Geri-Finals - BPH - Apr 10 Flashcards
BPH - Benign Prostatic Hypertrophy /Hyperplasia
- Nonmalignant adenomatous overgrowth of the periurethral prostate gland.
- Most common problem of male reproductive system
- Occurs in 50% of men over 50 and 80% of men over 80
- Does not predispose to development of prostate cancer
BPH
- Pathophysiology
Not completely understood
Thought to result from endocrine changes from aging process
Possible causes
Excessive accumulation of dihydroxytestosterone
Stimulation by estrogen
Local growth hormone action
Typically develops in inner part of prostate
Enlargement gradually compresses urethra
Leads to clinical symptoms
BPH
– Risk Factors
Age
Family history
Diet
- ↑ intake of fats – butter, margerine
- ↓ zinc
Soy and fruit/vegetable intake reduce risks
BPH
– Clinical Manifestations
Symptoms usually gradual in onset
Early symptoms usually minimal because bladder can compensate
Worsen as obstruction increases
** If BPH interferes with ADL, then need to seek medical help
BPH
– Clinical Manifestations
Voiding symptoms:
- Decrease in caliber of force of urinary stream
- Difficulty in initiating urination
- Intermittency
- Dribbling at end of voiding
- Incomplete bladder emptying
BPH
– Clinical Manifestations
Irritative symptoms:
- Urinary frequency and urgency
- Dysuria
- Bladder pain
- Nocturia
- Incontinence
- With irritative symptoms, there is a possibility of infection
BPH
– Complications
Acute urinary retention is indication for surgical intervention in 25%-30% of patients
UTI and potentially sepsis
Incomplete bladder emptying with residual urine provides medium for bacterial growth
Calculi may develop in bladder because of alkalinization of residual urine
Hydronephrosis can cause renal failure
Pyelonephritis
Bladder damage
BPH
– Diagnostics
- Digital rectal exam (DRE) – the actual inserting of finger to the anus to check if prostate is enlarged
- Urinalysis with culture
- PSA level – not 100% accurate
- Serum creatinine
- Postvoid residual volume (PRV)
- Transrectal US - TRUS scan
- Uroflometry – abnormal voiding patterns
- Cystometry - evaluates bladder pressure and capacity and thus, detrusor muscle
BPH
– Diagnostics
Multichannel, or subtracted, cystometrogram (anything with –gram means procedure that uses a dye) measures intra-abdominal, total bladder, and true detrusor pressures.
Cystoscopy
- direct visualization
- flexible or rigid
BPH
– Collaborative Care
Goals:
- Restore bladder drainage
- Relieve symptoms
- Prevent complications
- Watchful waiting
- Dietary changes (add zinc to diet and reduce fat intake)
- Timed voiding schedule to reduce urinary retention and infection
BPH
- Medications
Alpha adrenergic blockers
relax the muscles of the bladder and prostate, lowers blood pressure by relaxing the blood vessels
- terazosin (Hytrin)
- doxazosin (Cardura)
- tamsulosin (Flomax)
5a-Reductase inhibitors
- Reduce size of prostate gland
- Takes 3-6 months for improvement
- S/E decreased libido, decreased ejaculation, ED
- finasteride (Propecia), (Proscar)
- finasteride (Propecia) – DO NOT TOUCH WITH YOUR BARE HANDS IF YOU ARE PREGNANT – this med is teratogenic !!
BPH
- Medications
Herbal therapy:
* Saw palmetto
- Shown to improve urinary symptoms and flow
Long-term effectiveness and ability to prevent complications unknown
- But this is not approved by FDA so we truly do not know whether or not they are effective
BPH
- Collaborative Care
Invasive therapy indicated for decrease in urine flow sufficient to cause discomfort persistent residual urine acute urinary retention hydronephrosis
BPH
- Invasive Procedures
** Transurethral resection (TURP)
Transurethral resection (TURP)
* Removal of prostate tissue using resectoscope inserted through urethra
* Outcome for majority is excellent, BUT effect can happen such as:
→ The incidence of erectile dysfunction after TURP is between 5% and 35% but tendency is it could resolve;
→ of incontinence, about 1%
→ Sexual potency and continence are usually retained, although about 5 to 10% of patients experience some postsurgical problems, most commonly RETROGRADE EJACULATION → ejaculates backway – goes to the bladder
** So, need to teach the patient that these tendencies of ED, sexual potency, incontinence & retrograde could happen but in most cases, are resolved overtime … in most cases..
BPH
- Less Invasive Procedures
a) Transurethral Microwave Thermotherapy (TUMT)
b) Transurethral Needle Ablation (TUNA)
c) Transurethral Laser Therapy
Transurethral Microwave Thermotherapy (TUMT)
– uses microwaves to destroy excess prostate tissue
Transurethral Needle Ablation (TUNA)
– uses low levels of radio frequency energy to burn away portions of the enlarged prostate
Transurethral Laser Therapy
– uses highly focused laser energy to remove prostate tissue
Post-TURP
Post-op urinary retention is common and patient is sent home with indwelling catheter 2-7 days
- From surgery, patient has CBI (Continuous Bladder Irrigation connected to the indwelling catheter) – DO NOT STOP it! You can reposition it but do not stop bec it can clot more.
- If there is a blockage, then you can stop it. can irrigate it.
POst-TURP
– Nursing Implication
- check patency of irrigation !!
- need to empty the bag often
- pain management related to spasm so give patient antispasmotic meds
- prevent infection
- check VS
- make sure post-op patient is safe
Urinary Assessment
- color, odor, amount, consistency
- dysuria
- abdominal distention
- voiding pattern and voiding history
Post-TURP Interventions
Inform client of possible complications of procedures
Post-op bladder irrigation to remove blood clots and ensure drainage or urine
Administer antispasmotics
Teach Kegel exercises
UTI Rx
Urinate q2-3hr and when first feeling urge
Teach need for adequate fluid intake
Use aseptic technique when using urinary catheter
Administer antibiotics pre-op
Provide patient opportunity to express concerns of alterations in sexual function
Post-TURP Interventions
Observe for signs of infection Dietary intervention Stool softeners to prevent straining Discharge instructions on indwelling catheter Managing incontinence 2-3L fluids daily Signs and symptoms of UTI Preventing constipation Avoid heavy lifting Refraining from driving or intercourse after surgery as directed
Post-TURP Interventions
Sexual counseling if ED becomes chronic or permanent problem
Avoid bladder irritants – coffee, mint, spicy foods, chocolate
Yearly digital rectal exam (DRE)
Post-TURP Evaluation
No complaints of pain
No evidence of UTI or other infection
Decreased fear of effect of surgery on sexuality
No post-op bleeding from performing activities that increase abdominal pressure
Absence of or satisfactory control of dribbling
