Sunday, January 15, 2006

prostate hypertrophy, benign

The prostate gland is an accessory organ that produces most of the seminal fluid. The prostate is located just below the outlet of the urinary bladder. The urinary stream travels through the center of the gland in the prostatic urethra. With advancing age and the influence of male sex hormones the periurethral (surrounding urethra) glandular tissues undergoes hyperplasia, with gradual enlargement of the gland. The inward encroachment of this tissue decreases the diameter of the prostate urethra.
Urinary flow is increasingly diminished as the prostate enlarges, thus these symptoms appear gradually. The patient may notice that it takes more effort to void and there is decreasing force and narrowing of the urinary stream. The residual urine remaining in the bladder accumulates, the bladder fills more quickly, and the urge to void occurs more and more frequently. Urgency, to the point of incontinence, may occur. Difficulty in starting the stream and hematuria (blood in urine) may occur. Residual urine is a good culture medium for bacteria, and if infection results, symptoms of cystitis (bladder inflammation) will be present. The combination of symptoms, i.e., hesitancy, narrowed stream, straining to void, frequency, urgency, and nocturia is known as prostatism. Any obstruction in the lower urinary tract can cause these symptoms, but the most common is prostatic enlargement.
Digital examination will reveal that the gland is enlarged. Cystoscopy (examination with a scope) will show the extent of the enlargement on the urethra and the effects on the bladder. Intravenous and retrograde pyelograms (X-rays of renal pelvis and ureter) will reveal possible damage to the upper urinary tract due to the backup of urine. These X-ray dye tests help demonstrate the amount of damage present. Blood chemistry tests such as serum creatinine are ordered to determine kidney function. Prolonged obstruction at the bladder neck can result in renal damage.
Symptomatic benign prostatic hypertrophy is treated surgically by removing part of the prostate gland. A transurethral resection (TUR) is the easiest type of prostate surgery because there is no external incision. Following a prostatectomy, hematuria (blood in urine) is generally present; frank (massive) bleeding is a serious emergency and a potential complication following surgery.
Scherer, J. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.


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