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Bph presentation


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Bph presentation

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As a part of my M.Sc. Nursing course, I have prepared PPT on Bengin Prostate Hyperplasia, which is an important topic from clinical as well as exam point of view. I hope this material will be helpful to the prospect nursing student. However, refer books for the better understanding of the topic.

As a part of my M.Sc. Nursing course, I have prepared PPT on Bengin Prostate Hyperplasia, which is an important topic from clinical as well as exam point of view. I hope this material will be helpful to the prospect nursing student. However, refer books for the better understanding of the topic.


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Bph presentation

  2. 2. Introduction – Histologic evidence of prostrate enlargement begins about the third decade of life and increases proportionally with aging. – Specifically, about 43% of men in their 40s – 50% of men in their 50s, – 75% to 88% in their 80s, and
  3. 3. – Nearly 100% of men reaching the ninth decade of life. – European and African Americans have similar prevalence rates of BPH, – but Asian Americans tend to have lower rates of BPH. – The incidence of BPH is lowest among immigrants, however, and it increases with subsequent generations, suggesting environmental as well as possible racial differences.
  4. 4. Definition The prostrate is the genital organ most commonly affected by benign and malignant neoplasms. Benign enlargement of the prostate gland is an extremely common process that occurs in nearly all men with functioning testes.
  5. 5. -The term benign prostatic hyperplasia or hypertrophy (BPH) is used to describe the disorder that occurs when the prostate growth sufficiently obstructs the urethral outlet resulting in bothersome lower urinary tract symptoms (LUTS), urinary tract infection (UTI), hematuria, or compromised upper urinary tract function.
  6. 6. It is defined as – “Noncancerous increase in size of prostate gland which involves hyperplasia in Prostatic stromal and epithelial cell – resulting in formation of large, fairly discrete nodules, in transitional zone of prostate, – Which push on and narrow the urethra resulting in an increase resistance to flow of urine from the bladder.”
  7. 7. ETIOLOGY AND RISK FACTORS – It is arrested following bilateral orchiectomy. – Androgens, and particularly testosterone, are not direct causes of BPH, their presence is critical to the normal growth and development of the prostate as well as BPH – Within the prostate, testosterone is converted to dihyrotestosterone (DHT) under the influence of an enzyme called 5-alpha reductase.
  8. 8. – DHT is active form of testosterone that supports prostate growth and development throughout life, and the prostate remains sensitive to androgen production throughout life to maintain both prostate size and function.
  9. 9. Additional factors associated – Defect in local substances that regulate the programmed cellular death (apoptosis) – Imbalances of local growth factors, – Local inflammation, and – Genetic factor – Frequent use of alpha-adrenergic agonists commonly found in over-the- counter cold medications or diet pills increases the severity of bothersome LUTS
  10. 10. Multiple possible risk factors for BPH – Dietary factors have been examined, and lycopene in cooked tomatoes, green and yellow vegetables, and other elements of a traditional Japanese diet appear to provide some protection against BPH – Smoking has been hypothesized to exert a protective effect on BPH because it reduces serum testosterone levels – Heavy alcohol use and cirrhosis of the liver impede prostate enlargement.
  11. 11. Obesity – Particularly an increased abdominal girth may increase the risk for BPH, – diabetes mellitus appears to exert only a modest affect on the incidence of BPH or its severity.
  14. 14. Complications of benign prostate enlargement. – Compromised renal function or renal failure. – Urinary tract infection and hematuria also may be associated with BPH – Urinary retention and obstruction
  15. 15. – International Prostate Symptom Score Index (IPSS) – is a short questionnaire commonly used by urologists to assess the client´s opinion about the severity of these manifestations – This instrument provides a reliable and valid description of bothersome LUTS associated with BPH, – but it fails to differentiate LUTS caused by BPH from those caused by other, non-obstructive etiologies.
  16. 16. – A DIGITAL RECTAL EXAMINATION (DRE) is performed to assess prostate size and to differentiate BPH from prostate enlargement – BPH reveals a symmetrically enlarged prostate with an obliterated central sulcus. – Prostatic infection (prostatitis) is associated with symmetric enlargement, a boggy consistency, and discomfort on palpation. – Adenocarcinoma of the prostate is associated with asymmetric enlargement, hardened nodules, or induration
  17. 17. – Urinalysis and blood tests for kidney function (urea nitrogen or blood urea nitrogen (BUN) and Creatinine) – Urine culture or prostate-specific antigen (PSA) to assess for cancer – Chemistry panels, such as electrolyte, liver function, and blood coagulation studies, may be added if surgery is being considered.
  18. 18. – Uroflowmetry may be completed to assess the voiding pattern and measure maximum and average flow rates. – A man starts this test with a full bladder, voids into a specific toilet or container, and empties his bladder to the best of his ability. – Residual urine is determined after the urine flow either by catheterization or by ultrasonography – A maximum urinary flow of 12 ml/sec or greater in a man aged 55 years or older greatly reduces the likelihood of urethral obstruction associated with BPH
  19. 19. MEDICAL MANAGEMENT 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.
  20. 20. 5-alpha reductase inhibitors: – These medications shrink prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective.
  21. 21. Combination drug therapy – Doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective. – Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement
  22. 22. PHYTOTHERAPEUTIC AGENTS – Use of herbs for healing purposes to manage BPH. – The most widely used agent is Serenoa repens (saw palmetto). – Saw palmetto is derived from a dwarf palm tree that grows in the southwest United States; – It contains a mixture of fatty acids, sterols (alcohol-based steroid), and flavonoids. – Its principal action in relationship to BPH appears to be inhibition of 5-alpha reductase enzyme activities similar to the action
  24. 24. Ineffective Therapeutic Regimen Management. – Provide Teaching About BPH – Encourage Fluids – Explain Medications.
  25. 25. DIAGNOSIS: IMPAIRED URINARY ELIMINATION. – Monitor the Urine Output – Catheterize
  26. 26. SURGICAL MANAGEMENT INVASIVE SUGERIES PROSTATECTOMY : The part of the gland causing the obstruction is removed in a procedure called a prostatectomy. 1. Transurethral Resection Of The Prostate 2. Suprapubic Prostatectomy: 3. Retropubic Prostatectomy: 4. Perineal Prostatectomy:
  27. 27. OPERATIVE TECHNIQUE TRANSURETHRAL RESECTION OF THE PROSTATE widely used technique for managing BPH, and it continues to be the ``gold standard`` against which all other procedures are measured Resectoscope is inserted through the urethra The surgeon visualizes the inside of the bladder by inserting a cystoscope (telescopic lens) through the resectoscope.
  28. 28. SUPRAPUBIC PROSTATECTO MY:– Suprapubic prostatectomy is a surgical approach that involves a lower abdominal incision – Prostate is too large – A bladder abnormality needs correction – An abnormal surgical exploration is necessary
  29. 29. RETROPUBIC PROSTATECTOMY: – The surgeon approaches the prostate through a low abdominal incision without entry into the bladder. – This is the operation of choice when the prostate is very large and a severe urethral stricture is present.
  30. 30. PERINEAL PROSTATECTOMY:An incision is made into the perineum between the anus and the scrotum. This operation is rarely used for treating BPH because of the great potential for erectile dysfunction.
  31. 31. MINIMALLY INVASIVE THERAPIES: 1. LASER-ASSISTED PROCEDURES: 2. Prostatic Stent 3. Hyperthermia And Thermal Therapy 4. Transurethral Electrovaporization Transurethral Incision Of The Prostate
  32. 32. LASER-ASSISTED PROCEDURES: – Transurethral ultrasound-guided laser incision of the prostate (TULIP) is a minimally invasive procedure in which a laser is used to make the incision into the prostate
  33. 33. Laser ablation of prostatic tissue – Its use subsequently declined because of the need for prolonged catheterization following the procedure and the length of time required to resect enough prostatic tissue to effectively relieve bladder outlet obstruction.
  34. 34. Holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate ( Green Light Laser)
  35. 35. HYPERTHERMIA AND THERMAL THERAPY: – Hyperthermia refers to the administration of temperature below 45’C; thermal therapy – Three techniques- microwaves, radiofrequency, or high-intensity ultrasound waves-may be used to heat the prostate and destroy prostate tissue – Temperature probe is placed in the rectum, and water is circulated through the system to prevent urethral or rectal heat injury
  36. 36. The transurethral needle ablation (TUNA) system – Uses radiofrequency energy to destroy prostatic tissue. – Special needles are placed into the prostate, and radiofrequency energy is used to provoke tissue coagulation and necrosis.
  37. 37. PROSTATIC STENT: – Prostatic stent insertion is indicated for clients who are extremely poor operative risks. – The mesh-like tube ( a coil-shaped device has also been used) can be inserted through a endoscope into the prostatic urethra, where it holds the urethra open mechanically. – Over time, usually about 3-6 months, epithelial cells grow over the stent, which is permanent in most cases
  39. 39. Risk for injury related to presence of urinary catheters, hematuria, irrigation, or suprapubic drains INTERVENTION – Maintain irrigation. – Monitor For Bleeding: – PREVENT CATHETER DISLODGEMENT: – Monitor For Retention:
  40. 40. Acute pain related to surgery and bladder spasms. – Ensure that the drainage system is not blocked – Antispasmodic medications, such as belladonna and opium (B&O) suppositories, propantheline bromide (Pro-Banthine)
  41. 41. SELF CARE – Provide Teaching – Teach Pelvic Rehabilitation
  42. 42. Treat Erectile Dysfunction: – Sildenafil (Viagra) may be given to post-prostatectomy – prevent or reverse apoptosis (programmed cellular death