Benign Prostatic Hyperplasia (BPH)

• Benign Prostatic Hyperplasia (BPH) affects males over 50, with an unknown cause
• BPH involves the gradual and abnormal enlargement of the prostate gland, compressing the urethra and causing voiding dysfunction
• BPH may be asymptomatic in early stages, often recognized during routine physical exams

Risk Factors

• Risk factors include hypertension, insulin resistance, obesity, and dihydrotestosterone (androgen-specific related to prostate tissue growth)

Clinical Features

• As prostate tissue enlarges, it constricts the urethra, leading to a smaller lumen and space for urine exiting the bladder

Early Symptoms (Obstructive Signs)

• Early symptoms involve voiding problems such as weak urinary stream, intermittency, and incomplete bladder emptying with post-void residual
• Hesitancy causes trouble initiating urine flow and requires abdominal pressure to help push urine out of the bladder
• Straining to void is also a symptom

Storage (Irritative, Filling) Symptoms

• Storage symptoms due to the growing bladder size from overfilling of urine include frequent and urgent urination, nocturia and incontinence
• Incontinence results from spasm and contraction of the bladder muscle, increasing pressure against the urethra

Complications

• Potential complications include hydronephrosis and kidney dysfunction, urinary tract infections like bladder cystitis or kidney pyelonephritis, and hematuria

Diagnostic Procedures

• Diagnostic procedures involve a routine digital rectal examination to check for abnormal prostate enlargement
• Routine urinalysis checks for bacteria and leukocytosis
• Checking serum creatinine and BUN levels assess kidney function

Pharmacotherapy

• Alpha-adrenergic antagonists/alpha-1 receptor blockers offer immediate action as smooth muscle relaxants on the bladder and prostate, without reducing prostate size (e.g., tamsulosin and doxazosin)
• Alpha 1-receptors exist in smooth muscles like the prostate and bladder neck, causing constriction when activated; blocking agents promote relaxation
• Monitor for orthostatic hypotension and implement fall precautions

5-alpha Reductase Inhibitors

• 5-alpha reductase inhibitors (finasteride) offers hormonal manipulation
• These inhibitors convert testosterone to dihydrotestosterone (DHT), limiting DHT to decrease prostate size, relieve bladder obstruction, and allow free urine flow

Complementary and Alternative Therapies

• Complementary and alternative therapies (CATs) example is Saw Palmetto extract but the consulting with a healthcare provider

Nursing Interventions

• Nursing interventions include urinalysis and assessing bladder distention and high postvoid residual, which can be done via palpating the abdomen or using a bladder scan after the client has urinated, ensuring privacy for the client

Teach Client

• Reduce intake of mild diuretics (caffeine, alcohol) and highly seasoned food to avoid bladder irritation
• Urinate frequently (every 2-3 hours) due to a high risk of urinary stasis
• Avoid constipation to prevent pressure on the bladder and prostate

Additional Teaching

• Avoid medications causing urinary retention, such as anticholinergics, antihistamines, and decongestants, as they reduce bladder muscle contractions
• Bladder muscle neck contraction is needed to push against obstruction

Severe Cases

• For severe cases, a transurethral resection, which is a surgical procedure removing part of the prostate, maybe required
• Provide and monitor continuous bladder irrigation post-resection
• Normal urine output should be light pink, while dark or red output may require increased irrigation flow rate or a prescription from a healthcare provider to irrigate the bladder in the presence of a clot

Monitoring Clot Presence

• Monitoring for the presence of clots is necessary
• Bladder spasms and decreased output may indicate clot presence, and sterile water irrigation is necessary to dislodge clots, as prescribed