Benign Prostatic Hyperplasia Flashcards
BPH
Benign Prostate Hyperplasia
Benign enlargement of prostate gland
Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue
DHT
dihydroxytestosterone
principal intraprostatic androgen in the cells of the prostate
Etiology and patho
Thought to result from hormonal changes from aging process
- excessive DHT accumulation in prostate cells that can stimulate overgrowth of prostate tissue
- increased proportion of estrogen over testosterone in blood
Compression of urehtra leads to…
decrease in caliber and force of urinary stream
difficulty in initiating voiding
intermittency of voiding
dribbling
Risk factors for BPH
Aging Obesity (especially increased waist circumference like the apples) Lack of physical activity Alcohol consumption Erectile dysfunction Smoking Diabetes
What is a potential risk factor?
positive family hx of BPH in first-degree relatives
Clinical manifestations
Many men usually have no symptoms Symptoms gradual in onset Nocturia often first symptom noticed Frequency, urgency Difficulty initiating and stopping stream Dribbling at end of urination Intermittency, incontinence Signs of cystitis (dysuria, pyuria, fever)
Complications
R/T urinary obstruction (acute urinary retention)
UTI and sepsis
Calculi (due to alkalinization of residual urine)
Renal failure (caused by hydronephrosis)
Pyelonephritis
Bladder damage
Diagnostic studies
History and PE DRE Urinalysis with culture PSA level TRUS scan Uroflometry Post void residual Cystoscopy
PSA
Prostate-specific antigen
Blood test may be done to rule out prostate cancer
PSA levels may be slightly elevated in patients with BPH
Serum creatinine levels may be ordered to rule out renal insufficiency
Because symptoms of BPH are similar to those of neurogenic bladdeer, a neruological exam may be performed as well
TRUS scan
Transrectal ultrasound
Scan allows for accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer.
Biopsies can be done during procedure
Done in patients with abnormal DRE and elevated PSA
Minimally invasive therapies
Becoming more common
Destroy prostatic tissue
Intraprostatic urethral stents
What minimally invasive therapies destroy prostatic tissue?
Lasers Radiowaves Ultrasound Microwaves Electrical current
Invasive therapy is indicated when…
Decrease in urine flow sufficient to cause discomfort
Persistent residual urine
Acute urinary retention
Hydronephrosis
TURP… what is it?
Transurethral resection
- removal of osbtructing prostate tissue using resectoscope inserted through urethra
- outcome for 80-90% is excellent
- relatively low risk
- performed under spinal or general anesthesia and requires hospital stay
- stop all anticoagulants a week before hand
TURP information
Bladder irrigated for first 24 hours to prevent mucous and blood clots
Complications include bleeding, clot retention, dilutional hyponatremia, retrograde ejaculation
-patients must stop anticoagulants week before surgery
*does not increase hydration
Goals for patient having invasive procedure
Restoration of urinary damage Treatment of UTI Understanding of... -upcoming procedure -implications for sexual functioning -urinary control
Focus: early detection and treatment…
Yearly physical exam and DRE for men over 50
Alcohol, caffeine, and cold and cough meds can increase symptoms
Urinate q 2-3 hours and when first feeling urge
Restricting fluids increases chance of infection
Preoperative care of TURP
Restore urinary drainage
-coude: curved-tip catheter
-filiform - rigid catheter, need doctor’s order
-aseptic technique very important in preventing infection
Administer antibiotics
-treat UTIs
Concerns regarding sexual function
Postoperative care for TURP
Assess for complications -hemorrhage,bladder spasms, urinary incontinence, infection Bladder irrigation to remove blood clots and ensure drainage or urine - CBI Administer antispasmodics Teach Kegel exercises Observe pt for signs of infection Dietary intervention Stool softeners to prevent straining
Instructions after prostate surgery
Care of indwelling catheter Managing incontinence Maintaining adequate fluid intake Observing for signs and symptoms of UTI, wound infection Preventing constipation Avoid heavy lifting -not more than 10 lb Refraining from driving, intercourse after surgery as directed
Bladder rules
may take up to 2 months to return to its normal capacity
instruct patient to drink at least 2 L of fluid per day
urinate q 2-3 hours to flush urinary tract
