ASIAN

INSTITUT
E OF
NURSING
SEMINAR ON: BENIGN EDUCATI
PROSTATIC HYPERPLASIA (BPH)
ON
SUBJECT: CLINICAL SPECIALITY 1 B
(MEDICAL SURGICAL NURSING)

SUBMITTED TO: SUBMITTED BY:

MRS RESHMA BEGUM FEBBY BORNROY LAMARE
ASSISTANT PROFESSOR OF ASIAN INSTITUTE ROLL NO 13
OF NURSING EDUCATION MSc (N) 2 ND SEMESTER
ASIAN INSTITUTE OF NURSING EDUCATION

SUBMITTED ON:
17/01/2025
INDEX
SL NO TABLE OF CONTENT PAGE NO
 1 Introduction 4

2 Definition of BPH 4

3 Anatomy and Physiology of Male Reproductive System 4-8

4 Epidemiology of BPH 8

5 Etiology and Risk factors of BPH 8-9

6 Pathophysiology of BPH 9

7 Clinical Manifestation of BPH 10

8 Diagnostic Evaluation of BPH 10-11

9 Management of BPH 11-16

10 Lifestyle and Home Remedies for BPH 16

11 Nursing Management of BPH 16-18

12 Complications of BPH 18

13 Prognosis of BPH 19

14 Conclusion of BPH 20

15 Journal Abstract 21

15 Bibliography 20

GENERAL OBJECTIVES: -
At the end of the class, the group will be able to explain in details about Benign Prostatic
Hyperplasia (BPH) its causes, signs and symptoms and management.

SPECIFIC OBJECTIVES: -
At the end of the class, the group will be able to
 define Benign Prostatic Hyperplasia (BPH)
 explain the epidemiology of BPH
 describe the etiology and risk factors of BPH
 explain the pathophysiology of BPH
 enlist the clinical manifestation of BPH
 explain the diagnostic evaluation of BPH
 describe the management of BPH
 explain the lifestyle and home remedies for BPH
 illustrate the nursing management for BPH
 enlist the complications of BPH
 describe the prognosis of BPH

INTRODUCTION
Benign prostatic hyperplasia (BPH) is one of the most common urological problems
encountered in aging males. It refers to a nonmalignant growth or "hyperplasia" of the
prostatic tissue. Hyperplasia occurs in the glandular and the stromal tissue, in the transition
zone of the prostate gland that surrounds the urethra, and may cause anatomic bladder outlet
obstruction (BOO) due to urethral compression. The urethral obstruction occurs by two
mechanisms- first, an increase in prostate volume causing physical obstruction of the urethra
(static component) and second, an increase in the stromal smooth muscle tone (dynamic
component). Nearly all men develop microscopic BPH by 90 years of age. It has a profound
effect on the quality of life in men, with difficulty in initiating or terminating urine flow
stream and reducing the feeling of well-being.

DEFINITION
Benign prostatic hyperplasia is also called BPH is a condition in men in which the prostate
glands becomes enlarged and not cancerous. It is also called benign prostate hypertrophy or
benign prostatic obstruction.
~ Sethi D, Rani K
Benign prostate hyperplasia means it is an enlargement of the prostate gland resulting
from increase in number of epithelial cells and stromal tissue and developing upward into the
bladder and obstructing the outflow of urine.
~ Urology Care Foundation

RELATED ANATOMY AND PHYSIOLOGY

The organs of the male reproductive system include the testes, a system of ducts (including
the epididymis, ductus deferens, ejaculatory ducts, and urethra), accessory sex glands
(seminal vesicles, prostate, and bulbourethral glands), and several supporting structures,
including the scrotum and the penis. The testes (male glands) produce sperm and secrete
hormones. The duct system transports and stores sperm, assists in their maturation, and
conveys them to the exterior. Semen contains sperm plus the secretions provided by the
accessory sex glands. The penis delivers sperm into the female reproductive tract and the
scrotum supports the testes.
EXTERNAL PARTS
Most of the male reproductive system is on the outside of your abdominal cavity or pelvis.
The external body parts include your penis, scrotum and testicles. Other names for these parts
are genitals or genitalia.
1. Penis
The penis is the male organ for sexual intercourse. It contains many sensitive nerve endings,
and it has three parts:
 Root. The root is the base of your penis. It attaches to the wall of your abdomen.
 Body (shaft). The body has a shape like a tube or cylinder. It consists of three internal
chambers: the two larger chambers are the corpora cavernosa, and the third chamber
is the corpus spongiosum. The corpora cavernosa run side by side, while the corpus
spongiosum surrounds your urethra. There’s a special, sponge-like erectile tissue
inside these chambers. The erectile tissue contains thousands of spaces. During sexual
arousal, the spaces fill with blood, and your penis becomes hard and rigid (erection).
An erection allows you to have penetrative sex. The skin of your penis is loose and
stretchy, which lets it change size when you have an erection.
 Glans (head). The glans is the cone-shaped tip of your penis. A loose layer of skin
(foreskin) covers your glans. Healthcare providers sometimes surgically remove the
foreskin (circumcision).
In most people, the opening of the urethra is at the tip of the glans. The urethra transports pee
and semen out of your body. Semen contains sperm. You expel (ejaculate) semen through the
end of your penis when you reach sexual climax (orgasm).
When your penis is erect, your corpora cavernosa press against the part of your urethra where
pee flows. This blocks your pee flow so that only semen ejaculates when you orgasm.
2. Scrotum
Scrotum is the loose, pouch-like sac of skin that hangs behind your penis. It holds your
testicles (testes) as well as nerves and blood vessels.
Your scrotum protects your testicles and provides a sort of “climate-control system.” For
normal sperm development, your testes must be at a temperature that’s slightly cooler than
body temperature (between 97 and 99 degrees Fahrenheit or 36 and 37 degrees Celsius).
Special muscles in the wall of your scrotum let it contract (tighten) and relax. Your scrotum
contracts to move your testicles closer to your body for warmth and protection. It relaxes
away from your body to cool them.
3. Testicles
Testicles (testes) are oval-shaped organs that lie in your scrotum. They’re about the size of
two large olives. The spermatic cord holds your testicles in place and supplies them with
blood. Most people have two testicles, on the left and right side of their scrotum. Your
testicles make testosterone and produce sperm. Within your testicles are coiled masses of
tubes. These are the seminiferous tubules. The seminiferous tubules produce sperm cells
through spermatogenesis.
4. Epididymis
Your epididymis is a long, coiled tube that rests on the back of each testicle. It carries and
stores the sperm cells that your testicles create. Your epididymis also brings the sperm to
maturity — the sperm that emerge from your testicles are immature and incapable
of fertilization. During sexual arousal, muscle contractions force the sperm into your vas
deferens.

INTERNAL PARTS
There are several internal (accessory) organs in the male reproductive system. They include:
a) Vas deferens
Vas deferens is a long, muscular tube that travels from the epididymis into your pelvic cavity,
just behind your urinary bladder. Your vas deferens transports mature sperm to the urethra in
preparation for ejaculation.
b) Ejaculatory ducts
Each testicle has a vas deferens that joins with seminal vesicle ducts to form ejaculatory
ducts. The ejaculatory ducts move through your prostate, where they collect fluid to add to
semen. They empty into your urethra.
c) Urethra
The urethra is the tube that carries pee from your bladder outside of your body. If you have a
penis, it also ejaculates semen when you reach orgasm.
d) Seminal vesicles
Seminal vesicles are sac-like pouches that attach to your vas deferens near the base of your
bladder. Seminal vesicles make up to 80% of your ejaculatory fluid, including fructose.
Fructose is an energy source for sperm and helps them move (motility).
 e) Prostate gland
The prostate is a single, doughnut-shaped gland. It measures about 4 cm from side to side,
about 3 cm from top to bottom, and about 2 cm from front to back. It is inferior to the urinary
bladder and surrounds the prostatic urethra. The prostate slowly increases in size from birth
to puberty. It then expands rapidly up to age 30; remains typically stable until about age 45,
when further enlargement may occur.
The prostate secretes a milky, slightly acidic fluid (pH about 6.5) that contains
several substances.
- Citric acid is used by sperm for ATP production via Krebs cycle.
- Several proteolytic enzymes (prostate specific antigen or PSA, pepsinogen, lysozyme,
amylase, and hyaluronidase) eventually break down the clotting proteins from the
seminal vesicles.
- Acid phosphatase, whose function is unknown.
- Seminal plasmin (an antibiotic) can destroy bacteria. It may decrease the number of
naturally occurring bacteria in semen and in the lower female reproductive tract.
Secretions of the prostate enter the prostatic urethra through many prostatic ducts. They
constitute about 25% of the volume of semen and contribute to sperm motility and viability.
The prostate gland contributes additional fluid to the ejaculate. Prostate fluids also help to
nourish your sperm. The urethra, which carries the ejaculate to be expelled during orgasm,
runs through the center of the prostate gland. Your prostate also converts some of your
testosterone into another hormone, called dihydrotestosterone (DHT), which plays a part in
sexual development throughout your life. When you're an adult, for example, it's involved in
both prostate growth and male pattern baldness.
f) Bulbourethral (Cowper) glands
Your bulbourethral glands are pea-sized structures on the sides of your urethra, just below
your prostate. They create a clear, slippery fluid that empties directly into your urethra. This
fluid lubricates your urethra and neutralizes any acids that may remain from your pee.

- The entire male reproductive system depends on hormones. Hormones are chemicals
that stimulate or regulate activity in your cells or organs. The primary hormones that
help the male reproductive system function include:
 Follicle-stimulating hormone (FSH). Your pituitary gland makes FSH. FSH is
necessary to produce sperm (spermatogenesis).
 Luteinizing hormone (LH). Your pituitary gland also makes LH. LH is necessary to
continue the process of spermatogenesis.
 Testosterone. Testosterone is the main sex hormone in people AMAB. It helps you
develop certain characteristics, including muscle mass and strength, fat distribution,
bone mass and sex drive (libido).
FUNCTIONS OF MALE REPRODUCTIVE SYSTEM
The organs that make up the male reproductive system perform the following:
 Produce, maintain and transport sperm cells and semen. Sperm cells are male
reproductive cells. Semen is the protective fluid around sperm.
 Discharge sperm.
 Produce and secrete male sex hormones such as testosterone that maintain male
reproductive function and to promote spermatogenesis and transport into the female
reproductive system for fertilization.
 The testes act as both endocrine and exocrine organs in that they are responsible for
androgen production and sperm production and transport.

EPIDEMIOLOGY
Benign prostatic hyperplasia is present in 8% of men of 31-40 years of age. The prevalence of
BPH increases after 40 years of age, with a prevalence of up to 90% at the age of 90 years.

ETIOLOGY
 Exact cause is unknown
 Hormonal alteration - With advancing age, the amount of the male hormone
testosterone, decreases relative to the amount of circulating estrogen, the main female
reproductive hormone which also circulates in the male.

RISK FACTORS
Two broad categories of risk factors exist that may contribute to the development of BPH.
 Non-modifiable risk factors:
 Age: Incidence, and prevalence of BPH increase markedly with age. Prostate
volume increases with age. LUTS incidence also rises in older men.
 Geography: International studies have observed lower prostate volumes in men
from Southeast Asia as compared to the Western populations.
 Genetics: BPH and LUTS, both have a genetic etiological component. One case-
control study involving patients <64 years of age undergoing BPH surgery,
observed that there was a 4- to 6-fold greater age-specific risk of BPH surgery in
relatives of BPH patients undergoing surgery. The study further concluded that
half of the men undergoing BPH-related surgery had the inheritable form of the
disease.
  Modifiable risk factors:
 Hormones: Testosterone, dihydrotestosterone, estrogen-prostate cells secrete 5-a
reductase which converts testosterone to DHT, which is a potent stimulator of
prostatic growth. DHT is not only necessary for prostate growth, but it also plays a
role in the development of BPH.
 Metabolic syndrome: Metabolic disturbances related to cardiovascular disease and the
lifestyle factors that cause these disorders can also increase the risk of development of
BPH and LUTS.
 Obesity: Increased adiposity is proven to be associated with an increase in prostate
volume.
 Diabetes mellitus: Elevated fasting plasma glucose, diabetes mellitus, all are linked to
prostatic hypertrophy, along with an increase in the risk of benign prostatic
hyperplasia and lower urinary tract symptoms.
 Diet: Both macro- and micronutrients are associated with the risk of BPH and LUTS.
Increased total energy consumption and intake of fats, dairy products, bread, poultry,
and starch can increase the risk of symptomatic BPH and prosthetic surgery whereas
carotenoid vegetables, fruits, polyunsaturated fatty acids, linoleic acid, vitamin A, and
vitamin D are associated with lower risk. Micronutrients- if vitamin E, selenium,
carotene, lycopene, etc., are present in the diet in higher concentrations, the risk of
BPH and LUTS is reduced.
 Physical activity: Exercise and increased physical activity reduce the risk of clinical
BPH and lower urinary tract symptoms by 25% as compared to a sedentary lifestyle.
 Inflammation: Systemic inflammation and oxidative stress are linked to BPH and
LUTS.
PATHOPHYSIOLOGY
Due to etiological factors Enlargement of prostate gland

Normally thin and fibrous outer capsule of prostate become spongy and thick as enlargement
progress

Hypertrophied lobes compress bladder neck or prostatic urethra, causing incomplete

emptying & urinary retention

Gradual dilation of ureter and kidneys

(Hydroureter & Hydronephrosis)

Prolonged urinary retention/obstruction cause urinary tract infection

CLINICAL MANIFESTATION
Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder
function, which results in incomplete emptying of the bladder. Prostate gland enlargement
varies in severity among men and tends to gradually worsen over time. Prostate gland
enlargement symptoms include:
 Increased frequency of urination: an enlarged prostate presses on the bladder and
urethra, making it difficult to urinate
 Urgent need to urinate: the enlarged prostate squeezes the urethra and makes it
difficult to empty the bladder.
 Nocturia: Nocturia, or frequent urination at night, is a common symptom of benign
prostatic hyperplasia (BPH) or an enlarged prostate. This is because BPH can make it
difficult to empty the bladder.
 Difficulty and hesitancy in starting urination: because the enlarged prostate squeezes
the urethra.
 Abdominal straining with urination
 Decreased volume & force of urinary stream: because the enlarged prostate squeezes
the urethra
 Dribbling at the end of urination: BPH can cause the prostate to grow, which can
block the urethra.
 Acute urinary retention: occurs when an enlarged prostate blocks or slows urine flow
 Blood in the urine (hematuria): the enlarged prostate can press on the urethra and
irritate the bladder.
 Recurrent Urinary tract infection: it can obstruct urine flow and increase bladder
pressure
 Epigastric discomfort
 Renal failure: blocking the flow of urine, which can lead to kidney damage
 Azotemia: the enlarged prostate can compress the urethra and obstruct urine flow.
 Fatigue: because it can disrupt sleep pattern
 Nausea & vomiting: An enlarged prostate can block urine flow, causing urine to
remain in the bladder for longer. This can lead to bacteria growth and a UTI. UTIs can
cause nausea, vomiting, fever, and chills
 Anorexia
 Interruption of urinary stream: the prostate gland grows and squeezes the urethra
 Formation of stones in the bladder: Bladder stones can form in men with benign
prostatic hyperplasia (BPH) because BPH can make it difficult to empty the bladder
 Impaired kidney function: it can obstruct the flow of urine from the bladder
 Renal failure: Benign prostatic hyperplasia (BPH) can cause renal failure when an
enlarged prostate compresses the urethra and makes it difficult to urinate
DIAGNOSTIC EVALUATION
1) History: History must include the onset and duration 5 symptoms general health
issues of the patient, sexual history, and assessing whether the patient is fit for any
surgical intervention, History related to the effect of symptoms on quality of life and
severity of the symptoms, use of any medications, and previously attempted
treatments should be taken.

2) Physical Examination:
 A focused physical examination targeting the suprapubic area for signs and symptoms
of bladder distention should be conducted. A neurological assessment should be
carried out to identify any sensory or motor deficits.
 A digital rectal examination (DRE) is an important component of the evaluation of
patients with suspected BPH. During DRE, the size and contour of the prostate should
be examined, any nodules must be assessed, and areas of the prostate suggestive of
malignancy must be evaluated.
 If the tone of the anal sphincter is decreased, or the bulbocavernosus reflex is absent,
an underlying neurological disorder can be suspected.

3) Urinalysis and Urine Culture: -

 Urinalvsis can be done using the dipstick method or centrifuge sediment
evaluation to detect any blood leukocytes, glucose, protein, or bacteria in the
urine.
 If an initial urinalysis indicates an abnormality, a urine culture can be done. It
helps to exclude the infectious etiology of irritative voiding symptoms.

4) Prostate-specific Antigen: Although benign prostatic hyperplasia does not lead to

malignancy, it certainly increases the risk of cancer so screening should be done
accordingly.

5) Ultrasonography: If the patient has urinary retention or signs of renal insufficiency, an

abdominal, renal, or transrectal ultrasound can be used to determine the bladder and
prostate size.

6) Endoscopy of Lower Urinary Tract: Cystoscopy is indicated in patients with

suspected foreign body or malignancy or the patients who are scheduled for invasive
treatment. If the patient has a history of trauma, prolonged catheterization, or sexually
transmitted disease, endoscopy may be indicated.

Other Tests
 Flow rate: Helps to determine the response of the patient to treatment and this is
usually done in the initial assessment phase.
 PVR urine volume: Helps to assess the severity of bladder decompensation. Can be
done invisibly with the catheter or noninvasively with the transabdominal ultrasonic
scanner.
 Pressure flow studies: Help to evaluate obstruction of the bladder outlet.
  Urodynamic studies: This helps to distinguish the ineffective bladder contraction from
obstruction of the bladder outlet.
 Cytological examination of urine: It is considered in clients who have predominantly
irritative symptoms. History of smoking, previous bladder cancer, and any other
history pointing toward the risk of prostate cancer must alert the clinician to consider
this test.

MANAGEMENT
MEDICAL MANAGEMENT
a) Watchful waiting: This strategy is recommended in patients who have mild symptoms
because of BPH and for those with moderate to severe symptoms who are not
bothered by their symptoms, with no complications. In these patients, medical
therapy is not likely to improve the symptoms or quality of life of patients. Patients
under watchful waiting are usually reexamined annually.
b) Drug therapy:
 Alpha-blockers: Increased tone of the smooth muscles of the urethra, bladder neck,
and prostate gland is a major cause of lower urinary tract symptoms secondary to
BPH. This increased smooth muscle tone is attributed to the alpha-1 adrenergic
receptor. The agents blocking these receptors, thus, relax the smooth muscle and allow
easier passage of urine.
Alpha-blocking agents include:
 Non-selective alpha-blocking agents, e.g., phenoxybenzamine
 Selective short-acting alpha-1 blocking agents, e.g., prazosin, indoramin, alfuzosin
 Selective long-acting alpha- 1 blocking agents, e.g., terazosin, doxazosin
 Alpha- la selective agents, e.g. tamsulosin, silodosin
 5-alpha-reductase inhibitors (5 ARIs): Dutasteride and finasteride are the two 5-alpha-
reductase inhibitors that have been currently approved for the treatment of benign
prostatic hyperplasia. In patients with LUTS secondary to BPH, 5-ARIs prevent the
progression of the symptoms, decrease the incidence of urinary retention and prevent
the need for prostate-related surgery in the future. The mechanism of action of 5-ARIs
is by reduction of prostate volume, thus reducing LUTS. Maximum prostate volume
reduction takes a minimum of 6 months of therapy. 5-ARIs block "testosterone to
DHT" conversion, leading to decreased DHT levels in the prostate, causing a
consistent decrease in prostate size and improving LUTS and urine flow.
Based on the severity of symptoms, a treatment approach can be decided. If
the symptoms are mild, a watchful waiting approach can be adopted. For moderate to
severe symptoms, watchful waiting or medical management can be instituted, based
on whether the symptoms are affecting the patient's activities of daily living. For
severe obstructive symptoms, surgery may be required to relieve the obstruction.
SURGICAL MANAGEMENT
1) Transurethral resection of the prostate (TURP) is the name of the procedure done for
patients with BPH. This surgery is a criterion standard for treating the obstruction of
the bladder outlet, caused by benign prostate hyperplasia.
Indications:
 Recurrent gross hematuria
 Urinary tract infections
 Failed voiding trials
 Renal insufficiency
 Acute urinary retention
 Failure of medical therapy
 If the patient wants to stop the medical therapy
 Financial difficulties rendering patients unable to take medical therapy

- Transurethral resection of the prostate is done under general or regional

anesthesia. The handheld device which is attached to a wire loop is placed in the
urethra through a working sheath. This loop helps to shave away the prostatic
tissue with the help of the high-energy electric cutting current. This entire device
is called a resectoscope and is attached to a camera to enable the surgeon to
visualize the procedure.

- TURP syndrome: TURP syndrome is a complication of transurethral resection of

the prostate, characterized by symptoms ranging from asymptomatic
hyponatremia to convulsions, coma, and death as a result of the absorption of
irrigation fluid during TURP. During TURP, small veins are cut open, and from
there, the irrigation fluid may get absorbed. Absorption of irrigation fluid of more
than 2,000 mL may lead to headaches, confusion, dyspnea, anxiety, arrhythmia,
hypertension, and seizures, which may be fatal if left untreated. These symptoms
are due to fluid overload in circulation. Excessive absorption of irrigation fluids
(having a highly hypotonic composition), can result in dilutional hyponatremia
and hypo-osmolality. This can lead to severe neurological symptoms.
Hyponatremia usually manifests only after the serum sodium concentration is
below 120 mmol/L. If TURP syndrome is suspected, bleeding should be
controlled and operation should be suspended. Aggressive treatment of
hyponatremia is warranted to prevent intravascular hemolysis which can occur
when the serum sodium concentration is less than 100 mmol/L.

- Side effects of TURP:

 Bleeding may require the abandonment of procedure. blood transfusion, or
prolonged hospital stay.
 During the procedure, veins may be cut open and a significant amount of
irrigation fluid may get absorbed into the body through these veins. This
may lead to transurethral resection syndrome.
 Urethral stricture can occur due to the placement of a large working
sheath and the use of electric energy.
  During the resection of the prostate, the urinary sphincteric mechanism
can also be partially resected. This can make the muscles at the bladder
outlet weak and incompetent. When the patient ejaculates, this sphincteric
mechanism will not be able to keep the bladder completely closed. So, the
ejaculate, rather than going to the penis, will go to the bladder (retrograde
ejaculation). This sphincter damage can also result in urinary
incontinence.
 The nerves that are responsible for the erection of the penis run along with
the outer border of the prostate and may get damaged because of the high-
energy current or heat generated during TURP resulting in impotence.

2) Suprapubic Prostectomy: It is one method of removing the gland through an

abdominal incision. An incision is made into the bladder & the prostate gland is
removed from above the pubic bone. Such an approach can be used for a gland to any
size & few complications
occur.

3) Retro pubic Prostectomy: In this method a lower abdominal incision is used to

remove the prostate gland without entering the bladder. This procedure is suitable for
large glands located high in the pelvis.

4) Perineal Prostectomy: This method involves removing the gland through an incision
in the perineum. This approach is practical when other approaches are not possible &
is useful for an open biopsy.

5) Transurethral Incision of Prostate: In this method an instrument is passed through the

urethra. One or two incisions are made in the prostate & prostate capsule to reduce the
prostatic pressure on the urethra to reduce urethral construction.

MINIMALLY INVASIVE THERAPY

Because drug treatment is not effective in all cases, researchers in recent years have
developed a number of procedures that relieve PH symptoms but are less invasive than
conventional surgery.
a) Transurethral Needle Ablation: It uses low-level radio frequencies to produce
localized heat to destroy prostate tissue. The radio frequencies are delivered by thin
needles placed into the prostate gland from a catheter. Shields protect the urethra
from heat damage. The TUNA System improves urine flow and relieves symptoms
with fewer side effects when compared with transurethral resection of the prostate
(TURP).

b) Microwave Thermotherapy: With this technique, precisely controlled microwaves are

passed through a catheter inserted in the urethral opening of the penis, guided to the
 prostate gland, and focused on the prostate tissue. The device that delivers the
microwave energy is called a Prostatron. The tissue is heated by the microwave
energy, causing cell death of the offending prostate tissue, while the surrounding
tissues are protected by a cooling system that dissipates the heat. The procedure takes
approximately one hour.

c) Transurethral Laser Resection: A laser guided through the urethra produces energy.
that is directed at the prostate tissue surrounding the constricted portion of the
urethra. The laser energy vaporizes the offending prostate tissue.

d) High energy focused ultrasound (HIFU) - Following insertion of an ultrasound probe

through the rectum behind the prostate gland, ultrasound energy is focused and used
to shrink the size of the prostate gland.

e) Prostate stent: A prostate stent is a tubular device inserted through the urethra to the
point of constriction, where it is allowed to expand. The pressure exerted by the stent
on the inside wall of the urethra widens its bore and reduces the obstruction to urinary
flow. However, an increased urgency to urinate may be experienced in the first few
days following insertion of the device.

f) Balloon urethroplasty: A tube with a small balloon at the end is inserted through the
urethral opening of the penis and guided to the constricted portion of the urethra,
where the balloon is inflated. The pressure exerted by the balloon against the inside
of the urethral wall increases the diameter of the urethra and improves the flow of
urine.

ALTERNATIVE THERAPY
 Phytotherapeutic agents and dietary supplements: Active compounds in plant
derivatives phytosterols, fatty acids, lectins, flavonoids, plant oils, polysaccharides,
etc. -although these agents are not officially approved for the treatment of BPH, they
are very popular as alternative therapies.
These agents may exert antiandrogenic, antiestrogenic, 15t anti-inflammatory,
detrusor strengthening, and alpha receptor blocking effects.
Some examples include saw palmetto or American dwarf palm plant, African plum
tree, stinging nettle, pumpkin, and rye.

 American dwarf palm (saw palmetto): Extracts of berries of the American dwarf plant
is one of the most popular alternative therapies for BPH. It has a mixture of fatty
 acids, phytosterols, and alcohols that exert antiandrogenic effects, 5-ARI effect, and
anti -inflammatory effect.

 Pygeum africanum (African plum tree): This extract is not well studied but what is
hypothesized is that it inhibits fibroblast proliferation and has an anti-inflammatory
effect.

 Rye (Secale cereale): The extract is derived from the pollens of rye plants grown in
southern Sweden. The mechanism involves alpha blockade, 5-ARI activity inhibition,
and prostatic zinc level increase.

 Pumpkin seeds (Cucurbita pepo): Many studies suggest that men with lower urinary
tract symptoms secondary to BPH who have urinary urgency and frequency, benefit
from the use of pumpkin seeds. The suggested mechanism of action includes
increased synthesis of prostaglandins and a high concentration of Linoleic acid.
Another mechanism is the anti-inflammatory property of gamma-tocopherol and the
nitric acid precursors present in pumpkin seeds.

LIFESTYLE AND HOME REMEDIES

Making some lifestyle changes can often help control the symptoms of an enlarged
prostate and prevent your condition from worsening. Try these measures:
 Limit beverages in the evening. Don't drink anything for an hour or two before
bedtime to help avoid wake-up trips to the bathroom at night.
 Don't drink too much caffeine or alcohol. These can increase urine production, irritate
bladder and worsen symptoms.
 Limit decongestants or antihistamines. These drugs tighten the band of muscles
around urethra that control urine flow, which makes it harder to urinate.
 Go when you feel the urge. Try to urinate when first feel the urge. Waiting too long to
urinate may overstretch the bladder muscle and cause damage.
 Schedule bathroom visits. Try to urinate at regular times to "retrain" the bladder. This
can be done every four to six hours during the day and can be especially useful if have
severe frequency and urgency.
 Stay active. Inactivity causes to retain urine. Even a small amount of exercise can help
reduce urinary problems caused by an enlarged prostate.
 Keep warm. Colder temperatures can cause urine retention and increase urgency to
urinate.

NURSING MANAGEMENT
Nursing Assessment
 Assess the condition of client.
 Monitor vital signs of patient and record.
 Maintain intake output chart.
 Monitor daily weight and record.
 If patient is having urinary retention, then insert catheter.
 Obtain urine culture if UTIs suspected.
 Prepare patient for diagnostic tests and surgery as appropriate.

Nursing Diagnosis
1) Acute pain related to bladder distension secondary to enlarged prostate.
Interventions: -
 Assess the level, location, intensity of pain by using pain relating scale.
 Avoid the activities that increase the pain.
 Provide comfortable bed, position to the patient.
 Initiate bowel to prevent constipation.
 Provide opioid analgesics to constipation as prescribed by doctor.
 Administer analgesics as prescribed by doctor.

2) Urinary retention related to urethral obstruction and loss of bladder tone due to
prolonged distension/retention.
Interventions: -
 Assess the patient usual pattern of urinary function.
 Assess for sign of urinary retention, amount and frequency of urination,
urgency and discomfort.
 Initiate measures to treat retention; encourage assuming normal position for
voiding.
 Administer cholinergic agent as prescribed by doctor, helps to stimulate
bladder contraction.
 Monitor the effect of medication.

3) Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan
and prognosis.
Interventions: -
 Obtain the history to determine the patients concerns.
 Ask questions regarding disease to check his understanding and knowledge of
his health problem.
 Provide education about diagnosis and treatment.
 Allow the patient to ask questions.
 Provide psychological support to the patient.
 Answer all the questions asked by the patient.
 Provide comfortable environment.
 4) Deficient knowledge related to disease condition, urinary difficulties, and treatment
modalities.
Interventions: -
 Assess knowledge deficit.
 Provide patient education.
 Clarify medical terminology.
 Create an open and non-judgmental environment where the patient feels
comfortable asking questions about their healthcare.
 Engage family members or caregivers in the educational process to ensure a
support system is well-informed and can assist the patient as needed.

5) Disturbed sleeping pattern related to the bladder pain, urinary urgency.

Interventions: -
 Minimize noise and interruptions, especially during hospitalization.
 Adjust the lighting, temperature, noise, and mattress. Use room-darkening
curtains and a fan.
 Encourage patients to stick to a consistent bedtime routine.
 Encourage patients to limit napping and participate in activities during the
day.
 Instruct patients to avoid caffeine and foods and drinks that interfere with
sleep before bed.

Preoperative Care if Patient is Having Surgery

 Urinary drainage must be restored before surgery. Prostatic obstruction results into
acute retention or inability to void.
 A urethral catheter such as coude (curved tip) catheter maybe needed to restore
drainage.
 If there is any infection treat before surgery.
 All type of prostate surgery results into some degree of retrograde ejaculation.
 Patient should be informed that the ejaculate maybe decreased in amount or totally
absent.

Postoperative care after surgery

 After surgery patient may will have catheter. Bladder irrigation is done to remove
clotted blood from bladder and ensure drainage of urine.
 Careful septic technique should be maintained when irrigating the bladder because
bacteria can easily enter into urinary tract.
 Blood clots are expected after surgery for the first 24-36 hours.
 If large amount of bright red color is present in urine it indicates hemorrhage.
 Activity that increases abdominal pressure such as walking for long periods should be
avoided.
  Sphincter tone maybe poor after catheter removal that results in continence so educate
about kegel exercises, pelvic floor muscle technique.
 Patient should be observed for signs of infection.
 Dietary intervention stool softeners should be given to prevent from straining while
bowel movements.

COMPLICATIONS
 Urinary retention: Client can feel sudden inability to urinate.
 Urinary tract infection: Inability to empty the bladder can increase the risk of
infection in urinary tract.
 Bladder stones: It can be caused by an inability to completely empty the bladder.
Bladder stones can cause infection, bladder irritation, and obstruction in urine flow.
 Kidney damage: Pressure in the bladder from urinary retention can directly damage
the kidneys or allow bladder infection to reach the kidneys.

PROGNOSIS
Deterioration in LUTS with increasingly problematic voiding symptoms is the most
common indicator of BPH disease progression. Patients may also present with complications,
including urinary retention, infections, or hematuria. Observational studies have
demonstrated that when left without treatment, clinical progression of BPH increased over 48
months, with 31% of the cohort requiring further treatment and 5% developing acute
retention in the same period.
The 5 alpha-reductase inhibitors have been shown to reduce the incidence of
urinary retention and delay the need for surgery, while alpha-blockers have not.

CONCLUSION
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland. It's
a common cause of urinary problems in men. BPH is a common disease that can be treated
with medical, surgical, or minimally invasive options. The best treatment depends on the
patient's symptoms, risk factors, and other factors. BPH can be associated with an increased
risk of prostate and bladder cancer. A poor diet may worsen BPH. Early treatment and
appropriate management shows good prognosis.

BIBLIOGRAPHY
BOOK REFERENCES
 Ansari J, “A Textbook of Medical Surgical Nursing – II” Part B, S Vikas & Company
(Medical Publishers) India, Edition 2021, Page number: 1220-1225.

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Publishers, First Edition, 2019, Page number: 453-457.

 Lewis, Dirksen, Heitkemper, Bucher, “Lewis’s Medical-Surgical Nursing”, Reed

Elsevier India Pvt. Ltd, Second South Asia Edition, Page number: 954-957.

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 Kaur S, “Textbook of Adult Health Nursing-I Medical Surgical Nursing”, Jaypee

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 Sethi D, Rani K, “Medical Surgical Nursing I & II”, Jaypee Brothers Medical
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INTERNET REFERNCES
 Langan RC, Available from National Institute of Diabetes, Digestive and Kidney
Diseases, 2024
https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-
problems/enlarged-prostate-benign-prostatic-hyperplasia.

 Deters AL, Available from Medscape, December 24 2024

https://emedicine.medscape.com/article/437359-overview?form=fpf

 McVary K, Available from UpToDate, December 31 2024

https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-
basics