Disorders of Prostate – Etiology and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management, Surgical and Nursing Management


Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a non-cancerous enlargement of the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen.

The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice. This condition is known as B.P.H., the enlargement of hypertrophy of the prostate gland. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems. BPH generally begins in a man’s 30s, evolves slowly, and mostly commonly only causes symptoms after 50.


Exact cause is unknown
Hormonal alternation – with advancing age, the amount of the male hormone testosterone, decreases relative to the amount of circulating estrogen, the main female reproductive hormone which also circulates in the male.


The main risk factors for prostate gland enlargement include:

Aging: Prostate gland enlargement rarely causes signs and symptoms in men younger than 40, but about half the men in their 60s have some signs and symptoms.
Family History: having a blood relative such as a father or brother with prostate problems means you have more likely to have problems as well
Ethnic Background: Prostate enlargement is more common in white and black men
Effects of chronic inflammation



Due to etiological factors enlargement of prostate gland -

Normally thin and fibrous outer capsule of prostate become spongy and thick as enlargement progress -

Hypertrophied lobes compress bladder neck or prostate urethra, causing incomplete emptying and urinary retention –

Gradual dilation of ureter and kidneys (Hydroureter and Hydronephrosis) –

Prolonged Urinary retention/obstruction cause urinary tract infection –



Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. Prostate gland enlargement varies in severity among men and tends to gradually worsen over time. Prostate gland enlargement symptoms include:



  • Digital Rectal Exam (DRE)
  • Prostate Specific Antigen (PSA) Blood Test
  • Urinary Flow Rate Study
  • Cystoscopy
  • Intravenous Pyelography (IVP)
  • Prostate biopsy
  • Urine test (urinalysis)
  • Transrectal ultrasound



The treatment plan depends on the cause of BPH, severity of the obstruction and the condition of the patient

  1. Watchful waiting: Watchful waiting is often chosen by men who are not bothered by symptoms of BPH. They have no treatment but get regular checkups and wait to see whether or not the condition gets worse
  2. Alpha – Adrenergic Receptor Blockers: These are drugs that can inhibit the contraction of the smooth muscle of prostate gland and bladder neck and, in this way, improve the urinary flow rate. These medications include terazosin (Hytrin), doxazosin (Cardura), tamrsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly.
  3. 5-alpha-Reductase Inhibitors: 5-alpha reductase inhibitors block the conversion of the male hormone testosterone into its active form in the prostate (DHT). The prostate enlargement in BPH is directly dependent on DHT, so these drugs lead to an approximate 25% reduction in prostate size over size to 12 months. Decreased levels of dihydrotestosterone, suppress glandular cell activity and decreases prostate size. Examples of 5-alpha reductase inhibitors include Finasteride (Proscar) and dutasteride (Avodart).



Surgery may also used to treat BPH, most commonly in men who have not responded satisfactorily to medication or those who have more severe problems, such as a complete inability to urinate.

  • Transurethral resection of the prostate (TURP): TURP is the most common procedure can be carried out through endoscopy. Used in 90 percent of all surgeries performed for BPH, TURP involves inserting an instrument called a resectoscope through the urethral opening of the penis and guiding it to the constricted portion of the urethra within the prostate gland. The gland is removed in small pieces with an electrical cutting loop. This procedure requires no incision
  • Suprapubic Prostectomy: It is one method of removing the gland through an abdominal incision. An incision is made into the bladder and the prostate gland is removed from above pubic bone. Such an approach can be used for a gland to any size and few complications occur
  • Retro Pubic Prostectomy: In this method, a lower abdominal incision is used to remove the prostate gland without entering the bladder. This procedure is suitable for large glands located high in the pelvis.
  • Perineal Prostectomy: This method involves removing the gland through an incision in the perineum. This approach is practical when other approaches are not possible and is useful for an open biopsy.
  • Transurethral Incision of Prostate: In this method, an instrument is passed through the urethra. One or two incisions are made in the prostate and prostate capsule to reduce the prostatic pressure on the urethra to reduce urethral construction



Because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery.



Pre-operative Assessment

  1. Obtain history of voiding symptoms, including onset, frequency of day and nighttime urination, presence of urgency, dysuria, and sensation of incomplete bladder emptying and decreased force of stream. Determine impact on quality of life.
  2. Perform rectal (palpate size, shape, and consistency) and abdominal examination to detect distended bladder, degree of prostatic enlargement
  3. Evaluate time intervals between voiding and record the amount voided each time. Keeping an hourly log for 48 hours gives a clear picture of the patient’s voiding pattern and amounts, and can help to establish a toileting schedule
  4. Assess client’s ability to empty his bladder
  5. Assess signs and symptoms of urinary problem
  6. Assess level of pain
  7. Assess vital signs
  8. Assess patency of urinary catheter
  9. Monitor blood urea nitrogen (BUN) and creatinine. This will differentiate between urinary retention and renal failure.
  10. Determine balance between intake and output. Intake greater than output may include retention.
  11. Monitor urinalysis, urine culture, and sensitivity. Urinary tract infection can cause retention but is more likely to cause frequency
  12. Assess the patient for erectile dysfunction or changes in frequency or enjoyment of sexual activity
  13. Assess the patient for potential complications



  1. Assess intensity duration and frequency of pain. A pain scale is more accurate measure of pain
  2. Assess the patient for voiding, urgency, frequency and dysuria
  3. Review medical history for diagnoses such as scarring, recurrent stone formation. It suggest detrusor muscle atrophy and/or chronic over distention because of outlet obstruction
  4. Encourage the patient for bed rest
  5. Introduce an indwelling catheter, if urinary retention is present. Relieve distention of urinary bladder
  6. Monitor intake and output. Intake greater than output may indicate retention
  7. Teach relaxation, deep breathing techniques. Relaxation calms spasms and relives pain
  8. Administer prescribed medication (analgesics, antispasmodics) and monitor response
  9. Provide privacy and time for patient to void. Privacy helps the patient to void
  10. Encourage the patient to assume normal position for voiding. Normal position stimulate bladder contraction
  11. Catheterize patient to determine amount of residual urine
  12. Prepare for and assist with urinary drainage, such as emergency cystostomy
  13. Encourage to avoid alcohol, caffeine, acidic juice and spicy food



Disorders of Prostate – Etiology and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management, Surgical and Nursing Management
Disorders of Prostate – Etiology and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management, Surgical and Nursing Management

Disorders of Prostate – Etiology and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management, Surgical and Nursing Management