BPH (ENLARGEMENT OF PROSTATE) IN ENGLISH

                                                    

                          BPH (ENLARGEMENT OF PROSTATE) IN ENGLISH

                         watch my youtube video to understand this topic in easy way-

   https://www.youtube.com/watch?v=M06nsy0ay88

 BPH-

            Benign prostatic hyperplasia (BPH) is known as enlargement of prostate gland resulting in compressed urethra. It is one of the most common diseases in aging men.

            It can cause bothersome lower urinary tract symptoms that affect quality of life by interfering with normal daily activities and sleep patterns. BPH typically occurs in men older than 40 years of age. By the time they reach 60 years of age, 50% of men have BPH. It affects as many as 90% of men by 85 years of age.

CAUSES-

Ø  The cause of BPH is not well understood, but testicular androgens have been blamed for this condition. Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth.

Ø  Estrogens may also play a role in the cause of BPH; BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT.

Ø  Risk factors for development of BPH include Smoking, heavy alcohol consumption, obesity, reduced activity level,  hypertension, heart disease, diabetes, and a  diet high in animal fat and protein and refined carbohydrates, low fiber diet etc. 

CLINICAL MANIFESTATIONS-

Ø  BPH may be asymptomatic for a long time, if symptoms occur, they may range from mild to severe. Symptoms may include-

Ø  Increased urinary frequency

Ø  Urgency of urination,

Ø  Nocturia (more frequent urination during night),

Ø  Hesitancy in starting urination,

Ø  The sensation of incomplete bladder emptying,

Ø  Abdominal straining with urination,

Ø  Decrease in the volume and force of the urinary stream,

Ø  Dribbling (urine dribbles out after urination)

Ø  Acute urinary retention (more than 60 mL of urine remaining in the bladder after urination)

Ø  Recurrent Urinary Tract Infections.

Ø  Ultimately, chronic urinary retention.

Ø  Generalized symptoms may also appear such as fatigue, anorexia, nausea, vomiting, and pelvic discomfort.

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of prostate enlargement)

Ø   Digital rectal examination (DRE) often reveals a large, rubbery, and non-tender prostate gland.

Ø  A urinalysis to screen for hematuria and UTI.

Ø  A Prostate Specific Antigen level is also obtained. 

TREATMENT-

Ø  The goals of medical management of BPH are to improve quality of life, improve urine flow, relieve obstruction, prevent disease progression, and minimize complications.

Ø  Patients with mild or moderate symptoms not having developed complications may be managed with watchful waiting.

Ø  Medical treatment for BPH includes-

Ø  Alphaadrenergic blockers such as alfuzosin,  terazosin, doxazosin and tamsulosin which relax the smooth muscle of the bladder neck and prostate.

Ø  5 alpha reductase inhibitors such as finasteride  anddutasteride also help in relieving symptoms.

Ø  Surgical resection of the prostate gland is another option for patients with moderate to severe lower urinary tract symptoms of BPH and for those with acute urinary retention or other complications.

Ø  Transurethral resection of the prostate (TURP)  involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra is also useful.

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  Voiding pattern and voiding history is very important in the assessment of patients with BPH

Ø  Patient is encouraged to discuss the problem and ask doubts and concerns to relieve anxiety related to diseases process and treatment.

Ø  Patient is explained about the treatment strategy and effects/side effects of medications.

Ø  Prescribed medicines are given on time to increase flow of urine and reduce discomfort.

Ø  The patient is continuously monitored for signs of complete obstruction and bladder distention.

Ø  Patient may undergo TURP, TUIP or surgery, so prepared the client accordingly and provide post procedure or post operative care.

Ø  Patient is monitored for signs of infection at surgical site and surgical site and asepsis is maintained in care

Ø  Health education is provided regarding continuation of medication and follow up  during discharge planning.