- difficulty beginning urination - Weak stream - hesitancy - Dribbling of urine upon completion - "Start Stop" stream

- Urgency/Frequency - Incomplete bladder emptying - Nocturia - Incontinence

- Bladder Outlet Obstruction - Bladder Stones - UTI - Acute Urinary Retention

- Increased renal pressure - Hydronephrosis - Hydroureters - Pyelonephritis - Acute Kidney Injury

Male Reproductive Disorders Flashcards by Savannah Moss

Benign Prostatic Hyperplasia (BPH)

a common, noncancerous enlargement of the prostate gland

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What is the most common diagnosis by a urologist for men ages 45-74?

BPH

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What race is more likely to develop BPH? who is least likely?

Caucasian and African American men are more likely

- Asian men are least likely

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What is the prostate?

-Donut/walnut shaped gland located b/t the bladder and the penis

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What surrounds the urethra for men?

the prostate gland

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What does the prostate do?

Assists in controlling the flow of urine

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What happens as the prostate enlarges?

As the prostate enlarges it pinches off the urethra and affects the flow of urine

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What is the cause of BPH?

NO known cause

- Theories are: smoking, HTN, Heart disease, Diabetes, or alcohol consumption

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How may the increase of estrogen enlarge the prostate?

increased estrogen means there is an increase in cell growth which can lead to enlargement

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Minor S/S of BPH

difficulty beginning urination
Weak stream
hesitancy
Dribbling of urine upon completion
“Start Stop” stream

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Mild S/S of BPH

Urgency/Frequency
Incomplete bladder emptying
Nocturia
Incontinence

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Moderate S/S of BPH

Bladder Outlet Obstruction
Bladder Stones
UTI
Acute Urinary Retention

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Severe S/S BPH

Increased renal pressure
Hydronephrosis
Hydroureters
Pyelonephritis
Acute Kidney Injury

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How is a diagnosis of BPH made?

based on symptoms
Confirmed w/ digital rectal exam
increase in Prostate Specific Antigen

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Treatment options for BPH

“Watch and Wait”
Annual physicals
Medications/Herbal remedies
Surgery
Catheterization

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Watch and Wait Method

used w/ minimal, not bothersome symptoms
annual follow up w/ rectal exam
if symptoms worsen they should go and see the doctor

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What should the nurse educate someone w/ BPH on?

Avoid OTC antihistamines and decongestants
Limit caffeine and alcohol intake
Limit fluid intake, especially 1-2 hours before bed
Empty the bladder when the urge is felt

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What medications are typically prescribed for BPH?

Alpha Adrenergic Blockers

- 5 Alpha Reductase Inhibitors

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Alpha Adrenergic Blockers

Helps the smooth muscles of the prostate to relax, reducing constriction of the urethra and improving urine

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5-Alpha Reductase Inhibitors

prevents the conversion of testosterone into DHT, shrinking enlarged prostate tissue that may be constricting the urethra

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What are some examples of 5-Alpha Reductase Inhibitors?

Proscar and Avodart

What are some Herbal Remedies for BPH?

Saw palmetto
African plum
Cernilton
South African star grass

What type of catheter would be used for a man with BPH?

Coude Catheter

When are you NOT allowed to remove a patient’s catheter?

When it was placed by the urologist

Saw Palmetto

acts as a 5-Alpha Reductase Inhibitor w/o any sexual complications

African Plum

has been found to treat urinary symptoms like frequency and urgency

Cernilton

works as an Alpha-Adrenergic blocker and helps to improve urine flow

South African Star Grass

help to eliminate urinary symptom

If the prostate enlargement is SMALL what is the best surgical option?

Transurethral Resection of the Prostate (TURP)

If the enlargement is SMALL to MODERATE what is the best surgical option?

Transurethral Incision of the Prostate (TUIP)

If the enlargement is LARGE what is the best surgical option?

Prostatectomy

TURP

a scope is passed through the urethra into the prostate and a cutting tool is used to remove the inner portion of the prostate

What might the patient expect after a TURP?

- urinary catheter in place for 3-5 days - Continual bladder irrigation for the 1st 24-36 hours - Blood tinged urine - Urgency, frequency, and/or urinary spasms for the 1st 6-8 weeks

What is some postop teaching for a patient after their TURP?

- increase fluid intake - High fiber diet - Do NOT resume blood thinning meds unless told to by doctor - Avoid strenuous activity - Avoid driving - Notify doc if unable to urinate or blood in urine becomes super thick

What should the nurse do for postop TURP patient?

- Maintain catheter patency - Monitor urine - Monitor for signs of hyponatremia - Avoid Enemas and Rectal tubes - Use urinary analgesics/antispasmodics as prescribed - Monitor for urinary retention after catheter removal

What are some complications that may occur with a TURP?

- Hemorrhage - Urethral Stricture - TUR (TURP) Syndrome

TUR Syndrome

hyponatremia/hypervolemia caused from the absorption of large amounts of fluid that are used to flush the surgical area during the procedure

Urethral Stricture

- Decreased urine stream - Incomplete bladder emptying - Spraying of the urine - difficulty, straining, or pain w/ urinating - increased urge - UTI

TUIP

incisions are made into the prostate and bladder neck to relieve pressure on the urethra

Prostatectomy

robotic, laparoscopic, open - all or parts of the prostate are removed - radical or simple

Radical Prostatectomy

all of the prostate is removed

Simple Prostatectomy

only the obstructing portion is removed

What are some potential complications of a prostatectomy?

- Urethral strictures - Infection - Hemorrhage - Retrograde ejaculation - Erectile disfunction - Incontinence - DVT

Nursing Care for postop prostatectomy

Assessments: - severity of BPH symptoms - safety concerns - vital signs - Distended abdomen - bladder scan - S/S UTI - patient anxiety - Understanding of procedure and potential complications

Nursing Actions postop prostatectomy

- Catheterize/bladder scan - Medicate as ordered - Strict I&O - Bladder spasms

What would the nurse teach a prostatectomy patient?

- Decrease fluid intake 1-2 hours before bedtime - Actions/side effects of medication - When to follow up w/ doc - When to call doc - What to expect

What should the nurse monitor for after a prostatectomy?

- Gross hematuria - tachypnea/tachycardia - Hypotension - Anxiety/restlessness - Pallor - Decreasing hemoglobin/hematocrit

What would the nurse do if clots are blocking the catheter tubing?

- Irrigate w/ 50-60 mL of sterile water/saline | - Make sure you pull out what you put in

Discharge Instructions

- Kegel exercises - Avoid strenuous exercises - Increase fluids and high fiber diet - Avoid long trips

What complications should the patient report to the doctor after discharge?

- Gross hematuria - Blood clots - Difficulty w/ urination - Fever >101 - Uncontrollable pain - Catheter falling out