bph case study nursing

Benign Prostatic Hyperplasia

Learn about the nursing care management of patients with benign prostatic hyperplasia in this nursing study guide .

Table of Contents

What is benign prostatic hyperplasia , pathophysiology, statistics and epidemiology, clinical manifestations, assessment and diagnostic findings, medical management, surgical management, nursing assessment, nursing diagnosis, nursing care planning & goals, nursing interventions, discharge and home care guidelines, documentation guidelines.

• Practice Quiz: Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common diseases in aging men.

• Benign prostatic hyperplasia (BPH) is the enlargement, or hypertrophy, of the prostate gland.
• The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine . Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs).
• The cause is not well understood, but evidence suggests hormonal involvement.
• BPH is common in men older than 40 years.
• It can cause bothersome lower urinary tract symptoms that affect quality of life by interfering with daily normal activities and sleep pattern.

The pathophysiology of BPH is as follows:

• Resistance. BPH is a result of complex interactions involving resistance in the prostatic urethra to mechanical and spastic effects.
• Obstruction. The hypertrophied lobes of the prostate may obstruct the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention .
• Dilation. Gradual dilation of the ureters and kidneys can occur.
• Schematic Diagram for Benign Prostatic Hyperplasia.

Here are the current statistics for BPH:

• BPH typically occurs in men older than 40 years of age.
• By the time they reach 60 years of age, 50% of men have BPH.
• BPH affects as many as 90% of men by 85 years of age.
• BPH is the second most common cause of surgical intervention in men older than 60 years of age.

The cause of BPH is not well understood, but testicular androgens have been implicated.

• Elevated estrogen levels. BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive.
• Smoking. Smoking increases the risk of acquiring BPH.
• Reduced activity level. A sedentary lifestyle could also lead to the development of BPH.
• Western diet. A diet high in animal fat and protein and refined carbohydrates while low in fiber predisposes a man to BPH.

BPH may or may not lead to lower urinary tract symptoms; if symptoms occur, they may range from mild to severe.

• Urinary frequency. Frequent trips to the bathroom to urinate may be an early sign of a developing BPH.
• Urinary urgency. This is the sudden and immediate urge to urinate.
• Nocturia . Urinating frequently at night is called nocturia.
• Weak urinary stream. Decreased and intermittent force of stream is a sign of BPH.
• Dribbling urine. Urine dribbles out after urination .
• Straining. There is presence of abdominal straining upon urination .

There are several ways to diagnose benign prostatic hypertrophy .

• Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and  nontender  prostate gland.
• Urinalysis. A urinalysis to screen for hematuri a and UTI is recommended.
• Prostate specific antigen levels. A PSA level is obtained if the patient has at least a 10-year life expectancy and for whom knowledge of the presence of prostate cancer would change management.
• Urinalysis:  Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection ); bacteria, WBCs, RBCs may be present microscopically.
• Urine culture:  May reveal  Staphylococcus aureus , Proteus, Klebsiella, Pseudomonas, or Escherichia coli.
• Urine cytology:  To rule out bladder cancer .
• BUN/Cr:  Elevated if renal function is compromised.
• Prostate-specific antigen (PSA):  Glycoprotein contained in the cytoplasm of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition.
• WBC:  May be more than 11,000/mm3, indicating infection if patient is not immunosuppressed.
• Uroflowmetry:  Assesses degree of bladder obstruction.
• IVP with post voiding film:  Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticula, and abnormal thickening of bladder muscle .
• Voiding cystourethrography:  May be used instead of IVP to visualize bladder and urethra because it uses local dyes.
• Cystometrogram:  Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.
• Cystourethroscopy:  To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).
• Cystometry:  Evaluates detrusor muscle function and tone.
• Transrectal prostatic ultrasound:  Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.

The goals of medical management of BPH are to improve the quality of life and treatment depends on the severity of symptoms.

• Catheterization . If a patient is admitted on an emergency basis because he is unable to void, he is immediately catheterized.
• Cystostomy . An incision into the bladder may be needed to provide urinary drainage.

Pharmacologic Management

• Alpha-adrenergic blockers (eg, alfuzosin , terazosin ), which relax the smooth muscle of the bladder neck and prostate, and 5alpha reductase inhibitors.
• Hormonal manipulation with antiandrogen agents (finasteride [Proscar]) decreases the size of the prostate and prevents the conversion of testosterone to dihydrotestosterone (DHT).
• Use of phytotherapeutic agents and other dietary supplements (Serenoa repens [saw palmetto berry] and Pygeum africanum [African plum]) are not recommended, although they are commonly used.
• One herbal medication effective against BPH is Saw Palmetto .

Other treatment options include minimally invasive procedures and resection of the prostate gland.

• Transurethral microwave heat treatment. This therapy involves the application of heat to prostatic tissue.
• Transurethral needle ablation (TUNA). TUNA uses low-level radio frequencies  delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues.
• Transurethral resection of the prostate (TURP). TURP involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra.
• Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostate glands.

Nursing Management

Nursing management of a patient with BPH includes the following:

Nursing assessment focuses on the health history of the patient.

• Health history. The health history focuses on the urinary tract, previous surgical procedures, general health issues, family history of prostate diseases, and fitness for possible surgery .
• Physical assessment . Physical assessment includes digital rectal examination.

Based on the assessment data, the appropriate nursing diagnoses for a patient with BPH are:

• Urinary retention related to obstruction in the bladder neck or urethra.
• Acute pain related to bladder distention.
• Anxiety related to the surgical procedure.

Main Article:   5 Benign Prostatic Hyperplasia (BPH) Nursing Care Plans

The goals for a patient with BPH include:

• Relieve acute urinary retention .
• Promote comfort .
• Prevent complications.
• Help patient deal with psychosocial concerns.
• Provide information about disease process/prognosis and treatment needs.

Preoperative and postoperative nursing interventions for a patient with BPH are as follows:

• Reduce anxiety . The nurse should familiarize the patient with the preoperative and postoperative routines and initiate measures to reduce anxiety.
• Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort.
• Provide instruction. Before the surgery , the nurse reviews with the patient the anatomy of the affected structures and their function in relation to the urinary and reproductive systems.
• Maintain fluid balance . Fluid balance should be restored to normal.
• Reduced anxiety.
• Reduced level of pain .
• Maintained fluid volume balance postoperatively.
• Absence of complications.

The patient and the family require instructions about how to promote recovery.

• Instructions. The nurse provides written and oral instructions about the need to monitor urinary output and strategies to prevent complications.
• Urinary control. The nurse should teach the patient exercises to regain urinary control.
• Avoid Valsalva maneuver. The patient should avoid activities that produce Valsalva maneuver like straining and heavy lifting.
• Avoid bladder discomfort. The patient should be taught to avoid spicy foods, alcohol, and coffee.
• Increase fluids. The nurse should instruct the patient to drink enough fluids.

The focus of the documentation in a patient with BPH includes:

• Degree of impairment.
• Client’s description in response to pain .
• Acceptable level of pain .
• Prior medication use.
• Level of anxiety and precipitating/aggravating factors.
• Description of feelings.
• Awareness and ability to recognize and express feelings.
• Treatment plan.
• Teaching plan.
• Client’s response to interventions, teaching, and actions performed.
• Attainment and progress toward desired outcomes .
• Modifications to plan of care.
• Referrals made.

Practice Quiz: Benign Prostatic Hyperplasia

Here’s a 5-item quiz about the study guide . Please visit our nursing test bank for more NCLEX practice questions .

1. Enlargement of the prostate gland, BPH, is usually associated with:

A. Dysuria . B. Dilation of the ureters. C. Hydronephrosis. D. All of the above.

2. The incidence of BPH among men older than 60 years of age is:

A. 35% B. 50% C. 65% D. 80%

3. The following are surgical procedures used in BPH except:

A. Prostatectomy. B. TURP. C. TUNA. D. Circumcision.

4. A result of the digital rectal examination in a patient with BPH includes what findings?

A. Enlarged, tender prostate. B. Large, rubbery prostate. C. Small, nontender prostate. D. Pus-covered prostate.

5. What is the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra?

A. Open prostatectomy. B. TUNA. C. DRE. D. TURP.

Answers and Rationale

1. Answer: D. All of the above.

• D: All of the symptoms mentioned are associated with BPH.
• A: Dysuria is present in BPH.
• B: Dilation of the ureters is present in BPH.
• C: Hydronephrosis is present in BPH.

2. Answer: B. 50%.

• B: 50% of men who reach 60 years old develop BPH.
• A: The incidence of BPH among men older than 60 years of age is not 35%.
• C: The incidence of BPH among men older than 60 years of age is not 65%.
• D: The incidence of BPH among men older than 60 years of age is not 80%.

3. Answer: D. Circumcision.

• D: Circumcision is not used in BPH.
• A: Prostatectomy can be used in BPH.
• B: TURP. can be used in BPH.
• C: TUNA can be used in BPH.

4. Answer: B. Large, rubbery prostate.

• B: BPH manifests a large, nontender, rubbery prostate when assessed through DRE.
• A: The prostate in BPH is not tender.
• C: The prostate in BPH is not small.
• D: The prostate in BPH is not covered in pus.

5. Answer: D. TURP.

• D: TURP the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra.
• A: Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostate glands.
• B: TUNA uses low-level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues.
• C: DRE is the manual palpation of the prostate via the rectum using the gloved fingers of the examiner.

Posts related to this study guide :

• 5 Benign Prostatic Hyperplasia (BPH) Nursing Care Plans
• 6 Prostatectomy Nursing Care Plans

2 thoughts on “Benign Prostatic Hyperplasia”

Thanks very much. Your teachings actually helps us in diagnosing BHP.

am so happy for you guidance how to work thank lot

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• v.5(Suppl 4); 2003

Benign Prostatic Hyperplasia: Case Scenarios

A 62-year-old man presents with a 4-year progressive history of:

• Increasing lower urinary tract symptoms (LUTS); American Urological Association (AUA) symptom score: 21
• Flow rate: 11 mL/s
• Post-void residual: 60 mL
• Prostate volume (on transrectal ultrasonography [TRUS]): 65 mL
• Prostate-specific antigen (PSA) level: 3.2 ng/mL

The patient states that he is not bothered significantly by his symptoms and does not desire active therapy.

What is his risk of progression?

This patient is at significant risk for benign prostatic hyperplasia (BPH) progression:

• Deterioration of symptoms
• Deterioration of flow rate
• Risk of acute urinary retention (AUR)
• Risk of surgery

What is the most appropriate medical therapy?

5-α-Reductase inhibitor therapy, combination 5-α-reductase inhibitor and α-blocker therapy, or very careful watchful waiting

The patient declines therapy.

Implications for management:

When deciding between watchful waiting and active treatment, this patient should be aware of his increased risk of BPH progression and unfavorable outcomes. Close follow-up is required to detect significant progression.

A 56-year-old man has a 2-year history of increasing voiding symptoms:

• AUA symptom score: 18
• Peak flow rate: 15 mL
• Post-void residual: 10 mL
• Prostate volume (on TRUS): 25 mL
• PSA level: 0.9 ng/mL

This patient has bothersome symptoms and desires treatment.

The risk of BPH progression in this patient with a small prostate and low baseline serum PSA level is low.

α-Blocker therapy

The patient begins α-blocker therapy and, within several weeks, reports significant symptom amelioration.

Implications for therapy:

Although bothered by his symptoms, this patient has a low risk of BPH progression. He is an ideal candidate for long-term α-blocker therapy.

A 68-year-old man with a 5-year history of increasing voiding symptoms:

• AUA symptom score: 22
• Maximum flow rate: 13 mL/s
• Residual urine: 50 mL
• Prostate volume (on TRUS): 55 mL
• PSA level: 3.1 ng/mL

This patient desires therapy because his symptoms are interfering with his daily activities and affecting his quality of life.

This patient is at significant risk for BPH progression:

• Risk of AUR

This patient would experience rapid amelioration of his symptoms with α-blocker therapy, but would experience the most long-term benefits in terms of symptom amelioration and prevention of BPH progression with combination therapy (5-α-reductase inhibitor and α-blocker).

The patient begins α-blocker therapy. Within several weeks he experiences significant symptom amelioration and quality-of-life improvement. He is happy with the clinical results of α-blocker therapy.

This patient has a reasonable chance for long-term symptom amelioration, but would experience greater improvement with combination therapy. He remains at increased risk for long-term progression, in terms of AUR and need for BPH-related surgery.

• Increasing LUTS; AUA symptom score: 21
• Prostate volume (on TRUS): 65 mL
• PSA level: 3.2 ng/mL

Combination therapy will produce the most clinically significant response, in terms of long-term amelioration of symptoms and reduction in risk of BPH progression (ie, symptom deterioration, AUR, and need for surgery).

The patient begins combination α-blocker and 5-α-reductase inhibitor therapy. He reports significant symptom improvement and quality-of-life improvement. The patient is happy with this therapy but questions whether he needs to continue both medications for the rest of his life.

Implications for medical therapy:

Strong evidence exists that the patient will do well on long-term combination therapy. Weak evidence exists that the patient will do well if α-blocker therapy is discontinued at 9 to 12 months and the 5-α-reductase inhibitor is continued indefinitely.

BPH Nursing Diagnosis and Nursing Care Plan

Last updated on January 28th, 2024 at 08:00 am

Benign Prostatic Hyperplasia BPH Nursing Care Plans Diagnosis and Interventions

The prostate is a walnut-shaped organ located between the male penis and bladder.

Because of its anatomical placement, urinary problems arise which in turn significantly affects the patient.

Signs and Symptoms of Benign Prostatic Hyperplasia

Causes and risk factors of benign prostatic hyperplasia.

The prostate is anatomically placed between the bladder and the penis. Inside these organs lies the urethra, a narrow passage starting from the bladder though the prostate and into the penile shaft.

The risk factors of BPH include the following:

Complications of Benign Prostatic Hyperplasia

Diagnosis of benign prostatic hyperplasia.

Laboratory studies involves the following:

Other tests include:

Treatment for Benign Prostatic Hyperplasia

Bph nursing diagnosis, nursing care plan benign prostatic hyperplasia 1.

Nursing Diagnosis: Infection related to urinary retention secondary to BPH as evidenced by presence of leukocytes and nitrates in the urine upon urinalysis, positive bacteria urine culture result, foul-smelling urine, temperature of 38.9 degrees Celsius, and increased frequency of urination

Nursing Care Plan BPH 2

Desired Outcome: The patient will be able to achieve normal pattern of urinary elimination.

Nursing Care Plan BPH 3

More BPH Nursing Diagnosis

Nursing references.

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).  Nursing diagnoses handbook: An evidence-based guide to planning care . St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020).  Saunders comprehensive review for the NCLEX-RN examination . St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Benign Prostatic Hyperplasia (BPH): Nursing Diagnoses, Care Plans, Assessment & Interventions

Benign prostatic hyperplasia or hypertrophy (BPH) is a gradual enlargement of the prostate gland (hyperplasia) due to an increase in the size of the cells (hypertrophy) . The breakdown of the balance between cellular proliferation and cell death results in excess prostate cells, causing BPH.

BPH is very common, affecting half of men by age 60. As men age, the prostate grows. The urethra runs through the prostate gland, so it becomes partially or completely blocked due to enlargement pressure, which results in difficulty urinating. If untreated, it may lead to kidney or bladder complications.

In this article:

• Nursing Process
• Review of Health History
• Physical Assessment
• Diagnostic Procedures
• Nursing Interventions
• Disturbed Sleep Pattern
• Risk for Deficient Fluid Volume
• Risk for Urinary Tract Injury
• Urinary Retention

Medications are typically attempted before surgery is performed. Dietary changes, weight loss, exercise, and pelvic floor training are noninvasive and low-cost methods to reduce BPH symptoms that the nurse can educate the patient about. 

The nurse must understand how to care for the patient hospitalized for surgical procedures for BPH, including monitoring urine output and characteristics, catheter care, and discharge instructions.

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to benign prostatic hyperplasia.

1. Assess the patient’s general symptoms. Prostate gland enlargement causes symptoms that tend to worsen over time, such as:

• Weakened urine stream 
• Increased urgency and frequency of urination
• Increased urination at night (nocturia)
• Inability to start (hesitancy) or continue urination
• An unsatisfied feeling of bladder emptying
• Dribbling towards the end of urination
• Urinary retention 
• Urinary incontinence
• Bladder distention
• Blood in the urine (hematuria)
• Urinary stasis 
• Urinary tract infections
• Painful urination (dysuria) 

2. Determine the patient’s risk factors. Factors that increase the risk of BPH include the following:

• Older age (up to 90% of men over 80 experience BPH symptoms)
• Metabolic syndromes (glucose intolerance, insulin resistance, and dyslipidemia)
• Hypertension
• Genetic factors (first-degree family history)
• Sedentary lifestyle

3. Review the patient’s medical history. While the cause of prostate enlargement is unknown, it is believed that aging, changes in the cells, and lower levels of testosterone play a role. Interestingly, men who had their testicles removed at an early age do not develop BPH.

4. Assess for complications. The following are health complications that can result from an enlarged prostate:

• Bladder or kidney stones
• Conditions affecting the bladder nerves

5. Review the patient’s medications. Certain medications can worsen BPH symptoms, including:

• Decongestants
• Antihistamines 
• Tricyclic antidepressants

6. Note any past surgeries. Investigate if there is scarring in the bladder from past surgery. This scarring may contribute to prostate enlargement. 

7. Interview the patient using a subjective questionnaire. The American Urological Association Symptom Index/International Prostate Symptom Score measures the severity of BPH symptoms. 

8. Review the client’s fluid intake. Alcohol, coffee, and caffeinated soda can increase diuresis and the urge to urinate. 

1. Perform a physical examination. Note for a palpable bladder, enlarged or tender lymph nodes in the groin, or a swollen or tender scrotum. When inspecting the external genitalia examination, assess for the following:

• Discharge from the urethra
• Narrowing of the urethral opening (meatal stenosis) 
• If the foreskin covering the penis can be pulled back (phimosis)

2. Perform a digital rectal examination. The nurse can assess the client’s prostate by performing a digital rectal examination to identify the size, shape, and abnormalities like nodules.

1. Evaluate blood tests. Blood tests include:

• Renal function tests (BUN, creatinine) to monitor for kidney problems
• Prostate-specific antigen (PSA) may be elevated

2. Assess urine characteristics and output. Evaluate the urine for abnormalities through the following tests:

• Urine dipstick: checks for the presence of infection, microscopic hematuria, protein, or glucose 
• Post-void residual volume: determines how much urine remains in the bladder after urinating
• Frequency-volume chart: tallies the fluid intake and urine output 
• Urodynamic studies: measure the urine flow through the bladder, sphincters, and urethra

3. Investigate the genitourinary system.  Prepare the patient for imaging procedures like:

• Transrectal ultrasound: measures and assesses the prostate with an ultrasound probe placed into the rectum
• Cystoscopy: views the bladder and urethra with a flexible scope device through the urethra

4. Anticipate a possible biopsy. Prostate biopsy utilizes transrectal ultrasonography to identify or rule out prostate cancer by examining the sample tissue. Prostate cancer and BPH can have similar symptoms.

Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with benign prostatic hyperplasia.

1. Manage the underlying cause. There are several treatments available for BPH. Patients with mild or no symptoms may only need a “wait and watch” approach with lifestyle modifications like avoiding fluids before bedtime.

2. Administer medications as ordered. The most common medications prescribed for BPH are the following:

• Alpha-blockers (doxazosin, prazosin, terazosin)
• 5-alpha reductase inhibitors (dutasteride, finasteride)
• Combination therapy (alpha-blockers and 5-alpha reductase inhibitors at the same time)
• Phosphodiesterase inhibitors (tadalafil) 

3. Consider the use of alternative medicine as recommended. Several types of herbal formulations and plant-derived chemicals have gained favor for the treatment of BPH, such as the following:

• Saw palmetto 
• African plum tree extract
• Rye grass pollen
• Stinging nettle
• Pumpkin seeds 

4. Prepare the patient for possible surgery. Transurethral Resection of the Prostate (TURP) is the gold standard for treating bladder outlet obstruction (BOO) caused by BPH. The following are some of the reasons to proceed with surgical intervention:

• Retention of urine
• Failed urination trials
• Recurrent hematuria
• Urinary tract infection
• Kidney obstruction
• Failed medical treatment
• Financial constraints related to long-term therapies

5. Anticipate the use of minimally invasive procedures. The majority of minimally invasive procedures use heat to destroy prostatic tissue. Heat is given in a limited and regulated manner to prevent complications associated with TURP. They also permit the administration of milder anesthesia, resulting in less anesthetic risk for the patient. These procedures include the following:

• Transurethral incision of the prostate
• Laser prostatectomy
• Transurethral needle ablation 
• High-intensity ultrasound energy therapy
• Water vapor thermal therapy
• Waterjet ablation therapy
• Prostatic urethral lift 

6. Collaborate with the healthcare provider for prostate removal. Open or robot-assisted prostatectomy (prostate removal) may be necessary for men with very large prostates.

7. Perform catheter care. Catheter care is essential for patients with intermittent bladder or suprapubic catheters to relieve symptoms or monitor urine output.

8. Perform continuous bladder irrigation. Following TURP, CBI is performed to decrease blood clots in the bladder and maintain the flow and patency of urine after surgery. The nurse titrates the flow of saline into the bladder to keep the urine light pink to clear. 

Prevent BPH

1. Promote an active lifestyle. Men with early-stage prostate cancer who exercised vigorously for at least three hours per week activated more repair cells than those who did not exercise. 

2. Exercise the pelvic muscles. Kegel exercises are very beneficial for individuals suffering from BPH symptoms. Teach the patient to clench their pelvic muscles to hold back their urine. Squeeze the muscles for a few seconds and then release. Three sets of ten Kegels per day should help with bladder control.

3. Reduce weight. BPH and prostate cancer risk are increased by belly obesity. Men can lose belly fat by eating a balanced diet and engaging in regular exercise.

4. Encourage vegetables and reduce fat. A diet low in fat and red meat and high in protein and vegetables may reduce the risk of symptoms related to BPH.

5. Refrain from caffeine and excessive alcohol. Caffeine and alcohol can increase urine production, irritate the bladder, and exacerbate urinary symptoms.

6. Encourage regular and scheduled urination. Promote the following bathroom habits:

• When the urge to urinate is felt, advise the patient to urinate immediately.
• Schedule bathroom breaks regularly.
• Teach about double voiding. Without straining, instruct the patient to urinate again to empty the bladder.

7. Find an alternative for medications. If the cause of the narrowing of the urethra is a medication (such as a decongestant or antihistamine), discuss an alternative with the healthcare provider.

Nursing Care Plans

Once the nurse identifies nursing diagnoses for benign prostatic hyperplasia, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for benign prostatic hyperplasia.

A distended bladder, renal colic, urinary tract infection, and procedures can cause acute pain associated with benign prostatic hyperplasia (BPH).

Nursing Diagnosis: Acute Pain

Related to:

• Distended bladder
• Renal colic 
• Catheter insertion
• Surgical procedures

As evidenced by:

• Complaints of bladder or rectal spasm
• Facial grimacing
• Distraction behaviors
• Restlessness
• Altered vital signs
• Diaphoresis

Expected outcomes:

• Patient will verbalize relief from bladder or urinary tract pain.
• Patient will demonstrate interventions to ease discomfort.

Assessment:

1. Perform a pain assessment. Poor pain management can result from inadequate assessment of acute and chronic pain . The key to effective pain management begins with an accurate pain assessment.

2. Identify triggering factors. Assess for factors that trigger or worsen pain, such as movement, urination, or ejaculation.

3. Review urinalysis results. A urinalysis should be performed to assess for an infection contributing to pain, causing burning with urination, flank or bladder pain.

Interventions:

1. Encourage sitz baths and warm soaks. Soothe perineal discomfort with a warm sitz bath for 20 minutes several times per day to relax the prostate and surrounding muscles.

2. Secure the catheter. Securing the urinary catheter correctly to the client’s thigh prevents pain from an injury in the penile-scrotal junction and pulling on the bladder when turning or ambulating.

3. Relieve bladder spasms. Administer antispasmodics as prescribed to minimize bladder spasms brought on by catheter sensitivity.

4. Promote prostate massage. Prostate massage can relieve excess fluids that build up in the prostate and reduce the inflammation and pressure causing the pain. The patient can be instructed on how to do this themselves.

5. Relieve pain with medications. Narcotics may be given following surgical procedures to relieve acute pain.

Disturbed sleep patterns associated with benign prostatic hyperplasia (BPH) can be caused by increased urination at night (nocturia).

Nursing Diagnosis: Disturbed Sleep Pattern

• Pain caused by BPH
• Increased urgency to urinate
• Increased frequency of urination
• Irregular sleeping pattern
• Inadequate sleep quality
• Bladder pain
• Bladder irritability
• Frequent urination
• Patient will be able to verbalize restful sleep.
• Patient will demonstrate a calm and well-rested appearance.
• Patient will receive at least 8 hours of sleep nightly.

1. Ask the patient to document nocturia. Have the patient document how often they awake at night to urinate. Patients can identify sleep disturbances and other elements that may affect the quality of their sleep for the provider to review.

2. Identify sleep habits . Assessing practices/habits that may interfere with sleep can reveal patterns that aid in explaining sleeping issues.

3. Review medications. Diuretics should not be taken close to bedtime if it can be avoided.

1. Encourage limiting fluid intake before bed. Limit fluid intake 2-4 hours before bedtime, as advised. Instruct the patient to drink plenty of fluids during the day (particularly water) to prevent dehydration. Emphasize limiting their intake of alcohol and caffeine (soda, tea, and coffee), which causes diuresis.

2. Administer desmopressin as prescribed. Desmopressin, a synthetic form of vasopressin, is used to replenish decreased levels of the hormone. It manages excessive thirst and prevents dehydration, and urine production, especially at night, limiting nocturia.

3. Shrink the prostate. 5-alpha reductase inhibitors like finasteride shrink the prostate and prevent hormonal changes that cause prostate growth which can reduce symptoms of BPH.

4. Provide compression stockings. During the day, keep the legs elevated or apply a pair of compression stockings to promote fluid circulation to lessen the need to urinate at night.

Patients with benign prostatic hyperplasia have an enlarged prostate, which compresses the urethra and interferes with urinating. However, once the obstruction is removed, patients with BPH are at risk for deficient fluid volume due to post-obstructive diuresis, increasing the urine output and possibly causing dehydration and electrolyte imbalance .

Nursing Diagnosis: Risk for Deficient Fluid Volume

• Disease process
• Postobstructive diuresis
• Insufficient fluid intake
• Problems associated with fluid elimination (CKD, CHF)

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.

• Patient will maintain a urine output of 0.5mL/kg/hr.
• Patient will remain free from any signs of dehydration, such as altered mental status, poor skin turgor, and alterations in vital signs.

1. Assess the patient’s hydration status and urine output. The patient’s intake and output should be assessed and monitored in patients with BPH as it can drastically change due to post-obstructive diuresis, resulting in the depletion of the patient’s total fluid volume.

2. Assess results of diagnostic studies. Uroflowmetry can help determine the severity of urethral blockages as well as the type of treatment needed. A cystoscopy and transurethral ultrasound may also be indicated.

3. Perform post-void residual assessment. A post-void residual > 1500 mL is more likely to result in post-obstructive diuresis.

4. Monitor laboratory studies, including renal function and electrolytes. Patients with BPH are at risk for developing electrolyte imbalances, especially hyponatremia , as fluid and sodium are excreted. While initial eGFR, BUN, creatinine, and electrolyte levels won’t predict the severity of diuresis, they are useful to compare and monitor post-diuresis.

1. Decompress the bladder. Insertion of a urinary catheter allows for complete and immediate drainage of the bladder without increased complications. Post-obstructive diuresis normally resolves within 24 hours, but the nurse must monitor closely for dehydration, electrolyte imbalances, and shock.

2. Closely monitor lab values, urine samples, and vital signs. Patients should have their electrolyte and renal function reassessed at least every 12 hours. A urine sample can assess for urinary sodium, potassium, and osmolality. Monitor vital signs for alterations indicative of hypovolemia.

3. Encourage fluid replacement. Patients who are alert and oriented should be encouraged to replace lost fluids orally. Cognitively-impaired patients may receive IV fluids. Excessive fluid intake should be avoided as this can exacerbate diuresis.

4. Continuously monitor the urine output. Urine output exceeding 200 mL per hour for 2 consecutive hours can help diagnose post-obstructive diuresis and requires close monitoring. When POD has resolved, the patient’s 24-hour urine output will be less than 3L.

Patients with benign prostatic hyperplasia risk developing urinary tract injury from the mechanism of prostate enlargement, compressing the urethra, and blocking urine flow. Complications may arise, such as infections or calculi, increasing the risk of injury. The patient may also require catheterization, which can cause urethral injury.

Nursing Diagnosis: Risk for Urinary Tract Injury

• Urinary tract obstruction
• Enlarged prostate
• Patient will remain free from any signs of urinary tract injury, such as hematuria.
• Patient will experience unobstructed urination with a urine output of 0.5–1.0 mL/kg/hr.

1. Assess and monitor the patient’s urinary elimination patterns. Assessing the patient’s urinary elimination patterns and characteristics like frequency, odor, consistency, volume, and color can help evaluate and confirm urinary tract injury and other problems.

2. Assess laboratory values, including complete blood count, urinalysis, and serum creatinine levels. Blood tests, urinalysis, and serum creatinine levels can help determine bladder infection and renal function.

1. Instruct on bladder training. Patients with BPH may benefit from alternative strategies to manage obstruction and urgency through bladder training like urinating every 2-3 hours to reduce urinary stasis and acute urinary retention.

2. Encourage adequate fluid intake. Restricting fluids should be avoided as this can increase the risk of developing urinary tract infections and renal calculi, resulting in urinary tract injury.

3. Assist in the aseptic insertion of a urinary catheter. If there is a sizable obstruction, a urinary catheter may be inserted to prevent urinary retention in patients with BPH. Select the correct catheter size and type to prevent urinary tract injury. It is often difficult to insert a Foley catheter with an enlarged prostate, and the patient may require a coudė catheter.

4. Encourage the patient to avoid bladder irritants. Bladder irritants like alcohol and caffeine should be avoided as this can increase prostatic voiding symptoms and the risk of developing bladder distention, overactivity, and urinary tract injury.

Urinary retention and associated symptoms are expected findings with benign prostatic hyperplasia (BPH).

Nursing Diagnosis: Urinary Retention

• Enlargement of the prostate
• Blockage of urine flow
• The inability of the bladder muscles to contract adequately
• Urinary frequency
• Urinary hesitancy
• Failure to empty the bladder
• Dribbling urine
• Overflow incontinence
• Sensation of bladder fullness
• Residual urine
• Patient will not experience a post-void residual greater than 50 mL.
• Patient will verbalize a reduction in hesitancy, dribbling, and bladder fullness.

1. Assess urine elimination patterns. Changes in urination in BPH include increased urges and frequency (both during the day and at night), a weak urine stream, and urine leakage or dribbling.

2. Palpate the patient’s bladder. Bladder distention is caused by increased pressure. It can lead to diverticula, trabeculation, and hypertrophy of the bladder detrusor. Urine output is gradually hindered when the prostatic urethra’s lumen extends and constricts.

3. Observe urine characteristics. Due to urinary retention, urine may have a dark color and a foul scent. Patients may also have blood in the urine. These symptoms could signal an underlying infection.

4. Identify additional signs and symptoms. Additional signs and symptoms include hypertension, edema , changes in mentation, bloody urine or semen, painful ejaculation, and frequent lower back, hip, pelvis, or thigh pain.

1. Assess post-void residual (PVR) volume. After the patient has urinated, assess the amount of urine left in the bladder using a bladder scanner. A PVR of less than 50 mL is considered normal, while greater than 200 mL is inadequate emptying.

2. Provide catheterization. Catheterization prevents urinary retention and eliminates the possibility of ureteral stricture in patients with BPH. An enlarged prostate can make inserting a catheter difficult. If the nurse is unable to complete the task, a urologist can be consulted to insert a catheter using a guidewire.

3. Relax the muscles. Provide alpha-adrenergic antagonists as ordered to ease the muscle tissue in the prostate gland and arteries, enhancing blood and urine flow.

4. Administer antibiotics. Administer antibiotics as prescribed if an infection is present due to the growth of bacteria from urinary stasis. 

5. Refer to a urologist. Because urinary retention interferes with the natural flow of urine, urinary retention is regarded as an urgent medical issue. Urologists are specialists who care for patients with urinary retention and BPH.

• Bocco, D. (2022, December 19). 7 foods to prevent an enlarged prostate. Healthline. Retrieved September 2023, from https://www.healthline.com/health/enlarged-prostate-diet
• Busch Center. (2021, May 20). 5 exercise tips for a healthy prostate. Busch Center | Setting the Standard. Retrieved September 2023, from https://buschcenter.com/5-exercise-tips-for-a-healthy-prostate/
• Cleveland Clinic. (2023, August). Benign prostatic hyperplasia (BPH): Symptoms & treatment. Retrieved September 2023, from https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia#symptoms-and-causes
• Deters, L. A. (2023, August 17). Benign prostatic hyperplasia (BPH) treatment & management: Approach considerations, Alpha-blockers, 5-Alpha-Reductase inhibitors. Diseases & Conditions – Medscape Reference. Retrieved September 2023, from https://emedicine.medscape.com/article/437359-treatment#showall
• Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
• Galan, N. (2023, May 15). Enlarged prostate diet: Foods to eat and avoid. Medical and health information. Retrieved September 2023, from https://www.medicalnewstoday.com/articles/321079#foods-to-eat
• Mayo Clinic. (2021, April 13). Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093
• NallN, R. (n.d.). Everything you need to know about nighttime urination. Healthline. Retrieved January 2023, from https://www.healthline.com/health/sleep/excessive-urination-at-night#treatment
• National Center for Biotechnology Information. (2022, May 8). Benign prostatic hyperplasia – StatPearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK558920/
• Ng, M., & Baradhi, K. M. (2022, August 8). Benign prostatic hyperplasia – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved September 2023, from https://www.ncbi.nlm.nih.gov/books/NBK558920/#:~:text=The%20development%20of%20benign%20prostatic,in%20clinical%20manifestations%20of%20lower
• Urology Care Foundation. (n.d.). Benign prostatic hyperplasia (BPH). Retrieved September 2023, from https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)
• Silvestri, L. A., & Silvestri, A. E. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
• WebMD. (2016, November 10). What is BPH? https://www.webmd.com/men/prostate-enlargement-bph/what-is-bph

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Differential Diagnosis

Benign prostatic hyperplasia:.

80% of men over the age of 80 are affected by benign prostatic hyperplasia (BPH). BPH causes an overgrowth in the transitional zone of the prostate. These overgrowths are nodular in nature and typically centered on the proximal prostate (Figure 1.1). This causes an obstruction of the urethra and increased detrusor muscle activity. which leads to lower urinary tract symptoms such as urinary frequency, hesitancy, and weak stream (Figure 1.2) (McCance & Huether, 2019).

The patient’s obesity, hyperlipidemia, and hypertension are all risk factors for BPH, as metabolic syndrome and BMI have a strong correlation with BPE and lower urinary tract symptoms due with BPH (Gacci, 2015). This increases the chance that the patient’s BPH would be symptomatic .  These risk factors also increase the risk of atherosclerosis and may lead to decreased vascular blood flow to the prostate and lower urinary tract. This is believed to be a contributing factor in the pathogenesis of BPH (Shimizu, 2014). Some studies have shown an association between a high consumption of dietary fat and the incidence of BPH.  The presence of an enlarged prostate, the patient’s moderate lower urinary tract symptoms are consistent with the diagnosis of BPH (McCance & Huether, 2019).

It is common for the symptoms of BPH to resolve with watchful waiting. (McCance & Huether, 2019)

Prostate Cancer

Prostate cancer is the most commonly diagnosed non-skin cancer in men, and more than 75% of diagnosis are in men over the age of 65. (McCance & Huether, 2019). Neoplasm develop in the periphery of the prostate and present as a palpable nodule (Figure 2.1). Symptoms are similar to that of BPH, but the symptoms are progressive and do not remit.

The patient has many risk factors for prostate cancer including family history, age, race, heart disease, obesity. Similar to BPH, some studies have shown a relationship between prostate cancer and fat-intake and obesity. High body mass index is associated with more aggressive forms of prostate cancer. Androgens are important in the growth and development of the prostate and may contribute to the development of prostate cancer. African-American men are more likely to develop prostate cancer, which is linked to higher levels of circulating androgens and lower levels of sulfate. The patient has two first-degree relatives that were diagnosed with prostate cancer, the patient has 5x times the risk of developing prostate cancer compared to the general population. (McCance & Huether, 2019)

A prostate-specific antigen test is often used to diagnose prostate cancer, but its use is controversial. Although the patient’s PSA was slightly elevated, biopsy is not recommended in men over 70 y.o. with a PSA of <10. (Carter, et al., 2018)

Urinary Tract Infection

A urinary tract infection is an inflammation of the urethral epithelium due to bacteria. It is most frequently caused by E.coli. After the age of 50, men are more likely to contract a UTI due to urinary retention caused by a growing prostate gland. Therefore, it is possible that our patient could have both BPH and a UTI, so and should be evaluated for both. A UTI can present with a variety of symptoms including frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If left untreated, a UTI can lead to sepsis, pyelonephritis, and renal damage. A UTI is diagnosed by the presence of high counts of specific microorganisms, leukocyte esterase, or nitrate reductase in a the urine (McCance & Huether, 2019)

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Multimodal approach combining thulium laser vaporization, bipolar transurethral resection of the prostate, and bipolar plasma vaporization versus bipolar transurethral resection of the prostate: a matched-pair analysis.

1. Introduction

2. materials and methods, 2.1. surgical indication, 2.2. inclusion criteria, 2.3. exclusion criteria, 2.4. surgical technique, 2.5. immediate and long-term comparison, 2.6. statistical analysis, follow-up data, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Gravas, S.; Gacci, M.; Gratzke, C.; Herrmann, T.R.W.; Karavitakis, M.; Kyriazis, I.; Malde, S.; Mamoulakis, C.; Rieken, M.; Sakalis, V.I.; et al. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur. Urol. 2023 , 84 , 207–222. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sinha, M.M.; Pietropaolo, A.; Hameed, B.M.Z.; Gauhar, V.; Somani, B.K. Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review. Turk. J. Urol. 2022 , 48 , 1–10. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Netsch, C.; Bach, T. Vaporization vs. enucleation techniques for BPO: Do we have a standard? Curr. Opin. Urol. 2015 , 25 , 45–52. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bach, T.; Xia, S.J.; Yang, Y.; Mattioli, S.; Watson, G.M.; Gross, A.J.; Herrmann, T.R. Thulium: YAG 2 mum cw laser prostatectomy: Where do we stand? World J. Urol. 2010 , 28 , 163–168. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Herrmann, T.R.W.; Becker, B.; Netsch, C. Thulium YAG is the Best Laser for the Prostate Because of Versatility. Eur. Urol. Open Sci. 2022 , 48 , 18–21. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhu, Y.; Zhuo, J.; Xu, D.; Xia, S.; Herrmann, T.R. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: A systematic review and meta-analysis. World J. Urol. 2015 , 33 , 509–515. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hou, C.P.; Lin, Y.H.; Juang, H.H.; Chang, P.L.; Chen, C.L.; Yang, P.S.; Tsui, K.H. Clinical outcome of transurethral enucleation of the prostate using the 120-W thulium Laser (Vela™ XL) compared to bipolar transurethral resection of the prostate (TURP) in aging male. Aging 2020 , 12 , 1888–1898. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kim, J.W.; Kim, Y.J.; Lee, Y.H.; Kwon, J.B.; Cho, S.R.; Kim, J.S. An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia. Korean J. Urol. 2014 , 55 , 41–46. [ Google Scholar ] [ CrossRef ]
• Wang, K.; Li, Y.; Teng, J.F.; Zhou, H.Y.; Xu, D.F.; Fan, Y. Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia: A meta-analysis of randomized controlled trials. Asian J. Androl. 2015 , 17 , 135–142. [ Google Scholar ] [ CrossRef ]
• Koca, O.; Keleş, M.O.; Kaya, C.; Güneş, M.; Öztürk, M.; Karaman, M.İ. Plasmakinetic vaporization versus transurethral resection of the prostate: Six-year results. Turk. J. Urol. 2014 , 40 , 134–137. [ Google Scholar ] [ CrossRef ]
• Pandolfo, S.D.; Crauso, F.; Aveta, A.; Cilio, S.; Barone, B.; Napolitano, L.; Scarpato, A.; Mirto, B.F.; Serino, F.; Del Giudice, F.; et al. A Novel Low-Cost Uroflowmetry for Patient Telemonitoring. Int. J. Environ. Res. Public Health 2023 , 20 , 3287. [ Google Scholar ] [ CrossRef ]
• Huang, K.C.; Chow, Y.C.; Chen, M.; Chiu, A.W. Combination of Thulium Laser Incision and Bipolar Resection Offers Higher Resection Velocity than Bipolar Resection Alone in Large Prostates. Urol. J. 2019 , 16 , 397–402. [ Google Scholar ] [ CrossRef ]
• Xie, T.; Lai, P.; Luo, M.; Xu, Y. The Effectiveness and Safety of Transurethral (Bipolar) Plasmakinetic Resection of Prostate Combined with Thulium Laser for Large Benign Prostatic Hyperplasia (>80ml). Urol. J. 2016 , 13 , 2889–2892. [ Google Scholar ]
• Ho, D.; Imai, K.; King, G.; Stuart, E. MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. J. Stat. Softw. 2011 , 42 , 1–28. [ Google Scholar ] [ CrossRef ]
• R Core Team. R: A Language and Environment for Statistical Computing ; R Foundation for Statistical Computing: Vienna, Austria, 2024. [ Google Scholar ]
• 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, L.; et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA guideline Part I-Initial Work-up and Medical Management. J. Urol. 2021 , 206 , 806–817. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Reich, O.; Gratzke, C.; Bachmann, A.; Seitz, M.; Schlenker, B.; Hermanek, P.; Lack, N.; Stief, C.G. Morbidity, mortality and early outcome of transurethral resection of the prostate: A prospective multicenter evaluation of 10,654 patients. J. Urol. 2008 , 180 , 246–249. [ Google Scholar ] [ CrossRef ]
• John, H.; Wagner, C.; Padevit, C.; Witt, J.H. From open simple to robotic-assisted simple prostatectomy (RASP) for large benign prostate hyperplasia: The time has come. World J. Urol. 2021 , 39 , 2329–2336. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fraundorfer, M.R.; Gilling, P.J. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur. Urol. 1998 , 33 , 69–72. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Porto, J.G.; Blachman-Braun, R.; Delgado, C.; Zarli, M.; Chen, R.; Ajami, T.; Marcovich, R.; Shah, H.N. Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum. Urology 2023 , 182 , 204–210. [ Google Scholar ] [ CrossRef ]
• Enikeev, D.; Taratkin, M.S.; Morozov, A.; Singla, N.; Gabdulina, S.; Tarasov, A.; Sukhanov, R.B.; Rivas, J.G.; Laukhtina, E.; Arshiev, M.; et al. Long-Term Outcomes of Holmium Laser Enucleation of the Prostate: A 5-Year Single-Center Experience. J. Endourol. 2020 , 34 , 1055–1063. [ Google Scholar ] [ CrossRef ]
• Xia, S.-J.; Zhang, Y.-N.; Lu, J.; Sun, X.-W.; Zhang, J.; Zhu, Y.-Y.; Li, W.-G. Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia. Zhonghua Yi Xue Za Zhi 2005 , 85 , 3225–3228. [ Google Scholar ]
• Bach, T.; Herrmann, T.R.W.; Ganzer, R.; Burchardt, M.; Gross, A.J. RevoLix vaporesection of the prostate: Initial results of 54 patients with a 1-year follow-up. World J. Urol. 2007 , 25 , 257–262. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mattioli, S.; Rubén Muñoz Recasens, R.; Berbegal, C.; Cortada, J.; Urmeneta, J.M.; Teichmann, H. Treatment of benign prostatic hyperplasia with the Revolix laser. Arch. Esp. Urol. 2008 , 61 , 1037–1043. [ Google Scholar ]
• Bach, T.; Wendt-Nordahl, G.; Michel, M.S.; Herrmann, T.R.; Gross, A.J. Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World J. Urol. 2009 , 27 , 541–545. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Herrmann, T.R.W.; Bach, T.; Imkamp, F.; Georgiou, A.; Burchardt, M.; Oelke, M.; Gross, A.J. Thulium laser enucleation of the prostate (ThuLEP): Transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J. Urol. 2010 , 28 , 45–51. [ Google Scholar ] [ CrossRef ]
• Cui, D.; Sun, F.; Zhuo, J.; Sun, X.; Han, B.; Zhao, F.; Jing, Y.; Lu, J.; Xia, S. A randomized trial comparing thulium laser resection to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: Four-year follow-up results. World J. Urol. 2014 , 32 , 683–689. [ Google Scholar ] [ CrossRef ]
• Deng, Z.; Sun, M.; Zhu, Y.; Zhuo, J.; Zhao, F.; Xia, S.; Han, B.; Herrmann, T.R.W. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: A systematic review and meta-analysis. World J. Urol. 2018 , 36 , 1355–1364. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sun, F.; Han, B.; Cui, D.; Zhao, F.; Sun, X.; Zhuo, J.; Jing, Y.; Liu, H.; Xia, S.; Yang, Y.; et al. Long-term results of thulium laser resection of the prostate: A prospective study at multiple centers. World J. Urol. 2015 , 33 , 503–508. [ Google Scholar ] [ CrossRef ]
• Worthington, J.; Lane, J.A.; Taylor, H.; Young, G.; Noble, S.M.; Abrams, P.; Ahern, A.; Brookes, S.T.; Cotterill, N.; Johnson, L.; et al. Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: The, UNBLOCS RCT. Health Technol. Assess. 2020 , 24 , 1–96. [ Google Scholar ] [ CrossRef ]
• Ditonno, F.; Manfredi, C.; Licari, L.C.; Bologna, E.; Franco, A.; Pandolfo, S.D.; De Sio, M.; De Nunzio, C.; Fiori, C.; Cherullo, E.E.; et al. Benign Prostatic Hyperplasia Surgery: A Snapshot of Trends, Costs, and Surgical Retreatment Rates in the USA. Eur. Urol. Focus 2024 , in press . [ Google Scholar ] [ CrossRef ]
• Cantiello, F.; Crocerossa, F.; Alba, S.; Carbonara, U.; Pandolfo, S.D.; Falagario, U.; Veccia, A.; Ucciero, G.; Ferro, M.; Mondaini, N.; et al. Refining surgical strategies in ThuLEP for BPH: A propensity score matched comparison of En-bloc, three lobes, and two lobes techniques. World J. Urol. 2024 , 42 , 431. [ Google Scholar ] [ CrossRef ] [ PubMed ]

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Coman, R.A.; Coman, R.T.; Popescu, R.-I.; Leucuta, D.C.; Couți, R.; Coman, I.; Al Hajjar, N. Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis. J. Clin. Med. 2024 , 13 , 4863. https://doi.org/10.3390/jcm13164863

Coman RA, Coman RT, Popescu R-I, Leucuta DC, Couți R, Coman I, Al Hajjar N. Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis. Journal of Clinical Medicine . 2024; 13(16):4863. https://doi.org/10.3390/jcm13164863

Coman, Roxana Andra, Radu Tudor Coman, Răzvan-Ionuț Popescu, Daniel Corneliu Leucuta, Răzvan Couți, Ioan Coman, and Nadim Al Hajjar. 2024. "Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis" Journal of Clinical Medicine 13, no. 16: 4863. https://doi.org/10.3390/jcm13164863

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