1. BENIGN PROSTATE HYPERTROPHY
OR
BENIGN PROSTATE HYPERPLASCIA

2. ENLARGEMENT OF THE PROSTATE GLAND
RESULTING FROM AN INCREASE IN THE
NUMBER OR SIZE OF EPITHELIAL CELLS
AND STROMAL TISSUE
50% MEN OVER 50YRS
90% MEN OVER 80YRS

3. ETIOLOGY
 Ageing
 Excessive accumulation of prostatic androgen
[dihydroxytestosterone]
 Stimulation by estrogen
 Local growth hormone action

4. RISK FACTORS
 Family history
 Environment
 Diet [saturated fatty acids]
 Reduced exercise
 Alcohol consumption

5. S/M
OBSTRUCTIVE IRRITATIVE
Reduced force of urine stream Frequency
Difficulty in initiating voiding Urgency
Intermittency Dysuria
Dribbling at the end of urination Bladder pain
Nocturia
Incontinence
Inflammation/ infection

6. COMPLICATIONS
 Acute urinary retention
 UTI & Sepsis secondary to UTI
 Incomplete bladder emptying – residual urine
 Stone formation
 Hydronephrosis
 Pyelonephritis
 Bladder damage

7. DIAGNOSTICS
 History & PE
 Digital Rectal examinaton
 Urinalysis
 Urine c/s
 PSA [Prostate specific antigen]
 Transrectal ultrasound
 Uroflowmetry
 Measure Postvoidal residual urine
 Cystourethroscopy

8. MANAGEMENT
GOALS
 Restore bladder drainage
 Relieve s/s
 Prevent / treat complications

9. CONSERVATIVE MODE
Wait – and – see approach
Dietary changes
 Decrease caffeine and artifical sweetners
 Limit spicy and acidic foods
Avoiding medications
 Decongestant
 Anticholinergics
Restrict evening fluid intake

10. MEDICATION
 5 α reductase inhibitor – finasteride
 α adrenergic receptor blockers – doxazosin
 Herbal therapy – saw palmetto

11. SURGICAL APPROACHES
Several approaches can be used to
remove the hypertrophied portion of the prostate
gland:
CLOSED
 Transurethral resection of the prostate (TURP),
 Transurethral incision of the prostate (TUIP)
OPEN
 Suprapubic prostatectomy,
 Perineal prostatectomy,
 Retropubic prostatectomy, and

12. SUPRAPUBIC PROSTATECTOMY
Suprapubic prostatectomy is one method of
removing the gland through an abdominal
incision. An incision is made into the bladder,
and the prostate gland is removed from above.

13. PERINEAL PROSTATECTOMY
Perineal prostatectomy involves removing
the gland through an incision in the perineum.
This approach is practical when other
approaches are not possible and is useful for
an open biopsy.

14. RETROPUBIC PROSTATECTOMY
Retropubic prostatectomy, another
technique, is more common than the
suprapubic approach. The surgeon makes a low
abdominal incision and approaches the
prostate gland between the pubic arch and the
bladder without entering the bladder

15. TRANSURETHRAL RESECTION OF THE PROSTATE(TURP)
Removal of prostate tissue using a resectoscope
inserted through the urethra (excision and
cauterisation) under spinal or general anaesthesia

16. TRANSURETHRAL INCISION OF THE PROSTATE(TUIP)
Done under LA. Indicated for men with
moderate s/s with small enlargement and who
are poor surgical candidates

17. MINIMALLY INVASIVE THERAPY
 Transurethral microwave thermotherapy (TUMT)
An outpatient procedure of delivery
microwaves directly to the prostate through a
transurethral probe. (113°F/ 45°C)
 Transurethral needle ablation (TUNA)
Low wave radio frequency is used to heat
prostate gland with the help of a needle
providing greater precision.

18. OTHER…..
 Laser prostatectomy
 Visual laser ablation
 Interstitial laser coagulation
 Intra prostatic urethral stents

19. NURSING MANAGEMENT
GOALS
 Restoration of urinary drainage
 Treatment of UTI
 Understanding of procedures

20. PREOPERATIVE INTERVENTIONS
 Avoid alcohol and caffeine
 Avoid cold as it causes smooth
muscle contraction
 Advise to urinate in every 2-3 hrs
 Normal fluid intake to avoid fluid intake & volume
overload.
 Catheterisation
 Antibiotic before any invasive
procedures

21. POSTOPERATIVE
 main complications- hemorrhage, bladder spasms,
urinary incontinence, infections
 Bladder irrigations with normal saline [pink, no
clots]
 Monitor inflow & outflow of irrigant
 Catheter care
 avoid activities that increase the abdominal
pressure
 To relieve bladder spasms- opium suppositories,
antispasmodics with relaxation techniques.

22.  After catheter removal, patient should urinate within
6hrs
 Patient should practice pelvic floor muscle technique
(Kegel exercise)
 Encourage to practice starting and stopping the stream
during urination
 Dietary management – fiber and easily digestible food
 Stool softners
 Avoid straining during defecation
 Avoid heavy weightlifting
 Sexual counseling