Benign Prostatic Hypertrophy
Mr.Ramu, a 60 year old man is admitted in the urological unit with the diagnosis of benign prostatic hypertrophy. Answer the following questions :
a) Define benign prostatic hypertrophy. (2)
b) Discuss the clinical manifestations (2)
c) Explain the surgical approaches for benign prostatic hypertrophy. (4)
d) Draw a nursing care for Mr.Ramu including health education. (7)
Definition
Benign prostatic hypertrophy is defined as enlargement of the prostatic gland due to the proliferation of the glandular elements in the prostate causing nodules well encapsulated by other elements in the organ.
Clinical Menifestations
Increased frequency of urination : usually voiding only small amounts of urine
Interrupted sleep to urinate at night
Urinary urgency
Lack of control of urination
Hesitancy - delay in initiationg micturition
Hesitant, interrupted, weak urinary stream
Incomplete bladder emptying
The sensation of incomplete evacuation
Straining - The need to strain or push (Valsalva maneuver) to initiate and maintain urination
Decreased force of stream
Dribbling or dripping
PR - per rectal examination : prostate size assessed
Young adult prostate is approximately 20 g.
Most asymptomatic men have glands less than or equal to 2 fingerbreadths.
Investitations
Lab Studies
Urinalysis: for the presence of blood, leukocytes, bacteria, protein, or glucose.
Prostate-specific antigen (PSA):
Urine culture
Electrolytes, BUN, and creatinine
Imaging Studies
Ultrasonography (abdominal, renal, transrectal) and intravenous urography
CT scanning or MRI, have no role in the evaluation and treatment of patients with uncomplicated BPH.
Other Tests
Voiding diary (frequency voiding chart):
Flow rate
Postvoid residual (PVR) urine
Pressure flow studies
Urine cytology
Endoscopy of the lower urinary tract (cystoscopy)
Surgical Approaches
Transurethral resection of the prostate (TURP)
Open prostatectomy - transvesical prostatectomy
Laser enucleation of the prostate, similar to a TURP procedure
Transurethral needle ablation of the prostate (TUNA)
Nursing Care
Urinary retention : catheterization (per penile urethra or suprapubic)
Urgency : Dutas T - dutasteride with tamsulosin, Torq SR
Nursing process : the patient undergoing prostatectomy
Preoperative Nursing Diagnosis
anxiety about surgery and its outcome
Pain related to to bladder distention
Knowkedge about factors related to ht edosorders and the treatement protocol
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