Benign Prostatic Hyperplasia (BPH)
BPH Collaborative Care: Invasive Therapy - ✔️✔️Invasive therapy indicated when:
-decrease in urine flow sufficient to cause
discomfort
-persistent residual urine
-acute urinary retention
-hydronephrosis
-Transurethral Resection (TURP):
-removal of obstructing prostate tissue using
resectoscope inserted through urethra
-outcome for 80% to 90% is excellent
-relatively low risk
-performed under spinal or general anesthesia
and requires hospital stay
-bladder irrigated for first 24 hours to prevent
mucous and blood clots
-complications include bleeding, clot retention,
dilutional hyponatremia, retrograde
ejaculation
-patients must stop anticoagulants before
surgery
-Transurethral incision of the prostate (TUIP):
-moderate to sever symptoms
-for patients with a small or moderately enlarged
prostate gland
-local anesthesia
-several small incisions made into prostate
to expand the urethra improves urine
flow
BPH Complications - ✔️✔️- Acute urinary retention (Related to obstruction and
relatively uncommon in BPH):
-complication with sudden, painful inability to
urinate
-treatment involves catheter insertion and
possible surgery
-UTI and Sepsis:
-incomplete bladder emptying with residual
urine provides medium for bacterial growth
, -Calculi may develop in bladder because of alkalization of residual urine
-Renal Failure: caused by hydronephrosis
-Pyelonephritis
-Bladder damage
-Ureteral damage due to repeated TURPs
BPH Pathophysiology - ✔️✔️Though to result from hormonal changes from aging
process:
-Excessive accumulation of DHT in the
prostate cells that can stimulate overgrowth
of prostate tissue
-Increased proportion of estrogen over
testosterone in blood
Compression (from enlargement) of the urethra leads to:
-Decrease in caliber and force of the
urinary stream
-Difficulty in initiating voiding
-Intermittency of voiding
-Dribbling
-BPH develops in the inner part of the prostate.
-This enlargement gradually compresses the urethra, eventually leading to partial or
complete obstruction.
-There is no direct relationship between the size of the prostate and the severity of
symptoms or degree of obstruction.
-The location of the enlargement is the most significant in the development of
obstructive symptoms.
BPH Risk Factors - ✔️✔️Aging
Obesity (especially increased waist circumference)
Lack of physical activity
Alcohol consumption
Erectile dysfunction
Smoking
Diabetes
BPH Clinical Manifestations - ✔️✔️Usually gradual in onset:
-manifestations associated with obstruction of lower urinary tract
-early symptoms are usually minimal because bladder can compensate
-worsen as obstruction increases
BPH Collaborative Care: Invasive Therapy - ✔️✔️Invasive therapy indicated when:
-decrease in urine flow sufficient to cause
discomfort
-persistent residual urine
-acute urinary retention
-hydronephrosis
-Transurethral Resection (TURP):
-removal of obstructing prostate tissue using
resectoscope inserted through urethra
-outcome for 80% to 90% is excellent
-relatively low risk
-performed under spinal or general anesthesia
and requires hospital stay
-bladder irrigated for first 24 hours to prevent
mucous and blood clots
-complications include bleeding, clot retention,
dilutional hyponatremia, retrograde
ejaculation
-patients must stop anticoagulants before
surgery
-Transurethral incision of the prostate (TUIP):
-moderate to sever symptoms
-for patients with a small or moderately enlarged
prostate gland
-local anesthesia
-several small incisions made into prostate
to expand the urethra improves urine
flow
BPH Complications - ✔️✔️- Acute urinary retention (Related to obstruction and
relatively uncommon in BPH):
-complication with sudden, painful inability to
urinate
-treatment involves catheter insertion and
possible surgery
-UTI and Sepsis:
-incomplete bladder emptying with residual
urine provides medium for bacterial growth
, -Calculi may develop in bladder because of alkalization of residual urine
-Renal Failure: caused by hydronephrosis
-Pyelonephritis
-Bladder damage
-Ureteral damage due to repeated TURPs
BPH Pathophysiology - ✔️✔️Though to result from hormonal changes from aging
process:
-Excessive accumulation of DHT in the
prostate cells that can stimulate overgrowth
of prostate tissue
-Increased proportion of estrogen over
testosterone in blood
Compression (from enlargement) of the urethra leads to:
-Decrease in caliber and force of the
urinary stream
-Difficulty in initiating voiding
-Intermittency of voiding
-Dribbling
-BPH develops in the inner part of the prostate.
-This enlargement gradually compresses the urethra, eventually leading to partial or
complete obstruction.
-There is no direct relationship between the size of the prostate and the severity of
symptoms or degree of obstruction.
-The location of the enlargement is the most significant in the development of
obstructive symptoms.
BPH Risk Factors - ✔️✔️Aging
Obesity (especially increased waist circumference)
Lack of physical activity
Alcohol consumption
Erectile dysfunction
Smoking
Diabetes
BPH Clinical Manifestations - ✔️✔️Usually gradual in onset:
-manifestations associated with obstruction of lower urinary tract
-early symptoms are usually minimal because bladder can compensate
-worsen as obstruction increases
