Care of Patients with Benign Prostatic Hyperplasia (BPH) Flashcards
Means is an Enlarged prostate gland
Cause:
Risk Factors:
Prevention:
Benign prostatic hyperplasia/hypertrophy (BPH)
Prostate gland (surrounds urethra) enlarges and extends inward
Causes bladder outlet obstruction
50% if men over 60 are affected - seen lot in healthcare; consider with urinary retention; consider preop/postop or with urinary catheter issue
Means is an Enlarged prostate gland
Unclear
Likely the result of aging (huge influence) and the influence of androgens (male hormones) that are present in the prostate tissue - lot male hormones in prostate tissue so can affect enlargement of gland
Cause:
Obesity - modifiable
Diabetes Mellitus - modifiable and not; get under control less risk factor
Testosterone and androgen supplements - male hormones; taking them lot higher risk
Inactivity - modifiable
Risk Factors:
Avoid/decrease any drugs that can cause urinary retention - exacerbate it
Ex. anticholinergics, antihistamines, and decongestants
Prevention:
History
Clinical manifestations - big; compression of prostate
Physical assessment by provider
BPH assessment
Urinary frequency and urgency
Nocturia
Difficulty in starting (hesitancy) and continuing urination - cannot start or start a little bit then stop
Reduced force and size of the urinary stream (“weak” stream) - big
Sensation of incomplete bladder emptying - because do have incomplete bladder emptying so big risk of urinary retention
Straining to begin urination
Post-void (after voiding) dribbling or leaking - have urinary retention
Hematuria - bad enough
Clinical manifestations - big; compression of prostate
Inspection, palpation, and percussion of the abdomen
Digital rectal examination (DRE) - primary phys assessment by HCP
Physical assessment by provider
Feel prostate better from rectum
BPH is uniform, elastic non-tender enlargement versus hard nodule with prostate cancer; evaluate with biopsy if concerned about cancer
Digital rectal examination (DRE) - primary phys assessment by HCP
Urinalysis and culture
Prostate-specific antigen (PSA)
Other labs to rule out other causes: - CBC, BUN and serum creatinine, Culture and sensitivity of prostatic fluid
BPH lab assessment
Rule out infection; WBCs - check for infection of UT
Increased WBCs if infection present
Microscopic hematuria - blood in urine
Urinalysis and culture
Can be elevated in BPH but also other prostate issues (cancers)
Age also
Not definitive)
Prostate-specific antigen (PSA)
Systemic infection (elevated WBC’s)
Anemia (decreased RBC’s from hematuria)
Low RBC, Hgb
CBC
Both elevated if leads to kidney disease
For renal issues
Sig urinary retention can lead to issues with kidney
BUN and serum creatinine
Could be expressed/done during the DRE to check for prostatitis - infection/inflammation of prostate
Monitor these
Culture and sensitivity of prostatic fluid
Transabdominal ultrasound - US on abd
Transrectal ultrasound - more common: get better pic of prostate; put in rectum
Tissue biopsy
Cystoscopy
Bladder ultrasound scan - bladder scan
Imaging- BPH diagnostics
Used to rule out prostate cancer or think malignancy
Tissue biopsy
Scope used to evaluate for bladder neck obstruction
Common if not sure what going on and eval UT and checking for obstruction which can happen with prostate cancer
Scope into urethra and check UT
Cystoscopy
Evaluates for post void residual (PVR)
Good to do before go invasive
Scan bladder to see how much left after void
Bladder ultrasound scan - bladder scan
Evaluates for post void residual (PVR)
Good to do before go invasive
Scan bladder to see how much left after void
Bladder ultrasound scan - bladder scan
First treatment is drug therapy
BPH interventions-medications
Decreases Dihydrotestosterone (DHT) which reduces size of the prostate
Relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
Most effective drug therapy approach is a combination of the two - lot times try both
First treatment is drug therapy
Decreases androgen/male hormone decreasing size of prostate
May need to take for as long as 6 months before improvement noticed - care for pat; not notice it suddenly
Side effects: erectile dysfunction, decreased libido, dizziness due to orthostatic hypotension
Decreases Dihydrotestosterone (DHT) which reduces size of the prostate
Not have immediate response
Hopefully helps symp and better flow of urine
Also causes vasodilation and reduced peripheral vascular resistance
Side effects: assess for orthostatic hypotension, tachycardia, syncope and dizziness
Relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
Avoid drinking large volumes of fluid at one time - stress bladder and UT
Avoid alcohol, caffeine and diuretics - going dehydrate them
Void as soon as they feel the urge - not hold it; causes trouble with urinary symp
Avoid drugs that cause urinary retention - exacerbate symp worse; not take those; let provider know that issues with that if prescribed these meds
Lot more Noninvasive techniques to destroy excess prostate tissue than cervical management - destroying prostate tissue so excessive enlargement: heat, laser, radiation to destroy tissue and affect blood supply
Surgical management
Postoperative care for TURP
BPH interventions
Ex. anticholinergics, antihistamines and decongestants
Avoid drugs that cause urinary retention - exacerbate symp worse; not take those; let provider know that issues with that if prescribed these meds
Transurethral resection of the prostate (TURP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy
Surgical management
Gold standard
Enlarged portion of the prostate is removed
Epidural and spinal anesthesia are typically used; sometimes gen anesthesia but need have anesthesia
Most often seen
Go through urethra and resect portion of prostate
Transurethral resection of the prostate (TURP)
Minimally invasive and newer procedure
Less invasive
Holmium laser enucleation of the prostate (HoLEP)
Entire prostate removed; more invasive
Entire prostate removed; more invasive
Possible trauma to UT, urethra, bladder, etc; going into urethra
Continuous Bladder Irrigation (CBI) in place after surgery
Constantly 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, leakage - catheter larger and doing lot irrigant to UT - make aware of that
Increase fluid intake
Monitor for infection - some funny feelings with urine because irrigation and trauma of surgery; increased WBC, drainage, redness, swelling
Prevent complications of immobility - monitor for clots, pneumonia
Assess pain and VS q 2-4 hours - frequently assess pain
Postoperative care for TURP
3 way urinary catheter in place with continuous irrigation - continually irrigate UT
One port where urine drains out; another where instilling NS; one where balloon for indwelling cathether
Normal saline used to irrigate - hand up high and continually infuses into bladder through urethra and out; prevents clots from forming so not cause as much damage and keeps it clear
Typ good for 24 hr but sometimes need longer
Feel continuous urge to void because continually filling bladder and emptying it - aware of that and not force void around it and irritate it
Adjust bladder irrigation as much as want but goal is clear urine without clots and bleeding - sometimes pink; not want red blood; if clots: clot off urethra and have severe retention: very uncomfy and has damage to kidneys so keep really well
Will feel the urge to void continuously
Maintain the rate of the continuous bladder irrigation (CBI) to ensure clear urine without clots and bleeding
Continuous Bladder Irrigation (CBI) in place after surgery
Constantly irrigating and output because not include irrigation into I&O because not urine produced; emptying catheters often and looking at it so can adjust it so irrigate as min as necessary to keep urine clear without clots/bleeding
Normal for the urine to be blood-tinged after surgery
Constantly Assess color, consistency, and amount of urine output
Monitor for external obstructions (kinks) - retention; often have bladder spasms - monitoring for that
Monitor internal obstructions (blood clots, decreased output, bladder spasms) - do become obstructed: go in and manually irrigate to dislodge clot - very uncomfy for pat so want avoid - messy so want stay on stop
If becomes obstructed will have to manually irrigate with normal saline
Check the drainage tube frequently
Symptoms are normal and will decrease
May also pass small clots and tissue debris for several days
After catheter is removed, may experience burning on urination, urinary frequency, dribbling, leakage - catheter larger and doing lot irrigant to UT - make aware of that
At least 2000 to 2500 mL daily - couple L fluids a day - keeps urine clear and decreases risk of UT
Will decrease dysuria and keeps the urine clear
Adequate fluid intake
I&O very imp - keeping well hydrated
Increase fluid intake
