A 73 years old male brought to emergency department withcomplaint of 10 days post void urinary retention, increased frequency,dribbling and nocturia. Lower urinary tract symptoms (LUTS) were since 3 years.Patient also had right inguinal hernia 4 years ago and had a repair. Moreoverhe developed bilateral inguinal hernia 2 years back. Irrigation 1000 ml N/S wasin process and hernia repair was planned. Anatomy andPhysiology: The Prostate, which is part of the male reproductive system,is an exocrine gland that encloses the male urethra and its base is located atthe bladder neck.
A thin layer of connective tissue separates the prostate andseminal vesicles. The primary function of the prostate gland, which isregulated by testosterone, is to secrete a fluid that is added together withthe spermatozoa from the seminal vesicles to constitute majority of semen (Ross& Wilson, 2012). Epidemiology: BPH is a common problem that affects the quality of life inapproximately one third of men older than 50 years. BPH is histologicallyevident in up to 90% of men by age 85 years (Deters, 2015). Pathophysiology:Benign (noncancerous) enlargement of the prostate thatblocks the flow of urine through the urethra.
The prostate cells gradually multiply, creating an enlargement that putspressure on the urethra. As the urethra narrows, the bladder has to contractmore forcefully to push urine through the body. Over time, the bladder muscle may gradually become stronger, thicker,and overly sensitive; it begins to contract even when it contains small amountsof urine, causing a need to urinate frequently.
Eventually, the bladder musclecannot overcome the effect of the narrowed urethra so urine remains in thebladder and it is not completely emptied (Davis, 2014). Etiology and ClinicalManifestations: Causes may include; Age (Above 50s), Reproductive issues(lack of Semen production, decreased libido, erectile dysfunction,irregular/lack of sexual activity), Stress, Infections (frequent UTIs), Alcoholconsumption or Smoking, Hypertrophy may be idiopathic sometimes (Med.Ingenuity, 2008).
Hormonal imbalances and Diabetic or obese male may developBPH too (PC UK, 2013).Symptoms of enlarged prostate are; weak or slow urinarystream, feeling of incomplete bladder emptying, difficulty starting urination,frequent urination, urgency to urinate, getting up frequently at night tourinate, urinary stream that starts and stops, straining to urinate, continueddribbling of urine, returning to urinate again minutes after finishing (Davis, 2014). Diagnostics &Treatment:According to Bruner’s and Suddharth (2014) ultrasound (mayreveal enlargement, size of gland), urinalysis, urine detail report and cultureand sensitivity labs, creatinine (may be performed to determine if there isrenal impairment from prostatic back-pressure) and Complete blood count (HB,Hct for possible hematuria or hemorrhage), are commonly done diagnostics forclients with BPH. In addition, physical examination of male genitalia forprostatic examination may done.
Other systemic generalized examination is toorecommended. The treatment plan depends on the cause, the severity of theobstruction, and the patient’s condition. If the patient is admitted on anemergency basis because he cannot void, he is immediately catheterized.Although, prostatectomy to remove the hyperplastic prostatic tissue isfrequently performed.
Other treatment options are too available. These includetransurethral incision of the prostate (TUIP), balloon dilation, transurethrallaser resection, transurethral needle ablation, and microwave thermotherapy (Brunnerand Suddharth’s, 2014).Alpha-adrenergic receptor blockers relax the smooth muscleof the bladder neck and prostate. These agents help to reduce obstructivesymptoms in many patients.
Because the hormonal component of BPH has beenidentified, one method of treatment involves hormonal manipulation withanti-androgen agents (Brunner and Suddharth’s, 2014).The client of the case study underwent TURP, which anotherintervention. A Transurethral Resection of Prostate (TURP) is done by removingthe inner portion of the prostate that is pressing on the urethra. The surgeonwill insert an instrument up the penis through the urethra and cut away theprostate tissue until the passage is well open. The tissue that is cut awaywill drain out through the catheter.
No incision is made (Quinte Health Care,2009).NursingConsiderations:The major nursing concerns for these kinds of clients arecommonly related to urinary elimination, sexual dysfunction, risk for infectionand possibility of volume deficit. Post-operative pain management is also aconcern for nurses, however involving a multi-disciplinary team of acute painmanagement can be involved. Clients usually have shyness, difficulty in sharingthings related to personal incidents, so an additional moral responsibility tomaintain dignity and confidentiality of clients is necessary.
Familyinvolvement and a multidisciplinary health team can also be involved for abetter health outcome. Providing proper information and health educationteaching is another necessary component. Conclusion: BPH clients require specific care due to sensitivity of thesurgery and diseases. With proper understanding of the scientific informationrelated to the disease health acre team can better help the clients and sharingof this information with client and family is another important task to do inorder to keep them relax and decrease their anxiety related to disease andintervention.