Benign prostate enlargement

Prostate: It is a part of the male reproductive system, the size of a small walnut, located at the beginning of the urethra in the pelvis.

This gland contracts during ejaculation. The milky substance of the vein adds alkalinity to the semen, and the gelatinous state of the semen is due to this. This gland remains relatively small throughout childhood and begins to grow in puberty under the influence of the male hormone (testosterone). This gland reaches a constant size around the age of 20 and remains the same size until the age of 40 and 50. The contraction of the muscles of this gland slows down the flow of urine. In almost half of men over the age of 50, the prostate is enlarged and progresses towards the top and the neck of the bladder, which puts pressure on the neck of the bladder and causes obstruction and prevents the outflow of urine. This condition is called Benign Prostatic Hyperplasic (BPH).
Cause: The cause is not known, but the increase of male hormone is related to the size of this gland.

Recent studies have identified smoking, heavy alcohol consumption, high blood pressure, cardiovascular disease, and diabetes as risk factors. Other studies have considered nutritional factors as another factor. Diagnosis:

1-Physical examination through the anus.

2- Ultrasound

3- Bladderography (synoscopy)

4- PSA test – blood urea

5- Prostate sampling.

Clinical signs:

poor urine flow

Stopping and starting the flow of urine

  • Dripping urine leakage, especially after urination
  • Feeling that the bladder is not empty

Having trouble starting to urinate

  • Frequent urination, especially at night
  • Strong and sudden urge to urinate

Blood in the urine of BPH may cause a urinary tract infection

. Burning or pain during urination may also cause sudden inability to urinate. This condition is called acute urinary retention and is a medical emergency.

Open surgery:

In this surgical method, the pubic area is opened under complete anesthesia and after the complete removal of the prostate, several catheters are inserted, one in the pubic area and one in the urethra. The bladder and urethra are completely flushed with saline (N/S). This operation continues for 24 hours and is stopped after 24 hours, and during this period, the antibiotic is given intravenously (through a vein) and after the patient is discharged, it continues orally. The catheters used are a catheter in the urethra and a device called a mushroom (mushroom-shaped catheter) is placed in the area above the pubis. During this time, the probes are checked for clots and blockages to prevent clots.

Nursing diagnosis: Before surgery:

1- Anxiety caused by inability to urinate

2- Pain caused by bladder expansion

3- The patient’s lack of awareness about the factors related to the existing problem.

After surgery:

1- pain caused by incision (surgical cut)

2- Catheter insertion and spasm (muscle cramps) of the bladder

3- Lack of knowledge about post-surgery measures and recovery treatment

Education at home: Teach the patient how to maintain the drainage system and control urinary output. Inform the patient about the signs and symptoms that should be reported to the doctor, such as the presence of blood in the urine, decreased urinary output, and fever, and encourage the patient to drink plenty of fluids at home. Medicines should be taken as prescribed.

Any fever, chills, purulent secretions should be reported to the doctor. After removing the urinary tube, there is a possibility of urinary incontinence, which is normal.

Closed operation: In this method, you look at the prostate through a narrow and flexible tube through the duct, and if possible, it is shaved and its size is reduced (Turp). Other common methods include balloon dilatation, microwave heat therapy.

Evaluation: reduction of anxiety and pain. Understanding of surgical procedures and post-operative care and discomfort relief

Preoperative planning and goals: increasing awareness of prostate problems and events surrounding surgery.

After surgery: correction of body fluid volume disorders, relief of pain and discomfort, creating ability to perform personal care activities and not causing complications.

Producer: Fariba Mahmoudi (nursing expert)

Source: Bruner Sodarth, 14th edition, 2018, patient education book, Marie M. Kanabio (handbook)

Compilation date: summer 1400

Revision date: 3 years later “Mir Hosseini Hospital Shiraz” website

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