1. BPH The affiliated hospital of TaiShan medical college

2. BPH Etiology/pathophysiology: Etiology/pathophysiology: –Prostate secretes an alkaline substance that neutralizes seminal fluid and enhances sperm motility –Benign prostatic hypertrophy (BPH) enlargement of the prostate occurs more commonly in males >50 –Influenced by hormonal changes

3. BPH Clinical manifestations: Clinical manifestations: –S/s associated with urinary obstruction –UTI –Hematuria –S/s renal insufficiency Assessment: Subjective Assessment: Subjective –Urine stream difficult to start –Slow and painful urination –Urinary frequency and nocturia

4. BPH Assessment: Objective Assessment: Objective –Observe voiding patterns –Determine the severity of the obstruction Diagnostic tests: Diagnostic tests: –Rectal exam: hypertrophied prostate –Symmetrically enlarged –Uniform boggy presentation –Blood chemistry alteration –Cytological evaluation

5. BPH Four prostatectomy techniques: Four prostatectomy techniques: –Transurethral prostatectomy (TURP) –Suprapubic prostatectomy –Radical perineal prostatectomy –Retropubic prostatectomy

6. BPH TURP: TURP: –Have continuous closed bladder irrigation –Function to prevent occlusion of the catheter secondary to blood clot = bladder spasms –V/s and urine color will assessed q 2hours x 24 hours –Continuous irrigation is achieved by using a 3 way catheter One lumen for irrigation fluid, one for urine drainage, and one for balloon retention One lumen for irrigation fluid, one for urine drainage, and one for balloon retention

7. BPH TURP cont: TURP cont: –Irrigant is an isotonic solution –To determine the output, the nurse will subtract the amount of irrigation fluid from the Foley catheter output –Observe for hemorrhage –B&O (Belladona and opium) suppositories help to relieve bladder spasms; contraindicated in retropubic prostatectomy (no rectal stimulation)

8. BPH TURP cont: TURP cont: –Avoid prolonged sitting –Catheter will be removed when the urine becomes clear –Patient needs to be informed of the need for urinary frequency, voiding small amounts with some dribbling

9. See you next time