Based on the description of the patient’s symptoms, a physical exam, and laboratory blood work results, it can be acknowledged that he was suffering from an enlarged prostate. He has been experiencing the need to urinate frequently, especially at night, difficulty in starting this stream of urine, and a feeling that his bladder is never fully empty. He has concerns about cancer, but bloodwork results are all within normal limits which would indicate that cancer is not the cause of his urinating issues. Benign prostatic hyperplasia (BPH) or enlarged prostate, is the most likely diagnosis for his condition but differentials that should be ruled out include bladder cancer, bladder stones, bladder trauma, interstitial cystitis, neurogenic bladder, prostatitis, radiation cystitis, and urethral strictures in males (Dieters, 2015).
BPH is a physiological disease categorized by a proliferation of the cellular portions of the prostate. The accumulation of cells and enlargement of the glandular portion may result from the proliferation of epithelium and stroma, apoptosis, or both. BPH often occurs as a normal part of the aging process in men. The disease is largely based on the production of the hormones testosterone and dihydrotestosterone. It is estimated that 50% of men experience histopathologic BPH by 60 years of age and the incidence increases to 90% by age 85 (Nanda Nursing, 2013). The ICD-10 code for BPH or enlarged prostate without lower urinary tract symptoms N40.0.
Patients with mild, moderate or severe symptoms of BPH who are not disturbed by these symptoms or do not have any complications should be managed with watchful waiting. Medical interventions are not likely to improve either their symptoms or their quality of life. Risks associated with treatment have the potential to outweigh benefits (Dieters, 2015). In this case, the patient sought treatment which is out of the ordinary for him. Therefore, watchful waiting is not appropriate.
Transurethral resection of the prostate (TURP) has been widely accepted as the principle standard for releasing bladder outlet obstruction as a condition of BPH. As a practice, most patients do not require such surgical interventions for their lower urinary tract symptoms and can treat initially with medical therapy (Dieters, 2015). As this patient has been noncompliant with his care of health, starting with surgery may not be the best course of action.
Dieters note “A significant component of lower urinary tract symptoms secondary to BPH is believed to be related to the smooth muscle tension in the prostate stroma, urethra, and bladder neck.” To alleviate this tension alpha-1-adrenergic receptor-blocking agents are used. These medications are used to decrease resistance by relaxing the smooth muscle of the urinary tract and allow passage of urine. About a 5 point improvement is expected on specific BPH sales when patients take alpha blockers but they have not been shown to improve long-term risk for acute urinary retention or BPH-related surgery (Dieters, 2015). Other medications that may be helpful include antispasmodics, rectal suppositories, antibiotics and antibacterials (Vera, 2013),
In addition to medications and surgery, there are many different ways that patient can help himself to improve his health, but he will need guidance and education. He does not take advantage of the healthcare that is available to him and is uneducated about his needs so treatment for his should include training sessions. He should be taught to void his bladder completely not only when he feels the need to do so, but every 2 to 4 hours. This should minimize retention of urine and overdistension of his bladder. When he does so, he should pay attention to the size and force of the urine stream. This will be helpful to determine the degree of prostate obstruction which in turn leads to finding the best intervention. He should document the time and how much urine he was voiding each time and paying close attention to when output has diminished. As urine is retained, it creates the pressure in the ureters and kidney. This can lead to renal insufficiency. A deficiency in the flow of blood to the kidneys harms their ability to filter toxins out of the blood. The patient should also be encouraged to drink up to 3 liters of fluid a day which will help to flush the kidneys, bladder, and ureters. If need be, the patient should be counseled on the use of catheters and meticulous perineal cleansing and care to reduce the possibility of any ascending infection (Vera, 2013).
Upon examination, the suprapubic area should be palpated and percussed, looking for a distended bladder. Vital signs should be closely monitored, focusing on peripheral or dependent edema, changes in mentation, or hypertension. The patient should also be advised to weigh himself every day at home. Changes in these vital signs could indicate loss of renal function resulting in the accumulation of toxic wastes which could lead to complete kidney failure. Evidence of post-obstructive diuresis should also be considered as this could lead to hypovolemic shock, anuria, dehydrations, and loss of electrolytes (Vera, 2013).
With a properly balanced treatment of medications which may or may not lead to TURP and education and training, this patient should be able to regain the ability to urinate normally and live a routine life.
- Dieters, L. (2015, October 12). Benign Prostatic Hypertrophy Differential Diagnoses. Retrieved from MedScape: http://emedicine.medscape.com/article/437359-differential
- Nanda Nursing. (2013, April 14). Nursing Care Plan BPH wiht Diagnosis and Interventions. Retrieved from Nanda Nursing: http://nandanursing.com/nursing-care-plan-bph-with-diagnosis-and-interventions.html
- Vera, M. (2013, July 14). 5 Benign Prostatic Hyperplasia (BPH) Nursing Care Plans. Retrieved from Nursing Labs: http://nurseslabs.com/5-benign-prostatic-hyperplasia-nursing-care-plans/