Benign Prostate Hyperplasia (BPH)

• Benign prostate hyperplasia (BPH) causes urine retention.
• Prostate enlargement occurs only in males and doesn't lead to prostate cancer.
• BPH, common in older men, can cause partial or complete urinary obstruction.
• The size of the prostate doesn't determine the severity of the obstruction; the enlargement can cause it.
• Risk factors include family history, obesity, physical inactivity, and hormonal changes.
• Clinical manifestations develop gradually as the prostate enlarges.
• Symptoms are categorized as obstructive and irritative.
• Obstructive symptoms include difficulty starting urination, stopping and starting mid-stream, and straining to urinate.
• Irritative symptoms include urinary frequency, urgency, dysuria, bladder pain, nocturia, and incontinence.

Complications:

• Acute urinary retention is a sudden, painful inability to urinate, requiring catheter insertion and possibly surgery.
• Incomplete bladder emptying leads to UTIs and sepsis due to residual urine.
• Bladder calculi may develop due to stagnant urine.
• Hydronephrosis from BPH can cause renal failure.
• Pyelonephritis is a renal pelvis infection.
• BPH can lead to kidney damage and renal failure due to hydronephrosis, where the kidneys become dilated due to urine backup.

Diagnostic studies:

• Diagnosis involves history and physical examination, DRE, urinalysis with culture, PSA level, and serum creatinine.
• A high serum creatinine level can indicate renal failure.
• During a DRE, an enlarged and smooth prostate suggests BPH.
• Transrectal ultrasound (TRUS) scans assess prostate size and consistency.
• Uroflowmetry measures urine flow rate and caliber.
• Cystoscopy involves inserting a visualization scope to check for bladder damage.

Goals & Collaborative Care:

• Goals include restoring bladder drainage, relieving symptoms, and preventing/treating complications.
• Management strategies include watchful waiting, dietary changes, and timed voiding schedules.
• Avoid drinking fluids at night.
• Drug therapy includes:
• Tamsulosin (Flomax) relaxes smooth muscles to improve urine flow; monitor blood pressure.
• Finasteride (Proscar) reduces prostate size; improvement may take 3-6 months.
• TUMT (transurethral microwave therapy) can cause urinary retention, necrosis, and tissue damage with a risk of infection.
• TUNA (transurethral needle ablation) complications include UTI and urinary irritation.
• Laser prostatectomy destroys prostate tissue with a laser.
• TURP (transurethral resection of the prostate) removes obstructing prostate tissue using a resectoscope inserted through the urethra.
• Can remove entirely of partially. It is performed under spinal or general anesthesia.
• Bladder irrigation is needed to prevent blood clots. 3000ml bags for 24 hours.
• Complications of TURP:
• Bleeding.
• Clot retention.
• Post-operative goals include preventing complications, restoring urinary control, and achieving complete bladder emptying.
• Early detection education includes avoiding alcohol, caffeine, and cough medications.
• Encourage fluid intake during the day and limit it after 6 p.m.
• Preoperative care involves administering antibiotics.

Nursing Implementation:

• Bladder irrigation, kegel exercises, chills, burning, looks for signs of UTI
• Discharge instructions include managing an indwelling catheter if present, managing incontinence, and consuming 2-3 liters of fluids per day.
• Teach patients about the signs and symptoms of UTI and wound infection.

Benign Prostate Hyperplasia (BPH) leads to urine retention and is common in older men. Enlargement can cause partial or complete urinary obstruction. Symptoms are categorized as obstructive and irritative.