Benign Prostatic Hypertrophy
It is also called enlarged prostate. In approximately one half of men 50 years and older, the prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice. One of four men who reaches 80 years of age will require treatment for BPH.
Pathophysiology and Etiology:
- The process of aging and the presence of circulating androgens are required for the development of BPH.
- The prostatic tissue forms nodules as enlargement occurs.
- The normally thin and fibrous outer capsule of the prostate becomes spongy and thick as enlargement progresses.
- The prostatic urethra becomes compressed and narrowed, requiring the bladder musculature to work harder to empty urine.
- Effects of prolonged obstruction cause trabeculation of the bladder wall, decreasing its elasticity.
- In early or gradual prostatic enlargement, there may be no symptoms because the bladder musculature can initially compensate for increased urethral resistance.
- Obstructive symptoms include:
- urinary hesitancy
- diminution in size and force of urinary stream
- terminal dribbling
- sensation of incomplete emptying of the bladder
- urinary retention
- Irritative voiding symptoms include:
- Rectal examination would reveal smooth, firm, symmetric enlargement of the prostate
- Urinalysis to rule out hematuria and infection
- Serum creatinine and BUN to evaluate renal function
- Serum PSA to rule out cancer, but may also be elevated in BPH
- Optional diagnostic studies for further evaluation include:
- Urodynamics to measure peak urine flow rate, voiding time and volume, and status of the bladder’s ability to effectively contract
- Measurement of post-voidal residual urine by ultrasound or catheterization
- Cystourethroscopy to inspect urethra and bladder and to evaluate prostatic size
- acute urinary retention
- involuntary bladder contractions
- bladder diverticula
- vesicoureteral reflux
- gross hematuria and UTI
- Patients with mild symptoms are follow-up annually as BPH does not necessarily worsen in all men.
- Pharmacologic treatment:
- Alpha-adrenergic blockers to relax the smooth muscle of bladder base and prostate to facilitate voiding
- Finasteride has an anti-androgen effect on prostatic cells by reversing or preventing hyperplasia
- Surgery such as transurethral incision of the prostate or open prostatectomy, usually by suprapubic approach
- Newer approaches include laser surgery, transurethral electrovaporization, transurethral needle ablation, and thermotherapy
Photo credits: www.healthguide.howstuffworks.com
- Provide privacy and time for the patient to void.
- Assist with catheter introduction
- Monitor intake and output.
- Monitor patency of catheter
- Administer medications as ordered and educate patient about its side and adverse effects.
- Assess for and teach patient to report hematuria and signs of infection.
- Explain the possible complications of BPH and to report this at once.
- Advise patient to avoid drugs that impair voiding such as OTC cold medications containing sympathomimetics like phenylpropanolamine.
- Encourage compliance to follow-up check ups.