BPH (Exam 3) Flashcards
BPH Patho
prostate gland enlarges, extends upward and inward into bladder and causes bladder outlet obstruction, impairing urinary elimination
increased residual urine (stasis) or urinary retention causes overflow urinary incontinence where urine “leaks” around enlarged prostate causing dribbling; can result in UTIs, hydroureter, hydronephrosis, bladder stones, and contribute to CKD
Testosterone/DHT (BPH)
with aging and increased DHT (produced in prostate gland), the glandular units in prostate undergo modular tissue hyperplasia
BPH S/S
difficulty starting and stopping stream
frequency
straining to begin urination
nocturia
hesitancy
force and size of urinary stream
bladder fullness after voiding
post-void dribbling/leaking
bladder distention by palpation or bedside US
international prostate symptom score (I-PSS)
BPH Risk Factors
older age
family history
smoking/alcohol
obesity/decreased physical activity
DM
heart disease
western diet
testosterone/androgen supplements
BPH Diagnostics and Labs
UA/urine culture (increased WBCs and bacteria, possibly RBCs with hematuria/UTI)
serum prostate-specific antigen (PSA) and a serum acid phosphatase lvl to rule out prostate cancer
basic metabolic panel to examine kidney function (BUN and creatinine)
transabdominal ultrasound/transrectal ultrasound (TRUS)
MRI
digital rectal exam*
Digital Rectal Exam
may reveal enlarged, smooth prostate
C&S of prostatic fluid: performed if fluid is expressed during exam
BPH Meds
alpha blocking agents (Tamsulosin)*
5-alpha reductase inhibitor/5-ARI (Finasterine)*
Tamsulosin (BPH)
assess for OH, tachy and syncope, especially after first dose given to older men
teach to be careful with changing position, report weakness, lightheadedness, or dizziness immediately
bedtime dose may decrease risk of problems related to hypotension
Finasterine (BPH)
may need to take it for as long as 6 months before improvement is seen
teach about possible SE (ED, decreased libido, and dizziness due to OH); remind pts to change positions slowly
BPH Treatment
- “watchful waiting”; observation period with yr exam
- prostatic fluid can be released and obstructive symptoms reduced with frequent sex (???)
BPH Procedures
- transurethral needle ablation (TUNA); low radio frequency energy shrinks prostate
- transurethral microwave therapy (TUMT); high temps heat and destroy excess tissue
- interstitial laser coagulation (ILC)/CLP; laser energy coagulates excess tissue
- electrovaporization of prostate; high frequency electrical current cuts and vaporizes excess tissue
- prostatic stents; may be placed into urethra to maintain permanent patency after a procedure for destroying/removing prostatic tissue
- prostate artery embolization; interventional radiologist threads a small vascular catheter into prostates arteries and injects particles blocking some blood flow to shrink prostate gland
- surgical resection
- transurethral resection of the prostate (TURP); enlarged portion of prostate is cut into pieces and removed through urethra by endoscopic instrument
BPH Complications
UTI caused by urinary stasis and persistent urinary retention
kidney damage caused by backflow of urine into ureters
pt with BPH typically has frequent urges to void and may have overflow incontinence at times due to retention
BPH Nursing Care
teach pt about ways to prevent bladder distention, like avoiding drinking large amounts of fluid in short periods (1), avoiding alcohol/diuretics/caffeine (2), voiding as soon as urge is felt (3), and avoiding drugs that can cause retention like anticholinergics, antihistamines and decongestants (4)
teach pt to keep surrounding area clean and dry to prevent skin breakdown
remind him to toilet when he feels urge and wear a small absorbent pad to prevent soiling if needed
involve pts sexual partner in teaching about the cause of incontinence and any prescribed treatment
