Benign Prostatic Hyperplasia

In approximately one half of men 50 years and older, the prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine by encroaching (侵佔) on the vesical orifice.

The hypertrophied lobes of the prostate may obstruct the vesical neck or prostatic urethra, causing incomplete emptying of the bladder and urinary retention. As a result, a gradual dilation of the ureters and kidneys can occur. Urinary tract infections may result from urinary stasis. Urine remaining in the urinary tract serves as a medium for infective organisms.

The obstructive and irritative symptoms associated with BPH include increased frequency of urination, nocturia, urgency, hesitancy in starting urination, abdominal straining with urination, a decrease in the volume and force of the urinary stream, interruption of the urinary stream, dribbling (urine dribbles out after urination), a sensation that the bladder has not been completely emptied, acute urinary retention (more than 60 mL of urine remaining in the bladder after urination), and recurrent urinary tract infections. Ultimately, azotemia (accumulation of nitrogenous waste products) and renal failure can occur with chronic urinary retention and large residual volumes.

If the patient is admitted on an emergency basis because he cannot void, he is immediately catheterized. The ordinary catheter may be too soft and pliable to advance through the urethra into the bladder.

Pharmacologic treatment for BPH includes use of alpha-adrenergic blockers (e.g. terazosin [Hytrin]). They relax the smooth muscle of the bladder neck and prostate.

Other treatment options for BPH include transurethral incision of the prostate, balloon dilation, transurethral laser resection, transurethral needle ablation, and microwave thermotherapy.

"Watchful waiting" in which patients are monitored periodically for severity of symptoms, physical findings, laboratory tests, and diagnostic urologic tests, is the appropriate treatment for many patients, because the likelihood of progression of the disease or the development of complications is unknown.

Smeltzer, S.C., & Bare, B.G. (2008). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Philadelphia, PA: LWW