It is a network of glandular

elements embedded in
smooth muscle and
supporting tissue.

Located at the neck of the
bladder(ie. below the
bladder).

Produces a slightly alkaline
secretion which is added to
semen to help neutralize the
acidity of the vaginal tract
and prolong the lifespan of
sperm.




BPH is an age related enlargement of the
prostate gland with formation of large
discrete lesions in the periurethral region of
the prostate. (Matfin & Porth, 2009)

The exact etiology is unknown.
Theories propose that factors due to aging causes an
increase in the production and secretion of the hormone
dihydrotestosterone (DHT-a metabolite of testosterone)
There is also increase in estrogen (which further sensitizes
the prostatic tissue to the growth producing effects of
DHT).
It is believe that aging causes a relative increase in
estrogen levels in males (despite decrease output of
testosterone by the testes) which facilitate the action of
androgens in the prostate. (Matfin & Porth, 2009)


Increase in DHT then stimulates the increase in
growth of prostatic cells which leads to
hyperplasia of glandular and fibromuscular
components of the prostate.

Thus mechanical enlargement of the prostate
gland (2-3 times more than its normal weight).

The increase in prostatic size compresses the
urethra and causes partial/ complete obstruction
of urinary outflow which causes symptoms of
weak urinary stream, etc. (Matfin & Porth, 2009)


The increase in urinary obstruction causes the
workload of the bladder increases to excrete
urine against the outflow resistance.

This results in increase hypertrophy of the
detrusor muscle and thickening of the bladder.
(Matfin & Porth, 2009)



Weak urinary stream
Postvoid dribbling
Frequency and urgency of urination
Pushing or straining to pass urine
Nocturia
Distention of the bladder
Constant urge to void
Overflow incontinence



Men older than 50 years old
Has a family history of BPH
Race: African descendants
High dietary intake of fat and meat


DIAGNOSTIC MEASURES:

History of client
Physical examination
Digital rectal examination
Urinalysis
Blood tests for serum creatinine and prostate
specific antigen
Urine flow rate
Ultrasonography: transabdominal/ transrectal

TREATMENT:
The first line of medical treatment is the class of
alpha adrenergic inhibitors and include the prostate
specific agents: alfuzosin and tamsulosin. These
agents which inhibit contraction of the smooth
muscle tissue of the prostate transitional zone
relieve obstructive and irritative symptoms.

5 alpha reductase inhibitors (5ARI) have also
been developed to reduce prostate volume and
thus reduce the obstructive symptoms. These
agents act by inhibiting the enzyme that
converts testosterone to the highly active form
dihydrotestosterone (DHT) which is
responsible for prostate enlargement.
Eg:dutasteride and finasteride
When pharmacological therapy fails, surgery is required to
remove the obstructing tissue.

Transurethral resection of the prostate (TURP).
Transurethral incision of the prostate (TUIP)
Transurethral needle ablation (TUNA)

Open prostatectomy: When a transurethral procedure
cannot be done, open surgery may be required. Open
prostatectomy for BPH is also performed for a prostate
that is too large to remove through the penis.

Assessment:
Conduct a full
physical
examination- with
a detail physical
assessment of the
urogenital system.

Nursing diagnosis:
Affected Needs
1.Rest/Comfort
/Activity
2.Elimination
3.Psychosocial (Ego
Integrity &
Sexuality)


Possible Nursing Diagnoses
1.Acute pain related to bladder distention, bladder
irritability, surgical trauma as evidenced by dysuria,
grimacing, pain intensity of 9 out of 10.

2. Urinary retention related to urethral obstruction,
prostatic enlargement, loss of bladder tone as evidenced
by bladder distention, dribbling of urine, inability to empty
bladder completely, dysuria and residual urine.




3. Anxiety related to lack of knowledge about disease and change in health
status as evidenced by nervousness, worry, expressed concerns about sexual
ability, and fear of outcome.

4. Sexual dysfunction related to surgical alterations in body structure and
function evidenced by. patient verbalization of concern about effect of the
therapy on his sexual activity and decrease libido



Assessment Diagnosis Patient outcome Interventions & Rational Evaluation
Need: Sexuality

Subjective data

Patient voiced
that he has no
desire to engage
in sexual activity.
Patient verbalize
concerned about
the effect of the
treatment
therapy on his
sexual activity

Objective data
Soft tender
prostate
Sexual dysfunction
related to surgical
alterations in body
structure and
function evidenced
by. patient
verbalization of
concern about
effect of the
therapy on his
sexual activity and
decrease libido
Patient will verbalize
understanding of the
effects of treatment
modalities on sexual
function at the end
of end of 8 hour shift
following nursing
and collaborative
intervention.
1. Educate patient of the effects of
treatment modalities on sexual
functioning. This is done as
different treatment modalities
affect sexual function differently
also patient will be more aware.

2. Discuss the effects of the illness
on sexuality. This makes the patient
aware of possible sexual
dysfunction.
3. Include partner in teaching and
counseling session. This will
promote mutual understanding and
support.
4. Discuss alternative forms of
sexual expression and refer to
sexual therapist. This will help
patient and spouse to maintain
intimacy and sexual role.
5.Reassure patient that sexual
function will return after problem
has been resolved
Patient
verbalizes
understanding
of effects of
treatment on
sexual abilities
by the end of
the 8 hr shift.
Planning: Ought to be specific to patient
goals/ outcome that is based on the affected
needs of the client.

Provide information about the condition, and
treatment modality.
Educate client about his medication and
their side effects.
Encourage client to notify the nurse or his
health care provider if he experiences any of
the side effect
Teach client to identify the signs of Urinary
Tract Infections (UTIs).

Educate the client about the importance of
maintaining high fluid intake.

Pre operative Client Teaching
Educate the client about the procedure.

Educate the client about the possible
outcomes (for example, the risks and
benefits).


Post operative Client Teaching

Teach client about the signs of infection and
encourage him to notify the nurse as soon as
he begins to experience any of the signs.

For a client who has had surgery, the client
should be warned against:
Lifting
Performing strenuous exercise


Post operative contd:
Taking long automobile rides
Engagement in sexual activity

Teach client about the importance of catheter
care and how to properly care for his catheter at
home.

Teach client about the importance of follow up
visits to his doctor and regular prostate
examination.


Matfin, G., & Porth, M.C. (2009).
Pathophysiology: Concepts of Altered Health
State, (8
th
ed), Philadelphia, PA: Lippincott
and Wilkins.