BPH

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 BRIEF ANATOMY OF THE PROSTATE GLAND:
The prostate Gland is an accessory gland of the male reproductive system,which is located below the urinary bladder & surrounding the commencement of the urethra.

DEFINITION:
This is the enlargement of the prostate Gland that compresses the urethra causing urinary obstruction.
This condition is common among among ppl (men) above 50yrs of age.

ETIOLOGY /CAUSES:
✏Tumour
✏Arteriosclerosis 
✏Hormonal activity (decreased Androgen,increased estrogen and increased androgen receptors)
✏Infection 
✏Metabolic or nutritional disturbances 
✏Aging.

RISK FACTORS:
✅Age (above 40yrs )
✅Race
✅Family Hx
✅Genetic factors.
✅Others (obesity,increased Ca intake and Dairy food).

PATHOPHYSIOLOGY:
👠Under normal circumstances, the prostate gland does not hinder the outflow of urine from the urinary bladder 2ru the urethra.
👠But,due to any of the listed causes/factors.e.g. Aging,the production of hormones that stimulate male xteristics (Androgen) diminishes and estrogen production increases.
👠This hormonal status would cause an androgen-estrogen imbalance, leading to an increase in the main prostatic intracellular androgen known as DIHYDROTESTOSTERONE; DHT (A testosterone derivative).

👠This means the increased estrogen levels lead to increased androgen receptors(5-A reductase receptors )in the prostate gland, leading to overgrowth of the prostatic cells (HYPERPLASIA )that begins around the urethra. 
👠The prostate gland enlarges and compresses the urethra,making its lumen to be reduced in size,thereby causing OBSTRUCTION IN URINARY FLOW.
👠This obstruction results in a compensatory increase /hypertrophy of the bladder muscle (Detrusor) thereby causing trabeculations or pockets in the bladder wall that will cause URINARY RETENTION,STASIS, AND RESIDUAL URINE/INCOMPLETE EMPTYING.
👠The urinary bladder becomes infected due to the retained urine and this causes inflammation of the bladder.
👠The thickening of the bladder(hypertrophy )results in less capacity thereby causing URINARY HESITANCY. 
👠Urinary stasis results in alkalinity of urine,leading to infection(UTI).
👠IF urinary obstruction is nearly complete,the stream of urine during micturition will be reduced in force and quantity.This leads to DRIBBLING OF URINE,URINARY FREQUENCY &URINARY URGENCY.
👠Frequency of urination,especially at night(NOCTURIA) will result in INSOMNIA.
👠Acute urinary retention leads to LOWER ABDOMINAL DISTENTION with SEVERE PAIN and DISTRESS due to inability to pass the urine(DYSURIA)
👠The enlarged prostate may may exert pressure on nerves causing BACK PAIN &SCIATICA.
👠Urinary retention leads to backflow of urine into the ureters causing their abdominal distention with urine(HYDROURETER)and further lead to distention of the renal pelvis with urine (HYDRONEPHROSIS ).
👠Prolonged hydronephrosis causes atrophyof the kidney tissue,leading to RENAL FAILURE WITH ITS MANIFESTATIONS(u can mention few of them).

CLINICAL MANIFESTATION:
🐒Urinary retention 
🐒Dribbling at the end of voiding
🐒Frequency 
🐒Urgency
🐒Hesitancy 
🐒Dysuria 
🐒Nocturia
🐒Irritation
🐒Infection 
🐒Hematuria 
🐒Fatigue
🐒Anorexia 
🐒Nausea
🐒Vomiting 
🐒Epigastric discomfort.

DIAGNOSTIC EVALUATION:
✔Excretory urography (will reveal urinary tract obstruction,hydronephrosis, calculi,tumours.filling and emptying defect of the bladder).
✔Elevated BUN and serum creatinine levels (suggest impaired renal function ).
✔Cystourethroscopy (will reveal prostate enlargement, bladder wall changes,calculi and raised bladder).
✔Serum analysis(will show elevated DHT) and PSA test.
✔Urinalysis  (will reveal Hematuria ).
✔Cystoscopy (will reveal any deviation from normal in the bladder).

MGT:
(MEDICAL MGT)
Note:✏✏Although the major mgt is surgical(prostatectomy ),there are conservative txts for relieving symptoms of an enlarged prostate gland.
They include:
💊Catheterization  (to empty the bladder in pts who cannot void).
💊Hormonal manipulation with anti-androgen agents (5-A reductase inhibitors ).e.g. Finasteride(roscar),Dutasteride .e.t.c. 
🌟Mode of action:They prevent the conversion of testosterone to DHT. 
💊Antimicrobials(Antibiotics) are used if infection occurs.
 💊Short term fluid restriction (To prevent bladder distention ).
💊Prostate massage and sits bath (To alleviate pain).
Surgical partial prostatectomy (Removal of the enlarged portion of the PG).
There are four (4) forms,which include:
🌟Transurethral resection(TURS):Removal of the enlarged portions of the prostate by inserting the instrument(electrical cutting loop) 2ru the urethra.
🌟Suprapubic (Transversical):This is abdominal or pubopic incision into the bladder to remove the prostate gland.
🌟Perineal prostatectomy:Through the perineum,the gland is removed.
🌟Retropubic prostatectomy:This is incision of the lower abdominal wall to remove the enlarged gland.

NURSING MGT :💉💉
As usual,our care will be categorised into 2.
 ✔ Specific Pre-operative care.
🐵Alley pt's anxiety.
🐵Explain procedure (type of surgery)to the pt.
🐵Observe input and output.
🐵Observe all the general pre-op care.e.g. Vital signs,pre-op medications.e.t.c.
✔Specific post-op care:
🐵Observe vital signs and surgical site for bleeding and manage accordingly. 
Nt:✏Three-way catheter for bladder drainage will help to prevent clot formation.
🐵Care of catheter should be ensured to prevent infection. 
🐵Patient Education.
🌟Teach pt bladder training such as Perineal exercise; which is achieved by tending the buttocks 2geda and gradually relaxing them.
🌟Encourage early ambulation,passive and active exercises to prevent complication.
🌟On discharge, educate pt to urinate immediately the urge comes and encourage copious fluid intake to help in flushing blood clots and also to prevent dehydration. 
🌟Educate pt to report any abnormality to the appropriate health facility.

NURSING DIAGNOSES:
👉Acute pain related to surgical incision eb pt's facial grimacing. 
👉Imbalanced nutrition less than body requirement rt inability to retain ingested food (N/V) or loss of appetite  (Anorexia) eb weight loss.
👉Hyperthermia rt inflammation of the bladder/urinary tract infection eb elevated T reading (specify it pls..).e.g.38.3°C,39.0°C.
👉Situational low self Esteem rt dribbling/Urinary urgency /Frequency eb decreased social interaction/social withdrawal. 
👉Anxiety rt to unknown outcome of surgery eb pt asking to many questions/pt's uncooperative manner or compliance with treatment.

COMPLICATIONS :
⚠Haemorrhage 
⚠Injury(Bladder and kidney damage). 
⚠Infertility 
⚠Incontinence 
⚠Urinary Tract Infection 
⚠Bladder spasm.e.t.c.

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