturia (excessive urination at night)
Incontinence

12.
Continue
 Inflammation and infection
 Decrease volume and force of the urinary
stream
 Sensation of incomplete emptying

13.
Continue
 Generalized symptoms include
Fatigue
Anorexia
Nausea and vomiting
Epigastric discomfort

14.
Complications
 Acute urinary retention
 Urinary tract infections(UTI)
 Renal stone (kidneystone)/ Bladder stone
 Bladderdamage/ decompensation
 Hydronephrosis
 Pyelonephritis
 Sexual Dysfunction
 Urinary incontinence

15.
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

16.
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
 Transrectal Ultrasound- to rule out enlargement
 Uroflowmetry & Urodynamics -to evaluate the flow-rate
It is electric recording
of urine flow-rate
throughout course of
micturition.

17.
Assessment and Diagnostic
Tools
 Post-voidal residual 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-Invasive urodynamic procedure
to determine bladder capacity & compliance

18.
Assessment and Diagnostic
Tools
 Cystourethoscopy- to visualise the prostatic urethera
and bladder.
 Complete blood studies are performed because
hemorrhage is 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.

19.
Medical Management
 The main goals of medical management are-
 Restore bladder function
 Relieve signs and symptoms
 Prevent and treat complications

20.
Contd..
 The treatment Plan depends on the cause of
BPH, the severity of the obstruction, and the
patient’s general health conditions.
 If the patient is admitted on an emergency
basis because he can not void, he is
immediately catheterized.

21.
Dietary Management
 Decrease amount of intake caffeine and
artificial sweetners, limit spicy and acidic foods
and alcohol.

22.
Pharmacological Management
 Alfa-adrenergic blockers such as doxazosin,
tamsulosin (relaxes smooth muscles of bladder neck
and prostate to facilitate voiding).
 5-alfa reductase inhibitors such as finasteride and
dutasteride (exert anti-androgen effect on prostatic
cells and can reverse or prevent hyperplasia).
 Aromatase Inhibitors
 Symptomatic Management

23.
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

24.
Contd…
 2 newer approaches balloon dilatation of prostate
under endoscopy and TUIP.
 Indications-
 Acute urinary retention
 Recurrent infection
 Recurrent hematuria
 Azotemia

25.
Closed Surgical Procedures
 TURP (Transurethral resection of the prostate)
 TUIP (Transurethral incision of the prostate)
 TUMT (Transurethral Microwave therapy)
 TUNA (Transurethral Needle ablation)

26.
Open Surgical Procedures
 Suprapubic Prostatectomy
 Perineal Prostatectomy
 Retropubic Prostatectomy

27.
Others
• Newer treatments include balloon urethroplasty,
laser therapy, and intraurethral stents
• 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

28.
TURP
 Removal of prostate tissue using a
resectoscope is inserted through the tip of
penis and into the tube that carries urine from
bladder (urethra) under spinal or general
anaesthesia.

29.
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.

30.
TUMT
 A small microwave antenna is inserted through the
tip of penis into the tube that carries urine from
bladder (urethra)

31.
TUNA
 Radiofrequency ablation, is a minimally invasive
treatment option used to treat benign prostatic
hyperplasia. During the procedure, radiofrequency
needles are placed through the urethra into the
area of the prostate that is pressing on the urethra.

32.
Suprapubic Prostatectomy
 Suprapubic Prostatectomy 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.

33.
Perineal prostatectomy
 Perineal prostatectomy involves removing the
gland through an incision in the perineum. (This
method is practical when other methods or
approaches are not possible.

34.
Retropubic prostatectomy
 Retropubic prostatectomy 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 the bladder.

35.
Cancer of Prostate

36.
Cancer of Prostate
 Abnormal proliferation of cells of prostate.
 Most common carcinoma in men over 65 years.
 Etiology is UNKNOWN. Increased risk if family
history, influences of dietary intake, S. testosterone
levels are under investigation.

37.
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.

38.
Clinical Manifestation
 Symptoms due to metastasis:
 Pain in lumbosacral area radiating to hips &
down legs.
 Perineal & rectal discomfort.

39.
Clinical Manifestation
 Anemia, weight loss, weakness, nausea, oliguria,
hematuria
 Lower extremities edema occurs when pelvic node
metastasis compromise venous return.

40.
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)

41.
Medical Management
 Periodic PSA determination & examination for
evidence of metastasis
 Symptomatic management
 Analgesics & Narcotics to relieve pain
 TURP to relieve obstruction
 Suprapubic cystostomy

42.
Surgical Management
 Radical Prostatectomy- entire prostate gland,
capsule, seminal vesicle and pelvic lymph nodes
are removed.
 Cryosurgery of prostate freezes prostatic tissue
killing tumor cells without removing gland.

43.
Radiation
 External beam radiation- focused on prostate.
 Interstitial radiation (Brachytherapy)
 Complications- Radiation cystitis (frequency,
urgency, nocturia), Uretheral stricture, Radiation
enteritis (diarrhoea, anorexia, nausea), Radiation
Prostatitis (diarrhoea, rectal bleeding), Impotence.

44.
Hormonal therapy (Palliative)
 Aim is to deprive tumor cells & its by-product.
 Bilateral orchidectomy (removal of testes)
 Luteinizing hormone releasing hormone analogues
 Antiandrogen drugs
 Complications- hot flushes, N/V, gynaecomastica,
sexual dysfunction.

45.
Nursing Management
 The goals of nursing management
Restoration of urinary drainage
Treatment of urinary tract infections
Understanding the procedure

46.
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.

47.
Pre-operative Interventions
 Avoid alcohol and caffeine
 Advise to urinate every 2-3 hours
 Normal fluid intake should be maintain and
avoid over fluid intake and volume over land.
 Antibiotics before any Invasive procedure

48.
Post-Operative Care
 Assess the patient’s conditions.
 Main complications is hemorrhage, bladder
spasm, urinary Incontinence and infections.
 Bladder irrigation
 Catheter care
 Avoid activities that increase abdominal
pressure.

49.
Post-Operative Care
 ToRelive bladder spasms use Anti spasmodics
 After removing catheter, patient should urinate
within 6 hours.
 Patient should practice pelvic floor exercise ( kegel
exercise)
 Encourage to practice straining and stoping the
stream during urination.

50.
Post-Operative Care
 Dietary advice or management including
fiber and easily digestibale food
 Adminster stool softners, avoid heavy alcohol
intake, weighting, and sexual intercourse.

51.
Prostatitis

52.
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

53.
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

54.
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.

55.
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.

56.
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.

57.
Investigations
 Culture & Sensitivity test for urine
 Rectal examination- tender, painful swollen
prostate, warm to touch in acute cases.
 Elevated leucocytes (leucocytosis)

58.
Management
 Antimicrobial therapy- 10-14 days
 Suprapubic cystostomy. Avoid uretheral
catherization
 Antipyretics

59.
Chronic bacterial prostatitis
 Antimicrobial- 4 weeks (Ciprofloxacin, Norfloxacin,
Sulfonamides)
 Oral antispasmodic agents to relieve urinary
frequency, urgency.

60.
Non bacterial prostatitis
 Antimicrobial 2 weeks (Doxycycline, Erythromycin)
 Symptomatic relief
 Anti-cholinergics to relieve spasms
 Anti-inflammatory
 Hot sitz bath

61.
Nursing Considerations
 History of previous LUTS/STDs
 Recent voiding patterns
 Genital examination-uretheral discharge
 Rectal examination except acute bacterial
prostatitis
 Urine culture & sensitivity

62.
Nursing Diagnosis &
Interventions
 Ineffective thermoregulation related to infection/
Hyperthermia related to infection
 Monitor vitals
 Cooling measures
 Hydration status
 Oral/Parenteral fluids
 Antipyretics as prescribed.

63.
Nursing Diagnosis &
Interventions
 Pain & discomfort related to inflammation
 Bed rest
 Warm sitz bath to relieve pain & promote
muscular relaxation of pelvic floor
 Stool softeners, high fibers diet to prevent
constipation
 Anti-inflammatory & Analgesics as prescribed