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Bening Prostate Hypertrophy (BPH) - Coggle Diagram
Bening Prostate Hypertrophy (BPH)
Definition
Noncancerous enlargement of the epithelial and fibromuscular components of the prostate gland.
Common disorder in men >50 years old.
Etiology
Influence by a combination of androgens, growth factors, estrogens and epithelial-stromal interactions.
Dihydrotestosterone (DHT) binds with androgen receptors in cell nuclei.
Risk Factor
Ethnic background-White and black men > Asian men
Diabetes & heart disease
Family history
Lifestyle-obesity
Pathophysiology
Increase in size of prostate gland
Formation of large nodules in transitional zone of prostate
Push on & narrow urethra
Increase resistance of urine flow from bladder
Hyperplasia of prostatic stromal & epithelial cell
Clinical Manifestations
Abdominal straining
Decreased in volume and force of urinary stream
Urgency
Dribbling
Nocturia
Sensation of incomplete emptying of bladder
Increased frequency of urination
Acute urinary retention
Hesitancy in starting urination
Recurrent UTI
Continuation
Nausea & vomiting
Pelvic discomfort & pain
Anorexia
Ultimately azotemia
Fatigue
Renal failure (associated with urinary retention & large residual volumes)
Hematuria
Diagnostic Test
Urinary flow rate recording & measurement of postvoid residual (PVR) urine
Urodynamic studies
Prostate-specific antigen (PSA)-detect for cancer
Urinalysis
FEME: presence of blood, leukocytes, bacteria
C&S
Physical examination
Signs of bladder distention
Neurological examination for sensory and motor deficits
Digital rectal examination (DRE): assess for prostate size, symmetry and contour
Ultrasound
IPSS
(AUA symptoms score)
Blood test-kidney function test
History Taking
Medication history
Possible cause to urethral stricture (history of urethral trauma, urethritis, or urethral instrumentation)
Previously attempted treatment
Sexual history
Medical history and cancer prostate
Family history of BPH
International Prostate Symptoms Score (AUA symptoms score)
Onset, duration, symptoms
Treatment and Management
Suprapubic cystostomy
Watchful waiting
Reassurance: noncancerous
Lifestyle medication
Manage nocturia: reduce nighttime fluid
Eliminate bladder irritants (caffeine, alcohol, nicotine)
Avoid drug that aggravate symptoms (e.g., androgens, anticholinergic agents, caffeine diuretic, sedatives)
Follow up 6-12/12
Catheterization (severe urinary retention)
Pharmacological
Treatment depend on cause, severity of obstruction and patient condition
Surgical (Minimally invasive therapy)
Transurethral needle ablation
Laser prostatectomy
Transurethral microwave thermotherapy
Photo vaporization
Interstitial laser coagulation
Intraprostatic urethral stents
Surgical (Invasive therapy)
Transurethral resection of prostate (TURP)
Transurethral incision of prostate (TUIP)
Open prostatectomy
Complications
Recurrent UTI, urosepsis
Gross hematuria
Renal insufficiency
Bladder calculi
Involuntary bladder contractions
Bladder diverticula
Urinary incontinence
Hydronephrosis
Urinary retention
Nursing Diagnosis