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Lemessa Jira BPH slide share

1. Benign Prostatic Hyperplasia(BPH) By:- Lemessa Jira 2. Presentation out linesã Objectives ã ProstateOverview ã Definition of BPH ã Epidemiology ã Etiologies…
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  • 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
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