03.01 Nursing Care and Pathophysiology of BPH (Benign prostatic hyperplasia)

This lesson is going to cover benign prostatic hyperplasia or BPH. Let’s just break down this word. Benign means that it is non-cancerous. Prostatic refers to the prostate. Plasia usually refers to growth, so anytime you see hyperplasia, it’s referring to excessive growth or overgrowth.

So, BPH is an enlarged prostate gland that is non cancerous. This only occurs in males because females do not have a prostate gland. That might seem obvious, but hey, some people don’t know that. No one’s really sure what causes it, except that it’s more common in older men with low testosterone levels. As you can see, the prostate sits here just below the bladder and it surrounds the urethra. So as it grows and enlarges, it can restrict the outflow of urine and obstruct the urethra. It is important that we rule out other possible causes like prostate cancer or a UTI or even kidney stones. BPH is diagnosed initially by a digital rectal exam. The provider will insert a finger in the rectum to feel the prostate and will be able to tell if it’s enlarged. We also use a blood test called the PSA or the prostate specific antigen that will indicate any prostate issues, as well as an ultrasound of the area.

Patients will complain of feeling like they never quite get their bladder completely emptied. They may also say they don’t seem to have as much force behind their stream or that they notice some dribbling after they void. Patients may also experience nocturia, which is when you have to wake up in the middle of the night to pee, even if you peed right before bed. Now, because of this obstruction, we may also see urinary stasis which can lead to UTI’s or kidney stones, and we may see some hematuria, which is blood in the urine, if there’s any damage to the bladder, urethra, or to the prostate itself.

In terms of therapeutic management, there are two main classes of drugs we can give for BPH. One is alpha blockers like Tamsulosin - these will help to relax the smooth muscle in the neck of the bladder and the prostate so that it allows this opening to be a little wider. The other is 5-alpha reductase inhibitors like Finasteride that will help to shrink the overall size of the prostate. Ultimately, if we can’t shrink it and the meds aren’t working, the patient can have what’s called a TransUrethral Resection of the Prostate, or a TURP. They literally go in through the urethra and pull out the prostate through the urethra. So, we either try to widen the opening, shrink the prostate, or just remove it altogether.

Our priority concepts for a patient with BPH will be elimination and cellular regulation. With cellular regulation we want to make sure we’re giving those meds on time and supporting the patient post-biopsy so that we can rule out any malignancy. As far as elimination, we want to encourage increased fluid intake and avoid things like caffeine to prevent urinary stasis, and encourage them to get on a voiding schedule which will help them make sure they’re getting their bladder empty whenever possible. Check out the care plan attached to this lesson for more detailed nursing interventions and rationales.

So let’s do a quick recap. Benign Prostatic Hyperplasia or BPH is enlargement of the prostate in males due to advancing age or a change in testosterone levels. It can obstruct the urethra causing urinary retention and discomfort and incomplete bladder emptying. This can lead to urinary stasis, putting them at risk for a UTI or kidney stones. We want to give meds to relax the neck of the bladder or to shrink the prostate, or we may see the patient having their prostate removed in a TURP procedure. The goal is to avoid urinary retention, so we get them on a voiding schedule, avoid caffeine and increase their fluid intake.

So that’s it for BPH, be sure to check out all the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!