Health & Medicine

Lemessa Jira BPH slide share

Description
1. Benign Prostatic Hyperplasia(BPH) By:- Lemessa Jira 2. Presentation out linesã Objectives ã ProstateOverview ã Definition of BPH ã Epidemiology ã Etiologies…
Published
of 53
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  • 1. Benign Prostatic Hyperplasia(BPH) By:- Lemessa Jira
  • 2. Presentation out lines• Objectives • ProstateOverview • Definition of BPH • Epidemiology • Etiologies • Pathophysiology • Symptomsof BPH • Diagnosis • Treatment Options • Nursing Management 2
  • 3. Objectives• At theend of session, thestudent will beableto • DefineBPH • Identify thepredominant location in theprostatewhereBPH developsand describehow thisfact relatesto thesymptomsand signsof BPH • List thesymptomsBPH • List theimportant componentsof thephysical exam of apatient with BPH • List themedical and surgical treatment optionsfor BPH. 3
  • 4. Introduction 4 ProstateOverview
  • 5. • Walnut sized gland at baseof malebladder • Surroundstheurethra • Producessemen that transportssperm during ejaculation • Prostategrowsto its 5 What istheProstate (Heidenreich, 2014)
  • 6. Prostate… • normal adult sizein aman’searly 20s; it beginsto grow again during themid-40s 6 (Heidenreich, 2014)
  • 7. • Enlarged Prostate orBenign Prostatic Hyperplasia (BPH) • Prostatitis • Prostate Cancer • Eachco nditio n affects the pro state differently. (Sosa, 2014) 7 What Can Happen to the Prostate
  • 8. What isBPH? 8 No rmal adult size = appro ximately 1 .5 inches in diameter (Silva, 2014)
  • 9. Normal vs. Enlarged Prostate • Astheprostateenlarges, pressurecan beput on theurethracausing urinary problems (LUTS) Corona, 2014 9 Normal Prostate Enlarged Prostate (Corona, 2014)
  • 10. Epidemiology •BPH affects50% of men over 50yrs •Affects40-50% of men ages51-60 •Affects80%+ men over age80 •Obesity, higher body mass index (BMI) and lack of exercise may increase the risk of BPH ( Sosa, 2014) 10
  • 11. • Causenot completely understood • Elevated estrogen levels. BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitivedueto aromataseenzyme. (Getzenberg, 2014) 11 Etiologies
  • 12. Etiologies • Smoking. Smoking increasestherisk of acquiring BPH dueto anti-estrogenic effect. 12 (Getzenberg, 2014)
  • 13. Etiologies… • Reduced activity level. A sedentary lifestyle could also lead to thedevelopment of BPH. • Western diet. A diet high in animal fat and protein and refined carbohydrates while low in fiber predisposesaman to BPH. 13 (Getzenberg, 2014)
  • 14. • Resistance. BPH is a result of complex interactions involving resistance in the prostatic urethrato mechanical and spastic effects. (Getzenberg, 2014) 14 Pathophysiology
  • 15. Pathophysiology cont…. • Obstruction. The hypertrophied lobes of the prostate may obstruct the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention. • Dilation. Gradual dilation of the ureters and kidneyscan occur. 15 (Getzenberg, 2014)
  • 16. • Urinary frequency. Frequent trips to the bathroom to urinate may be an early sign of a developing BPH./ 3-5 timesper hrs/ • Urinary urgency. sudden and immediate urgeto urinate. • Nocturia. Urinating frequently at night. 16 Symptoms of BPH (Silva, 2014)
  • 17. Symptoms… • Weak urinary stream. Decreased and intermittent forceof stream isasign of BPH. • Dribbling urine. Urine dribblesout after urination. • Straining. Thereispresence of abdominal straining upon urination. 17 (Silva, 2014)
  • 18. • Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and nontender prostate gland. 18 Diagnosis (Silva, 2014), (Mottete, 2014)
  • 19. Diagnosis… • Prostate specific antigen levels. - Elevated PSA levels may indicate an enlarged prostate. •  normally PSA level is under 4 (ng/mL) in the blood 19 (Silva, 2014)
  • 20. Diagnosis… • BUN/Cr: Elevated if renal function is compromised. Normal rangesBUN: • adult men: 8 to 20 mg/dL • adult women: 6 to 20 mg/dL • children: 5 to 18 mg/dL 20
  • 21. Diagnosis… • WBC: May bemorethan 11,000/mm3, • Normal value= 4,500 to 11,000 white blood cells per microliter (mcL). • Uroflowmetry: Assessesdegreeof bladder obstruction. 21 (Silva, 2014)
  • 22. Diagnosis… • Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum). 22 (Silva, 2014)
  • 23. urinary function test(s) consistent with an enlarged prostate • Uroflowmetry –Normal: 10 – 21 mL/sec –Patient: 7 mL/sec • Residual UrineVolume –> 50 mL significant –Patient: 110 mL (Abrams, 2013) 23
  • 24. Differential Diagnosis • Urethral stricture • Bladder neck contracture • Carcinomaof theprostate • Carcinomaof thebladder • Bladder calculi • Urinary tract infection and proctatitis 24 (Silva, 2014)
  • 25. Treatment Options 25
  • 26. Therapy • Watchful waiting and behavioral modification • Medical Management – Alphablockers – 5-alphareductaseinhibitors – Combination therapy • Surgical Management 26 (Oelke, 2013)
  • 27. Watchful Waiting and Behavioral Modification • is the preferred management technique in patientswith mild symptoms • 1/3 improveon own. 27 (Oelke, 2013)
  • 28. Watchful Waiting and Behavioral Modification…. Decrease caffeine, alcohol )diuretic effect( Avoid taking large amounts of fluid over a short period of time Void whenever the urge is present, every 2-3 hours Maintain normal fluid intake, do not restrict fluid 28 (Oelke, 2013)
  • 29. Watchful Waiting and Behavioral Modification…. Avoid bladder irritants to include artificial sweeteners, carbonated beverages Limit nighttimefluid consumption BPH symptomscan bevariable, intermittent 29 (Oelke, 2013)
  • 30. Medical Managment • Catheterization: if the patient is admitted to an emergency basis because he is unable to void, heisimmediately catheterized. 30
  • 31. • Nutritional supplements – Saw Palmetto • Alphablockers – Doxazosin (Cardura)=Initial dose1mg po/d for 1or 2wks maxim dose1 to 8mg po/d – Terazosin (Hytrin)= Initial dose: 1 mg orally onceaday at bedtime, Maintenance dose: 1 to 5 mg orally onceaday. Maximum dose: 20 mg per day. 4 to 6 weeks ( Margie, 2014) 31 Medical Management
  • 32. Medical Management… – Tamsulosin (Flomax)=initial doseo.4mg po/d, maxim dose0.8mg po/d for 6-12 months – Alfuzosin (Uroxatral) = 10 mg orally oncea day immediately after thesamemeal each day for 2 to 3wks Sideeffects: postural hypotension, dizziness, fatigue 32 ( Morgia, 2014)
  • 33. Medical Management… • 5-alphareductaseinhibitors – Finasteride (Proscar)=5mg po/d for 3months, Dutasteride (Avodart)= 0.5 mg orally onceaday for 6 - 12 months – Less effective for relief of BPH symptoms than alpha blockers 33( Morgia, 2014)
  • 34. Combination Therapy • Concomitant use of alpha blockers and 5-alpha reductaseinhibitors – Should be reserved for patients who are at significant risk of progression and adverse outcome • Patient wantsto avoid surgery • Significant cost associated with dual medications (Morgia, 2014) 34
  • 35. Surgical Management • Transurethral needle ablation (TUNA). A combined visual and surgical instrument (cystoscope) is inserted and guides a pair of tiny needles into the prostate tissue that is pressing on theurethra. 35 (LEE, 2012)
  • 36. Surgical Management… • TUNA useslow-level radio frequencies to producelocalized heat that destroysprostate tissuewhilesparing other tissues. 36 (LEE, 2012)
  • 37. Surgical Management… • Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostateglands. 37 (LEE, 2012)
  • 38. Surgical Management… • Retropubic –Midlineabd. incision • Perineal –Incision between thescrotum and anus • Suprapubic –Abdominal incision 38(LEE, 2012)
  • 39. Surgical Management… • Patients who have developed complications of BPH (i.e urinary retention, renal insufficiency, recurrent UTI and obstructed urinary flow ) arebest treated surgically. 39 (LEE, 2012)
  • 40. Complicationsof BPH • Urinary retention • UTI • Sepsissecondary to UTI • Residual urine • Calculi • Renal failure • Hematuria 40 (Speakman, 2014)
  • 41. • Nursing Management 41
  • 42. Nursing Assessment Isbaseon health history • Health history. The health history focuses on the urinary tract, previous surgical procedures, general health issues, family history of prostate diseases, and fitness for possible surgery. • Physical assessment. Physical assessment includesdigital rectal examination. 42
  • 43. Nursing Diagnosis • Based on the assessment data, the appropriate nursing diagnosesfor apatient with BPH are: • Urinary retention related to obstruction in the bladder neck or urethra. • Acute painrelated to bladder distention. • Anxiety related to thesurgical procedure. 43
  • 44. Thegoalsfor apatient with BPH include: • Relieveacuteurinary retention. • Promotecomfort. • Prevent complications. • Help patient deal with psychosocial concerns. • Provideinformation about disease process/prognosisand treatment needs. 44 Nursing Care Planning &Goals
  • 45. Nursing Interventions • Nursing Interventions • Preoperativeand postoperativenursing interventionsfor apatient with BPH areasfollows: • Reduce anxiety. Thenurseshould familiarizethe patient with thepreoperativeand postoperative routinesand initiatemeasuresto reduceanxiety. • Relieve discomfort. Bed rest and analgesicsare prescribed if apatient experiencesdiscomfort. 45
  • 46. Nursing interventions… • Provide instruction. Beforethesurgery, the nursereviewswith thepatient theanatomy of theaffected structuresand their function in relation to theurinary and reproductive systems. • Maintain fluid balance. Fluid balanceshould berestored to normal. 46
  • 47. Evaluation • Reduced anxiety. • Reduced level of pain. • Maintained fluid volumebalance postoperatively. • Absenceof complications. 47
  • 48. Take-Home Messages • Aging Population= More BPH • Not all Male LUTS=BPH • Not all BPH=LUTS • Consider Combination Therapy • Quality of life issues 48
  • 49. References 1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent—update 2013. European urology. 2014;65(1):124-37. 2. Hambrock T, Hoeks C, Hulsbergen-van de Kaa C, Scheenen T, Fütterer J, Bouwense S, et al. Prospective assessment of prostate cancer aggressiveness using 3-T diffusion- weighted magnetic resonance imaging–guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. European urology. 2012;61(1):177-84. 3. Sosa MS, Bragado P, Aguirre-Ghiso JA. Mechanisms of disseminated cancer cell dormancy: an awakening field. Nature Reviews Cancer. 2014;14(9):611-22. 4. Silva J, Silva CM, Cruz F. Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? Current opinion in urology. 2014;24(1):21-8. 49
  • 50. Reference… 5. Corona G, Vignozzi L, Rastrelli G, Lotti F, Cipriani S, Maggi M. Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions. International journal of endocrinology. 2014;2014. 6. Getzenberg RH, Kulkarni P. Etiology and pathogenesis. Male Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. 2014:218. 7. Mottet N, Bastian P, Bellmunt J, Van den Bergh R, Bolla M, Van Casteren N, et al. Guidelines on prostate cancer. Eur Urol. 2014;65(1):124-37. 8. Abrams P, Chapple C, Khoury S, Roehrborn C, De la Rosette J. Evaluation and treatment of lower urinary tract symptoms in older men. The Journal of urology. 2013;189(1):S93-S101. 50
  • 51. Reference… 9. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. European urology. 2013;64(1):118-40. 10. Morgia G, Russo GI, Voce S, Palmieri F, Gentile M, Giannantoni A, et al. Serenoa repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH. An Italian multicenter double-blinded randomized study between single or combination therapy (PROCOMB trial). The Prostate. 2014;74(15):1471-80. 11. Lee NG, Xue H, Lerner LB. Trends and attitudes in surgical management of benign prostatic hyperplasia. The Canadian journal of urology. 2012;19(2):6170-5. 51
  • 52. Reference… 12. Speakman MJ, Cheng X. Management of the complications of BPH/BOO. Indian Journal of Urology. 2014;30(2):208. 13. Jain P, Neveu B, Fradet Y, Pouliot F. Moderated Posters 8: Prostate (Cancer/BPH) July 1, 2014, 0730-0915. CUAJ. 2014;8:5-6Suppl3. 52
  • 53. THANK YOU 53
  • We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks
    SAVE OUR EARTH

    We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

    More details...

    Sign Now!

    We are very appreciated for your Prompt Action!

    x