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  2. 2. Objective At the end of the class the student will be able to- Define benign prostate hyperplasia. • Enlist risk factor and causes of benign prostate hyperplasia. • List down the clinical manifestation of benign prostate hyperplasia. • Explain the stages of benign prostate hyperplasia. • Enumerate diagnostic evaluation the benign prostate hyperplasia. • Explain the management of benign prostate hyperplasia.
  3. 3. • Level of prostate specific antigen • Normal 4-8 nmol/ml • BPH 9-10 nmol/ml • Less than 4 nmol/ml • Diagnostic for BPH & suggestible for CA • More than 10 nmol/ml Suggestive for CA Prostate.
  4. 4. Control of urine semen flow • The prostate acts as a kind of valve, preventing urine flow during the ejaculation and or permitting urine flow in between. Control of urine semen flow • The prostate acts as a kind of valve, preventing urine flow during the ejaculation and or permitting urine flow in between
  5. 5. Prostate is a fibro muscular glandular structure situated between the neck of the bladder and external urethral sphincter and surround the prostatic urethra. • iconical in shape Definition:
  6. 6. SURFACE It has 3 surfaces 1. Anterior 2. posterior 3. Two inferior- lateral
  7. 7. LOBES it has 5 lobes 1.Anterior 2.Posterior 3.Median 4.Two Lateral Size • About 3cm vertically, 4cm Transversally at base and about 2cm antero- posteriorly. Weight • 15-20 gm
  8. 8. Physiology of prostate gland • Prostate also secretes a glycol proteinious fluid which is known as PSA, The PSA actually liquefies the semen and allows the sperm to swim freely, and it is the best tumour marker for Ca prostate.
  9. 9. Prostate secretion • The prostatic fluid is thin, slightly acidic (pH 6.4) and forms about 20% of semen volume. • It contains spermine (for the motility of sperms), spermidine, prostate glandins (for uterus stimulation), zinc (affects testosterone metabolism of the prostate), citric acid (buffer), immunoglobulins, phosphatases and proteases.
  10. 10. DEFINITION IT IS COMMON DISEASE IN AGING MEN. Is a non cancerous enlargement or hypertrophy of the prostate gland. When prostate enlarges, then it can squeeze down on urethra and impede (slow) the flow of urine. It is also known as benign prostatic hyperplasia and abbreviated as BPH.
  11. 11. RISK FACTOR • Aging >40 YR • Family history. • Ethnic background. Prostate enlargement is less common in Asian men than in white and black men.
  12. 12. • Diabetes and heart disease. Diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH. • Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.
  14. 14. Clinical manifestation
  15. 15. Less common signs and symptoms include • Blood in the urine • Fatigue • Anorexia • Nausea and vomiting • Pelvic discomfort
  16. 16. Diagnostic evaluation
  17. 17. • HISTORY COLLECTION Past health history Present health history • Physical examination • Urinary blood test to screen for benign prostate hyperplasia • Ultrasound of the prostate
  18. 18. • prostate-specific antigen (PSA) test: PSA is a protein made only by the prostate gland. PSA level above 4.0 ng/mL. • Transrectal ultrasound-guided biopsy):biopsy of the prostate done through the rectum using an ultrasound to guide.
  19. 19. A DIGITAL RECTAL EXAM (DRE): During the examination, the gently puts a lubricated, gloved finger of one hand into the rectum use the other hand to press on the lower belly or pelvic area.
  20. 20. The main aim is to: • improve the quality of life, • improve urine flow, • relieve obstruction, • prevent disease progressive and minimize complication.  Treatment depend on the severity of disease, symptoms, causes of disease, and patient condition.  Immediate catheterization.
  21. 21. Lifestyle Decreasing fluid intake before bedtime. Avoid alcohol, smoking, consumption.
  22. 22. Voiding position Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume) There is no differences between the standing and sitting positions for healthy males, but that, for elderly males with lower urinary tract symptoms, voiding in the sitting position:
  23. 23. • post void residual volume was decreased • maximum urinary flow was increased, • voiding time was decreased • This urodynamic profile is associated with a lower risk of urologic complications, such as cystitis and bladder stones
  24. 24. Medical management .
  25. 25. • The two main medication classes for BPH management are alpha adrenergic blockers and 5α-reductase inhibitors. • alpha adrenergic blockers: it is most common choice for initial therapy like alfuzosin, doxazosin. • Alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow.
  26. 26. • 5α-Reductase inhibitors: finasteride and dutasteride are used for BPH. These medications inhibit the 5α-reductase enzyme, which, in turn, inhibits production of DHT {dihydrotestosterone or androstanol one}, a hormone responsible for enlarging the prostate.
  27. 27. Surgical management
  28. 28. Surgical management If medical treatment is not effective: Surgery for bph include: Transurethral incision of the prostate (TUIP} Transurethral Resection of the Prostate–TURP Photo selective Vaporization of the Prostate (Laser PVP) Transurethral microwave therapy (TUMT) Transurethral needle ablation (TUNA)--radiofrequency ablation
  29. 29. Transurethral incision of the prostate (TUIP} 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). prostate that surrounds the urethra, 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. 30. • TURP – Transurethral Resection of the Prostate: Transurethral Resection of the Prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from Benign Prostatic Hyperplasia (BPH).
  31. 31. • Laser PVP (Photo selective Vaporization of the Prostate) During laser PVP surgery, a tube with an imaging system (cystoscope) is inserted into the penis. A surgeon places a laser through the cystoscope to burn away (vaporize) excess tissue that is blocking urine flow through the prostate.
  32. 32. Transurethral microwave therapy (TUMT) It's generally used for men with small- to moderate-sized prostates. A small microwave antenna is inserted through tip of the penis into the bladder (urethra). The antenna emits a dose of microwave energy that heats and destroys excess prostate tissue blocking urine flow.
  33. 33. • Transurethral needle ablation (TUNA)--radiofrequency ablation • A combined visual and surgical instrument(resectoscope) is inserted through the tip of the penis. • the cystoscope, doctor guides a pair of tiny needles into the prostate tissue that is pressing on the urethra.
  34. 34. 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.
  35. 35. Nursing management
  36. 36. Acute pain related to bladder distension as evidence by patient verbalization. GOAL: To reduce pain Intervention: • Maintain patient comfort. • Assess the location, intensity duration of pain. • Provide comfort measures such as back rub, helping patient assume position of comfort. Suggest use of relaxation and deep-breathing exercises, diversional activities.
  37. 37. • Urinary Retention related to mechanical obstruction or enlarged prostate as evidence by frequency of urination . GOAL: Void in sufficient amounts INTERVENTION: • Encourage patient to void every 2–4 hr and when urge is noted • Observe urinary stream, noting gravity and force. • Administer medications as indicated
  38. 38. RISK OF deficient fluid volume related to renal dysfunction. Goal: reduce the risk of fluid volume. Intervention • Monitor output carefully. Note outputs of 100–200 mL per hr. • Encourage increased oral intake based on individual needs. • Monitor BP, pulse. Evaluate capillary refill and oral mucous membranes. • Monitor electrolyte levels, especially sodium.
  39. 39. Prevalence of lower urinary tract symptoms in patients of benign prostatic hyperplasia attending Tertiary Care Hospital in the State of Andhra Pradesh M Nagarathnam, S. A. A. Latheef Background: There are only few studies available on the prevalence of lower urinary tract symptoms (LUTS) evaluated by the international prostate symptom score tool (IPSS), and it has not been validated in the Indian population. Aim: The purpose of the present study was to determine the prevalence of lower urinary tract symptoms in patients of benign prostatic hyperplasia (BPH) and to validate the IPSS tool in the studied population.
  40. 40. Materials and Methods: One hundred BPH aged >51 years attending the outpatient department of Urology were recruited for the study. LUTS were evaluated using the international IPSS. The IPSS was validated for reliability and reproducibility by Cronbach's alpha and intraclass correlation coefficient (ICC). Results: The coefficients of Cronbach's alpha and ICC were 0.80 and 0.86, respectively. The majority of patients had moderate symptoms (72 followed by severe symptoms (17%). Severity of symptoms increased with age (P < 0.01). The total score was associated with age (P< 0.01). The majority of patients (12%) with the severity of symptoms had reported that symptoms bother them to some extent.