NR 576 Week 7 CPG BPH presentation.pptx

30 June 2024

Clinical Practice Guidelines: Benign Prostatic Hyperplasia

Chamberlain University: Adult Geriatric Primary Care Nurse Practitioner Program

Course: NR 576 Differential Diagnosis in Adult-Gerontology Primary Care Instructor: Dr. Cid Date: June 21, 2023

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Introduction

Benign prostatic hyperplasia (BPH) is a common condition that affects the prostate gland in men. It is a non-cancerous enlargement of the prostate that can lead to lower urinary tract symptoms (LUTS). This condition becomes increasingly prevalent with age and can significantly impact the quality of life due to urinary symptoms and complications.

Disease and Background

Understanding Benign Prostatic Hyperplasia

BPH is characterized by the proliferation of glandular epithelial tissue within the prostatic transition zone. This hyperplasia results in the enlargement of the prostate gland, which can obstruct the flow of urine through the urethra (Lerner et al., 2021).

Pathophysiology

The pathophysiology of BPH involves two main sections of the prostate: the inner (transition) zone and the outer (peripheral) zone. The hyperplasia primarily occurs in the transition zone. A key enzyme in this process is 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT). DHT is a potent androgen that stimulates the growth of prostate cells, leading to hyperplasia (Lerner et al., 2021).

Incidence and Prevalence

BPH is a prevalent condition, especially in older men. The prostate begins to enlarge typically between the ages of 40 and 45. By the age of 60, approximately 60% of men exhibit signs of BPH, and this prevalence increases to about 80% by the age of 80 (Lerner et al., 2021). This high prevalence highlights the importance of recognizing and managing BPH in the aging male population.

Clinical Presentation

Symptoms of BPH

BPH presents with a range of lower urinary tract symptoms (LUTS) that can vary in severity. These symptoms include:

  • Decreased Force of Stream: A noticeable reduction in the strength of the urine stream.
  • Hesitancy: Difficulty in starting urination.
  • Post-Void Dribbling: Dribbling of urine following the completion of urination.
  • Sensation of Incomplete Emptying: A feeling that the bladder is not fully emptied after urination.
  • Overflow or Urge Incontinence: Unintentional loss of urine due to overflow or a sudden, strong urge to urinate.
  • Inability to Voluntarily Stop Stream: Difficulty in stopping the urine stream mid-flow.
  • Urinary Retention: The inability to empty the bladder completely, leading to accumulation of urine.
  • Straining: The need to strain or push to initiate or maintain urination.
  • Nocturia: Frequent urination at night.
  • Frequency: Increased frequency of urination.
  • Urgency: A sudden, compelling urge to urinate.
  • Dysuria: Pain or discomfort during urination (Lerner et al., 2021).

Objective Findings

Physical examination and diagnostic tests are crucial in evaluating BPH. The objective findings may include:

  • Digital Rectal Examination (DRE): This may reveal an enlarged, firm, and smooth prostate.
  • Prostate-Specific Antigen (PSA) Test: Elevated PSA levels may indicate prostate enlargement or inflammation.
  • Urinalysis: To rule out infections or other urinary conditions.
  • Uroflowmetry: To measure the rate of urine flow.
  • Post-Void Residual (PVR) Volume: To assess the amount of urine remaining in the bladder after urination.

Management of Benign Prostatic Hyperplasia

Treatment Approaches

The management of BPH involves a combination of lifestyle modifications, medication, and in some cases, surgical intervention. The treatment approach depends on the severity of symptoms and the impact on the patient’s quality of life.

Lifestyle Modifications

  • Fluid Management: Reducing fluid intake, especially before bedtime, to minimize nocturia.
  • Bladder Training: Techniques to increase the interval between urination.
  • Dietary Changes: Avoiding caffeine and alcohol, which can irritate the bladder.

Medications

Several medications are available to manage BPH, including:

  • Alpha-Blockers: Medications such as tamsulosin and alfuzosin relax the smooth muscles of the bladder neck and prostate, improving urine flow and reducing symptoms.
  • 5-Alpha Reductase Inhibitors: Drugs like finasteride and dutasteride reduce the size of the prostate by inhibiting the conversion of testosterone to DHT.
  • Phosphodiesterase-5 Inhibitors: Medications such as tadalafil, typically used for erectile dysfunction, can also improve urinary symptoms in men with BPH.

Surgical Options

For patients with severe symptoms or complications that do not respond to medical therapy, surgical intervention may be necessary. Options include:

  • Transurethral Resection of the Prostate (TURP): The most common surgical procedure for BPH, involving the removal of prostate tissue through the urethra.
  • Laser Surgery: Procedures such as holmium laser enucleation of the prostate (HoLEP) use laser energy to remove excess prostate tissue.
  • Prostatectomy: Surgical removal of the prostate gland, typically reserved for very large prostates or when other methods have failed.

Emerging Therapies

Research is ongoing to develop new treatments for BPH. Emerging therapies include minimally invasive procedures such as prostatic urethral lift (PUL) and water vapor therapy, which offer effective symptom relief with fewer side effects compared to traditional surgery (McVary et al., 2019).

Conclusion

Benign prostatic hyperplasia is a prevalent condition among older men, leading to significant urinary symptoms and affecting the quality of life. Understanding the pathophysiology, clinical presentation, and management options for BPH is crucial for healthcare providers. Through a combination of lifestyle modifications, medication, and potentially surgical intervention, BPH can be effectively managed, improving patient outcomes.

References

Lerner, L. B., McVary, K. T., Barry, M. J., Bixler, B. R., Dahm, P., Das, A. K., Gandhi, M. C., Kaplan, S. A., Kohler, T. S., Martin, S., Minor, J. J., Moul, J. W., Parsons, J. K., Roehrborn, C. G., Rukstalis, D. B., Shiffman, R. N., Wilt, T. J., & Preminger, G. M. (2021). Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms (2021). American Urological Association.

McVary, K. T., Roehrborn, C. G., & Avins, A. L. (2019). Update on AUA guideline on the management of benign prostatic hyperplasia. The Journal of Urology, 202(3), 592-598.