Male Reproductive Disorders Flashcards
Benign Prostatic Hyperplasia (BPH)
a common, noncancerous enlargement of the prostate gland
What is the most common diagnosis by a urologist for men ages 45-74?
BPH
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
What is the prostate?
-Donut/walnut shaped gland located b/t the bladder and the penis
What surrounds the urethra for men?
the prostate gland
What does the prostate do?
Assists in controlling the flow of urine
What happens as the prostate enlarges?
As the prostate enlarges it pinches off the urethra and affects the flow of urine
What is the cause of BPH?
- NO known cause
- Theories are: smoking, HTN, Heart disease, Diabetes, or alcohol consumption
How may the increase of estrogen enlarge the prostate?
increased estrogen means there is an increase in cell growth which can lead to enlargement
Minor S/S of BPH
- difficulty beginning urination
- Weak stream
- hesitancy
- Dribbling of urine upon completion
- “Start Stop” stream
Mild S/S of BPH
- Urgency/Frequency
- Incomplete bladder emptying
- Nocturia
- Incontinence
Moderate S/S of BPH
- Bladder Outlet Obstruction
- Bladder Stones
- UTI
- Acute Urinary Retention
Severe S/S BPH
- Increased renal pressure
- Hydronephrosis
- Hydroureters
- Pyelonephritis
- Acute Kidney Injury
How is a diagnosis of BPH made?
- based on symptoms
- Confirmed w/ digital rectal exam
- increase in Prostate Specific Antigen
Treatment options for BPH
- “Watch and Wait”
- Annual physicals
- Medications/Herbal remedies
- Surgery
- Catheterization
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
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
What medications are typically prescribed for BPH?
- Alpha Adrenergic Blockers
- 5 Alpha Reductase Inhibitors
Alpha Adrenergic Blockers
Helps the smooth muscles of the prostate to relax, reducing constriction of the urethra and improving urine
5-Alpha Reductase Inhibitors
prevents the conversion of testosterone into DHT, shrinking enlarged prostate tissue that may be constricting the urethra
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
