BPH (ENLARGEMENT OF PROSTATE) IN ENGLISH
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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-
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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)
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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.
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