Mr.Nidhin Jose

SUBMITTED BY:

MR.NIDHIN JOSE,

1st YEAR MSc NURSING,

MEDICAL AND SURGICAL NURSING,

2011-2013 BATCH,

SARVODAYA COLLEGE OF NURSING.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME ON INTENDED WORK

6.0 INTRODUCTION

“Poor health is not caused by something you don't have; it's caused by disturbing something that you already have. Health is not something you need to get, it's something you have already if you don't disturb it.”

~Dean Ornish.

How health is perceived depends on how health is defined. The World Health Organization (WHO), in the preamble to its constitution, defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” (Hood &Leddy, 2003).Although this definition of health does not allow for any variation in degrees or wellness or illness, the concept of health-illness continuum allows for a greater range in describing a person’s health status. By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill.An assessment of the client’s state of health is an important aspect of nursing.1

The structures in the male reproductive system include testes, the vas deferens (ductus deferens) and seminal vesicles, the penis and certain accessory glands, such as the prostate gland and Cowper’s gland (bulbourethral gland).

Benign prostatic hyperplasia (BPH) also known as Benign prostatic hypertrophy (technically a misnomer), Benign enlargement of the prostate (BEP), and Adenofibromyomatous hyperplasia, refers to the increase in size of the prostate. Properly, BPH involves hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists. It involves hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate.

Specifically, about 43% of men in their 40s will have evidence of BPH, as will 50% of men in their 50s, 75% to 88% in their 80s and nearly 100% of men reaching the ninth decade of life. The main causes of BPH are advancing age, smoking, drinking alcohol, imbalance of local growth factors, local inflammation of the prostate, genetic factors etc. The risk persons are diabetes clients, hypertensive patients, liver cirrhosis clients, obese peoples, and low socio economic peoples etc.

When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes with the normal flow of urine. Storage symptoms include urinary frequency, urgency (compelling need to void that cannot be deferred), urgency incontinence, and voiding at night (nocturia).Voiding symptoms include urinary stream, hesitancy (needing to wait for the stream to begin), intermittency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present.Other symptoms include Weak urinary stream, Prolonged emptying of the bladder, Abdominal straining, Irregular need to urinate, Incomplete bladder emptying, Post-urination dribble, Irritation during urination ,Bladder pain, Problems in ejaculationAlthough prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections.2

The majority of complications that develop in BPH are related to urinary Obstruction. Another complication is Urinary Tract Infection (UTI) & potentially sepsis secondary to UTI. Other less common but potential complications include Renal Failure caused by Hydronephrosis, Pyelonephritis, and Bladder damage. Sometimes sexual problems like erectile dysfunctions, painful ejections may occur. BPH is not considered to be a premalignant lesion. But nowadays, studies show that it will lead to prostate cancer as a complication.3

In Denmark, the largest registry study was done among 3 million men regarding the association between benign prostatic hyperplasia (BPH) and prostate cancer. The finding was reported that, the risk of dying from prostate cancer 2-fold among those hospitalized for BPH and up to 8-fold among those who underwent surgery. The possible clinical implication of their study was that men with benign prostatic hyperplasia should follow these men carefully to ensure early diagnosis and treatment of a possible prostate cancer as BPH complication, thereby enhancing the chance of curative treatment.4

6.1 NEED FOR THE STUDY

Benign prostatic hyperplasia (also called BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through). As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. "Benign" means the enlargement isn't caused by cancer or infection. "Hyperplasia" means enlargement. Many research studies are conducted on this BPH because of its high incidence and prevalence.5

BPH is one of the most common diseases of aging men; ranking in the top 10 most commonly diagnosed conditions in men over age 50 years. The prevalence of histopathologic BPH is age-dependent, with initial development usually after 40 years of age. More than half of men in their 60s and up to 90% of men in their 70s and 80s have some symptoms of BPH.6

According to W H O report, the rate of BPH by continents are as follows: Australia (20-28%), Antarctica (20-28%), North America (25-42%), Europe (35-50%), Asia (40-65%), South America (60-75%) & Africa (70-90%). 7

A recent AUA guideline suggests an increase in the incidence of BPH worldwide and predicts by the age of 60 years, more than 50% of men will have microscopic evidence of the disease and by the age of 85 years, as many as 90% of men will be affected.8

The fact sheet done in at USA shows that approximately 8.4 million men over age 50 in the United States are candidates for treatment of BPH: 3.0 million age 50 to 59, 2.6 million age 60 to 69, 2.8 million age 70 to 79. In eight out of 10 cases, symptoms relating to changes or problems with urination – including frequent urination; urgency, leaking or dribbling; and a hesitant, interrupted or weak urine stream – suggest the presence of BPH.9

Datamonitor survey study shows that ,among adults around certain selected countries shows that there were 92.4 million prevalent cases of benign prostatic hyperplasia (BPH) in men over age 50 in the seven major countries (the US, Japan, France, Germany, Italy, Spain, and the UK);approximately 49% of these cases were symptomatic. The largest number of cases (28.4 million) was in the US.10

A survey study was done at Stirling reported that a prevalence of BPH is present in 255 per 1000 in a community of men aged 40-79 years & 89% had not consulted their doctor about urinary symptoms due to BPH in the year prior to the study.11

A Cross- sectional study on prevalence of benign prostatic hyperplasia in a Iranian men 40years old or older done in Iran reported that , through an interview & Questionnaire shows that the prevalence of BPH in Iranian population increased with age, from 1.2% in men 40–49 to 36% in those >70years. A positive association was found between BPH and body mass index (BMI),height, diabetes mellitus, increased total energy intake, age-adjusted levels of total PSA, heart disease, and marital status. The prevalence of BPH is relatively high in Iran. 12

An article in Indian Medical Journal Science cited that,‘BPH became public concern for India’. For preparing this article they went through many research studies on BPH and these studies, which conducted on BPH patients in India, suggest BPH as the most common pathological condition with an incidence of 92.97%.As a result the Indian urologist started to take studies to identify the risk factors of BPH and preventing them.13

An article in Hindu Newspaper from Chennai editions, cited the increasing incidence of BPH cases in south India and its management. It is reported that, BPH is a common condition among older men of South India (especially in Chennai).After the age of 60, the incidence of BPH rises significantly. 14

So the studies show that, Incidence of BPH in worldwide and India is high. In India, the incidence is 92.97%.So immediate action should be done to prevent this disease. Nowadays the BPH is tends to change from benign to malignant. So if the client is having the BPH, he is at high risk for Prostate Cancer. Recently it is evident that BPH is reported first in the person who covers the age of 40 and then its risk and disease progress with advancing age. The more you understand about your disease condition, the better you can take care of yourself. So to prevent the disease, educating the client about BPH is necessary. Because of fear and misconceptions those who have the disease not going for treatment also. An educated client can prevent the disease by modifying the risk factors and his timely health consultation. So the need of this study has an important significance in the day-to-day life. Keeping all this in mind, the researcher felt that there is a need for assessing the knowledge level of patients about BPH and provide a teaching programme for them.

6.2 REVIEW OF LITERATURE

Literature review is a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications. The major goal of the literature review is to develop a strong knowledge base to carry out research. Thus, literature review helps in many ways, starting from selection and formulation of problem, providing conceptual framework for the study, assess feasibility, providing methodology, for comparison and replication, avoiding obstacles, and making generalisation.15

The literature review for the proposed study is categorized as follows:-

LITERATURE RELATED TO:-

1. INCIDENCE & PREVALENCE OF BPH.
2. CAUSES & RISK FACTORS OF BPH DISEASE.
3. PATHOPHYSIOLOGY &TREATMENT OF BPH.
4. KNOWLEDGE OF PUBLIC ABOUT BPH & EFFECTIVENESS OF AWARENESS PROGRAMME.

Literature on incidence & prevalence of BPH:-

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. By age 50 years, up to 50% of men may have histologically distinguished BPH with reported prevalence increasing to 90% by age 90. Histology indicating the presence of BPH includes proliferation of prostatic tissue around the urethra. Despite the high prevalence of histologic diagnosis, symptoms of the disorder do not affect all men presenting with BPH.16

The Baltimore Longitudinal Study of ageing which was done in USA, shows that the prevalence of histologically diagnosed prostatic hyperplasia increases from 8 percent in men aged 31 to 40, to 40 to 50 percent in men aged 51 to 60, to over 80 percent in men older than age 80. 17

A Study regarding the incidence of BPH that was done in Denmark, shows that the rates increase from 30% in man-years at age 45–49 years, to 52% in man-years at age of 65–69 years, to 82% in man-years at age above 85 years .18

A study regarding the prevalence of BPH and their quality of life that was done in Germanyshows that histological evidence of BPH occurs in up to 90% of men by the age of 80. It is unusual before the age of 45.19

A research on BPH from Bangalore published in Nursing Journal Of India.In that study the researcher states that, the incidence of BPH increases with age. The condition occurs in 25 percent of men aged 50 and in over 40 percent of men aged 60. In the age group 90 years and above, the prevalence of BPH is 80 percent.20

An article in The Times of India from Mumbai edition shows that, BPH can be seen in the vast majority of men as they age, particularly over the age of 70 years, around the world and India. Histological evidence of nodular hyperplasia can be seen in approximately 20% of men 40 years of age, a figure that increases to 70% by age 60 and to 90% by age 70. Only 50% of those who have microscopic evidence of nodular hyperplasia have clinically detectable enlargement of prostate, and of these individuals, only 50% develop clinical symptoms.21

Literature on Causes & Risk factors of BPH disease:-

Age is the major risk factor for BPH. Over half of men develop BPH by age 60 and about 85% of men have BPH by age 85. It is uncommon for BPH to cause symptoms before age 40. The risk of BPH increases with age, beginning at about age 40. The incidence increases with age 50% by age 50 and 80% by age 80.A family history of BPH appears to increase a man's chance of developing the condition.

Recent studies have also shown a link between insulin-resistance syndromes including obesity, high blood pressure, low levels of HDL (“good”) cholesterol, diabetes, and peripheral artery disease (PAD). Lifestyle factors that are unhealthy for the heart (lack of physical activity, cigarette smoking, poor diet) may also possibly increase BPH risk or worsen its symptoms.22

Studies have suggested that a higher proportion of estrogen may encourage cell growth within the prostate, which may lead to BPH or enlarged prostate. Another theory regarding the cause of BPH or enlarged prostate suggests that accumulation of dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, may encourage cell growth.Primary risk factors for BPH or enlarged prostate include, (a) Marital status — for reasons that are not known, men who are married are more likely to develop BPH or enlarged prostate than single men.(b) Nationality — BPH or enlarged prostate is more common in Americans and Europeans than in Asian men. The risk of BPH begins to rise in African-American men about five years earlier than it does for white American men. (c) Gender - BPH occurs only in men.23

In California, A study done regarding the relationship between Diabetes & enlarged prostate and it was published in Journal of clinical Endocrinology & Metabolism. It wasreported that, BPH is a common condition in older men, but the risk of developing the condition seems to be increased by high blood sugar levels. It stated that, BPH is a significant public health problem. Their findings suggest that, with the current epidemics of diabetes, BPH will pose an even greater problem in the near future. Blood glucose concentration was also associated with the risk of prostate enlargement, the results indicate. Those with elevated glucose had 3-times the risk of having an enlarged prostate. Diabetics were more than twice as likely to have prostate enlargement compared with men without diabetes.24

In Amsterdam (Netherlands), A study was conducted among BPH patients regarding the association of hypertension with symptoms of benign prostatic hyperplasia, in Amsterdam (Netherlands) among BPH patients. The investigators found that a significant, age dependent association exists between BPH symptoms and hypertension. This finding indicates a common pathophysiological factor for both disease states such as increased sympathetic activity.25

In Switzerland, A study was done on the effects of alcohol and coffee intake among 882people who covered 65 years of age, reported that the prevalence of BPH increased with age from 15% at 65 years to 41% at 80 years. There was a strong association between alcohol intake and has a positive correlation with coffee consumption.26

In USA, A study regarding Cigarette Smoking, and Risk of Benign Prostatic Hyperplasia was conducted among smokers & non smokers men. The study shows that current cigarette smoking was positively related to total BPH only among those who smoked35 or more cigarettes/day compared with never smokers. These findings suggest that avoidance of smoking may benefit BPH.27

In Taiwan, A Nationwide Population-Based study was done regarding the Increased Risk of Benign Prostatic Enlargement among 3305 liver cirrhosis patients. The test indicated that patients with liver cirrhosishad significantly enlargement prostate. They found that the risk for benign prostatic enlargementincreased after a diagnosis of liver cirrhosis.28

In California, A study was conducted on modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms, shows that Obesity, diabetes, physical activity and alcohol intake may substantially influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older men.29

In Sweden, A study was conducted on Obesity and benign prostatic hyperplasiadoneamong 25,892 obese men who are in between the age group 40 -75 years. In this study, the researchers found that abdominal obesity increases the estrogen-to-androgen ratio and may increase sympathetic nervous activity, influence the development of benign prostatic hyperplasia and the severity of urinary obstructive symptoms The results suggest that abdominal obesity in men may increase the frequency and severity of urinary obstructive symptoms and may increase the likelihood that such obese men will have BPH also.30