BPH and Male Reproductive Disorders Flashcards
Benign Prostatic Hyperplasia/hypertrophy
enlarged prostate gland- prostate gland enlarges and extends inward, causes bladder outlet obstruction
50% if men over 60 are affected
Causes BPH
Unclear
likely result of aging and the influence of androgens (male hormones) that are present in the prostate tissue
Risk factors of BPH
Obesity
DM
Testosterone and androgen supplements
Inactivity
Prevention of BPH
Avoid any drugs that can cause urinary retention
ex: anti-cholinergics, antihistamines, and decongestants.
BPH assessment
history, clinical manifestations and physical assessment by provider
clinical manifestations of BPH
urinary frequency and urgency
nocturia
difficulty in starting (hesitancy) and continuing urination
reduced force and size of the urinary stream (“weak” stream)
sensation of incomplete bladder emptying
straining to begin urination
post-void (after voiding) dribbling or leaking
hematuria
clinical manifestations of BPH
urinary frequency and urgency
nocturia
difficulty in starting (hesitancy) and continuing urination
reduced force and size of the urinary stream (“weak” stream)
sensation of incomplete bladder emptying
straining to begin urination
post-void (after voiding) dribbling or leaking
hematuria
Physical assessment completed by the provider for BPH
inspection, palpation, and percussion of the abdomen
Digital rectal exam (DRE)
Digital Rectal Exam (DRE)
BPHis uniform, elastic non-tender enlargement versus hard nodule with prostate cancer
Lab assessments for BPH
UA and culture
Prostate specific antigen (PSA)
Other Labs to rule out other causes: CBC, BUN, serum Creatinine, culture and sensitivity of prostatic fluid
Prostate specific antigen (PSA)
can be elevated in BPH but also other prostate issues
BPH imaging
transabdominal ultrasound
transrectal ultrasound
tissue biopsy
cystoscopy
bladder ultrasound scan
BPH Interventions- Medications
5 alpha reductase inhibitor
alpha 1 selective blocking agents
5 alpha reductase inhibitor
ex: finasteride and dutasteride
decreases dihydrotestoerone which reduces size of the prostate
may need to take for as long as 6 months before improvement noticed
AE: erectile disfunction, decreased libido, dizziness due to orthostatic hypotension
Alpha 1 selective blocking agens
tamsulosin
relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
also cause vasodilation and reduce peripheral vascular resistance
side effects: assess for orthostatic hypotension, tachycardia, syncope
most effective drug therpay approach is a combination of the two.
BPH Interventions- non pharmaceutical
avoid drinking large volumes of fluid at one time
avoid alcohol, caffeine, and diuretics
void as soon as they feel the urge to
avoid drugs that cause urinary retention (anticholinergics, antihistamines, and decongestants)
noninvasive techniques to destroy excess prostate tissue
Non invasive techniques to destroy excess prostate tissue
prostate artery embolization, transurethral needle ablation, transurethral microwave therapy, interstitial laser coagulation, electrovaoraization of the prostate
surgical interventions for BPH
transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), open prostatectomy
transurethral resection of the prostate (TURP)
gold standard, enlarged portion of the prostate is removed, epidural and spinal anesthesia are typically used.
Holmium laser enucleation of the prostate (HoLEP)
minimally invasive and newer procedure
Open prostatectomy
entire prostate removed
Post TURP care
continuous bladder irrigation in place after surgery, assess color, consistency and amount of urine output, check the drainage tube frequently, after catheter is removed, may experience burning on urination, urinary frequency, dribbling and leakage, increase fluid, monitor for infection, prevent complications of immobility, assess pain and VS q 2-4 hours
prostate cancer
second most common type of cancer in men and if found early, has near 100% cure rate. slow growing
causes of prostate cancer
number of factors