Exam 4: BPH

Question 1

BPH etiology

Answer 1

Prostate gland naturally enlarges over time, once urinary symptoms present it is called BPH

Hormonal changes from aging process

Does not predispose to development of prostate cancer

Question 2

BPH risk factors

Answer 2

Age (older)
Obesity
Reduced physical activity
Alcohol consumption
Smoking
Co-morbid conditions (diabetes, heart disease)
Western diet (high fat, high protein, high carb, low fiber)

Question 3

Symptoms of BPH

Answer 3

Urinary frequency
Hesitancy
Incontinence
Incomplete emptying of bladder
Dribbling post-voiding
Nocturia
Diminished force of urinary stream
Straining with urination
Urge to urinate
Hematuria

Question 4

Complications of BPH

Answer 4

Urinary stasis (Urine staying in bladder, normal PVR = 50-100 mL)
Chronic or acute urinary retention
Frequent UTIs
Backflow of urine causing kidney damage

Question 5

Diagnosis of BPH

Answer 5

Digital rectal exam
Transrectal ultrasound with needle aspiration biopsy
Bladder scan/post-void residual
PSA Prostate cancer screening can be elevated with BPH or UTI
Urinalysis
Urine culture and sensitivity
CBC
BUN, creatinine
Culture and sensitivity of prostate fluid

Question 6

Treatment of BPH

Answer 6

Goal: Re-establish better urine flow

Medications: 5-alpha reductase inhibitors, alpha-blocking agents, natural and complementary medications

Surgical procedures

Question 7

Finasteride

Answer 7

Prevents converstion of testosterone to DTH, reduces size of prostate gland in 6 months-1 year for improvement

Adverse effects: Decreased libido, erectile dysfunction, gynecomastia, teratogenic

Teaching: Avoid touching or crushing tablet and contact with semen if pregnant

Question 8

Doxazosin

Answer 8

Alpha adrenergic receptor antagonists relaxes bladder outlet and prostate gland, less pressure on urethra and better urine flow

Adverse effects: Orthostasis, tachycardia, syncope

Teaching: Slow position changes

Question 9

Surgical management of BPH

Answer 9

Shrink or destroy prostatic tissue

Transurethral resection of prostate (TURP): Scope introduced into urethra that cuts away excess prostate tissue

Pre-op: Assess ABCs, reduce anxiety by providing information and privacy

Post-op: Continuous bladder irrigation, pink or lighter bleeding is expected, dark red is bad, record amount irrigating solution instilled and minus output for I&Os, don’t give NSAIDs or Aspirin (bleeding)

Complications: Hemorrhage, erectile dysfunction, transurethral resection syndrome

Question 10

Immediate action needed post TURP procedure

Answer 10

Low urine output
Large blood clots in foley bag
Abdominal distention
Dark red urine