Benign Prostatic Hypertrophy or Hyperplasia Nursing Care Plan & Management

 Description

  1. A slow enlargement of the prostate gland occurs, with hypertrophy and hyperplasia of normal tissue.
  2. The enlargement causes narrowing of the urethra and results in partial or complete obstruction.
  3. The cause is unknown, and the disorder usually occurs in men older than 50 years. 
Causes

Because the condition occurs in older men, changes in hormone balances have been associated with the cause. Androgens (testosterone) and estrogen appear to contribute to the hyperplastic changes that occur. Other theories, such as those involving diet, heredity, race, and history of chronic inflammation, have been associated with BPH, but no definitive links have been made with these potential contributing factors.

Assessment
  1. Urgency, frequency, and hesitancy
  2. Changes in sizes and force of urinary stream
  3. Retention
  4. Dribbling
  5. Nocturia
  6. Hematuria
  7. Urinary stasis
  8. UTIs
Physical Examination

Inspect and palpate the bladder for distension. A digital rectal exam (DRE) reveals a rubbery enlargement of the prostate, but the degree of enlargement does not consistently correlate with the degree of urinary obstruction. Some men have enlarged prostates that extend out into soft tissue without compressing the urethra. Determine the amount of pain and discomfort that is associated with the DRE.

The International Prostate Symptom Score

  1. Incomplete emptying: Over the past month, how often have you had the sensation of not emptying your bladder completely after you have finished urinating? (Not at all _ 0, less than 1 time in 5 _ 1, less than half the time _ 2, about half the time _ 3, more than half the time _ 4, almost always _ 5)
  2. Frequency: Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? (Not at all _ 0, less than 1 time in 5 _ 1, less than half the time _ 2, about half the time _ 3, more than half the time _ 4, almost always _ 5)
  3. Intermittency: Over the past month, how often have you stopped and started again several times when urinating? (Not at all _ 0, less than 1 time in 5 _ 1, less than half the time _ 2, about half the time _ 3, more than half the time _ 4, almost always _ 5)
  4. Urgency: Over the past month, how often have you found it difficult to postpone urination? (Not at all _ 0, less than 1 time in 5 _ 1, less than half the time _ 2, about half the time _ 3, more than half the time _ 4, almost always _ 5)
Diagnostic Evaluation
  1. Physical examination, including digital rectal examination (DRE).
  2. Urinalysis and urodynamic studies to determine obstructed flow
  3. Renal function tests, including serum creatinine levels
  4. Complete blood studies, including clotting studies
Primary Nursing Diagnosis
  • Urinary retention (acute or chronic) related to bladder obstruction
Medical Management

The treatment plan depends in the cause, severity of obstruction, and condition of the patient. Treatment measures include:

  • Immediate catheterization if patient cannot void (a urologist may be consulted if an ordinary catheter cannot be inserted). A suprapubic cystostomy is sometimes necessary.
  • “Watchful waiting” to monitor disease progression.
  • Balloon dilation or alpha-1 adrenergic receptor blockers (terazosin) to relax smooth muscle of the bladder neck and prostate
  • Hormonal manipulation with antiandrogen (finasteride [Proscar]) decreases the size of the prostate and improves urinary flow.
  • Saw palmetto is a botanical remedy for mild to moderate BPH.
Surgical Management
  • Transurethral laser resection with ultrasound guidance
  • Transurethral needle ablation (spares urethra, nerves, muscles, and membranes)
  • Microwave thermotheraphy (using transurethral probe) applied to hypertrophied tissue, which then becomes necrotic and sloughs off

Surgical procedures such as prostatectomy can be used to remove the hypertrophied portion of the prostrate gland. Other kinds of surgery include:


  • Transurethral resection of the prostrate (TUR or TURP); urethral endoscopic procedure is most common approach.
  • Suprapubic prostatectomy (perineal incision); incontinence, impotence, or rectal injury may be complications
  • Retropubic prostatectomy (low abdominal incision)
Pharmacologic Intervention
  1. Phenoxybenzamine (alpha-adrenergic) 10 mg PO bid, to blocks effects of postganglionic blocker synapses at the smooth muscle and exocrine glands; improvement of urinary flow in 75% of patients
  2. Finasteride (5-alpha reductase) 5 mg PO qd, to shrinks prostate gland and improves inhibitor urine flow
  3. Other Medications: Prazosin, alfuzosin, doxazosin