A 73 years old male brought to emergency department with
complaint 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. Moreover
he developed bilateral inguinal hernia 2 years back. Irrigation 1000 ml N/S was
in process and hernia repair was planned.
The Prostate, which is part of the male reproductive system,
is an exocrine gland that encloses the male urethra and its base is located at
the bladder neck. A thin layer of connective tissue separates the prostate and
seminal vesicles. The primary function of the prostate gland, which is
regulated by testosterone, is to secrete a fluid that is added together with
the spermatozoa from the seminal vesicles to constitute majority of semen (Ross
& Wilson, 2012).
BPH is a common problem that affects the quality of life in
approximately one third of men older than 50 years. BPH is histologically
evident in up to 90% of men by age 85 years (Deters, 2015).
Benign (noncancerous) enlargement of the prostate that
blocks the flow of urine through the urethra.
The prostate cells gradually multiply, creating an enlargement that puts
pressure on the urethra. As the urethra narrows, the bladder has to contract
more 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 amounts
of urine, causing a need to urinate frequently. Eventually, the bladder muscle
cannot overcome the effect of the narrowed urethra so urine remains in the
bladder and it is not completely emptied (Davis, 2014).
Etiology and Clinical
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), Alcohol
consumption or Smoking, Hypertrophy may be idiopathic sometimes (Med.
Ingenuity, 2008). Hormonal imbalances and Diabetic or obese male may develop
BPH too (PC UK, 2013).
Symptoms of enlarged prostate are; weak or slow urinary
stream, feeling of incomplete bladder emptying, difficulty starting urination,
frequent urination, urgency to urinate, getting up frequently at night to
urinate, urinary stream that starts and stops, straining to urinate, continued
dribbling of urine, returning to urinate again minutes after finishing (Davis, 2014).
According to Bruner’s and Suddharth (2014) ultrasound (may
reveal enlargement, size of gland), urinalysis, urine detail report and culture
and sensitivity labs, creatinine (may be performed to determine if there is
renal impairment from prostatic back-pressure) and Complete blood count (HB,
Hct for possible hematuria or hemorrhage), are commonly done diagnostics for
clients with BPH. In addition, physical examination of male genitalia for
prostatic examination may done. Other systemic generalized examination is too
The treatment plan depends on the cause, the severity of the
obstruction, and the patient’s condition. If the patient is admitted on an
emergency basis because he cannot void, he is immediately catheterized.
Although, prostatectomy to remove the hyperplastic prostatic tissue is
frequently performed. Other treatment options are too available. These include
transurethral incision of the prostate (TUIP), balloon dilation, transurethral
laser resection, transurethral needle ablation, and microwave thermotherapy (Brunner
and Suddharth’s, 2014).
Alpha-adrenergic receptor blockers relax the smooth muscle
of the bladder neck and prostate. These agents help to reduce obstructive
symptoms in many patients. Because the hormonal component of BPH has been
identified, one method of treatment involves hormonal manipulation with
anti-androgen agents (Brunner and Suddharth’s, 2014).
The client of the case study underwent TURP, which another
intervention. A Transurethral Resection of Prostate (TURP) is done by removing
the inner portion of the prostate that is pressing on the urethra. The surgeon
will insert an instrument up the penis through the urethra and cut away the
prostate tissue until the passage is well open. The tissue that is cut away
will drain out through the catheter. No incision is made (Quinte Health Care,
The major nursing concerns for these kinds of clients are
commonly related to urinary elimination, sexual dysfunction, risk for infection
and possibility of volume deficit. Post-operative pain management is also a
concern for nurses, however involving a multi-disciplinary team of acute pain
management can be involved. Clients usually have shyness, difficulty in sharing
things related to personal incidents, so an additional moral responsibility to
maintain dignity and confidentiality of clients is necessary. Family
involvement and a multidisciplinary health team can also be involved for a
better health outcome. Providing proper information and health education
teaching is another necessary component.
BPH clients require specific care due to sensitivity of the
surgery and diseases. With proper understanding of the scientific information
related to the disease health acre team can better help the clients and sharing
of this information with client and family is another important task to do in
order to keep them relax and decrease their anxiety related to disease and