Module 1: Vascular and Genitourinary Conditions (BPH & Prostate Cancer)

Question 1

Benign Prostatic Hyperplasia (BPH)

Answer 1

Age-associated prostate gland enlargement that can cause urination difficulty

Epidemiology: Effects individuals equally across race

Diagnosis:

1. Based on symptoms
2. Confirmed with digital rectal examination (DRE) in men >40 yrs. old
3. Prostate specific antigen (PSA) blood test — considered a tumor marker (may also be present with infection/inflammation)

Complications:

1. Acute urinary retention
2. Bladder stones
3. Infection
4. Hydronephrosis
5. Postrenal AKI (obstruction in the urinary tract below the kidneys causing waste to build up in the kidneys)
6. Pyelonephritis

Question 2

BPH: Clinical Manifestations

Answer 2

Lower urinary tract CMs of BPH:

1. Difficulty starting flow of urine, even while straining
2. Weak stream of urine
3. Multiple interruptions during urination
4. Dribbling once urination is complete

Bladder changes (related to fluid retention):

1. Urinary urgency or frequency
2. Feeling of not emptying the bladder
3. Incontinence
4. Nocturia

Question 3

BPH: Management & Treatments

Answer 3

Management of patients with BPH (“Watchful waiting” if symptoms do not interfere ADLs):

1. Yearly DRE
2. Avoid tranquilizers and OTC decongestants (worsen symptoms) — tighten muscles in the prostate and bladder neck
3. Avoid excess fluids in the evening to decrease nocturia

Meds. (Improve symptoms 30-60% of the time):

1. 5-alpha reductase inhibitor admin. (inhibits metabolism of testosterone into DHT; DHT stimulates growth factors and prostatic hyperplasia) — takes 3-6 mos. to see effectiveness; Does not work on circulating testosterone (patients do not need to worry about impotence)
2. Alpha blockers admin. — promote smooth muscle relaxation; takes 2 weeks-4 mos. to see effectiveness

Alternative therapies:

1. Intermittent catheterization
2. Long-term indwelling catheterization (changed monthly)
3. Saw palmetto

Surgical management: Transurethral resection of the (inner) prostate (TURP); most common BPH surgery

Question 4

BPH: Nursing Assessment & Interventions

Answer 4

Nursing assessment of patients with BPH:

1. Urinary symptoms (subjective data)
2. Temp. — possible infection
3. Focused abdominal examination
4. Bladder scan — evaluate for urinary retention
5. Urinalysis — diagnostic signs of stones or infection

Interventions for patients with BPH:

1. Indwelling catheter care
2. Med. admin. as ordered

BPH education:

1. “Watchful waiting”
2. Decrease fluid intake in the evening (prevent nocturia)
3. Drug therapy education
4. Follow-up adherence
5. Surgical options
6. Post-surgical care

Question 5

Postate Cancer

Answer 5

Slow growing cancer, generally in the periphery of the prostate; possible metastasis to lymph nodes, lungs, and bone

Diagnosis:

1. Yearly DRE beginning at age 45-50
2. PSA blood test — false negative or false positive (due to infection/inflammation)
3. Biopsy

Risk factors:

1. FHX
2. Age >55 yrs.
3. Diet low in fruits and vegetables

Epidemiology:

1. Most common CA in males
2. 9% of CA deaths in males
3. Risk/occurrence for transgender women depends on age hormone therapy commenced (hormone therapy after >50 yrs. old is NOT protective)

Question 6

Prostate Cancer: Clinical Manifestations

Answer 6

CMs:
1. Many patients are asymptomatic

2. Symptoms mimic BPH as CA progresses — i.e. Weak urinary stream, hesitancy, frequency, urgency, and incontinence
3. “Hallmark” S/S: Hematuria and hemospermia
4. Pain
5. Rectal symptoms — i.e. Rectal pain/cramping, tenesmus (feeling of incomplete defecation)

Question 7

Prostate Cancer: Management

Answer 7

Medical management of prostate CA:

1. Hormonal ablation therapy (suppresses testosterone) — shrinks prostate prior to radiation
2. Chemotherapy (PO or IV) — refractory to hormone ablation therapy in advanced prostate CA

Non-surgical management of prostate CA:

1. External beam radiation
2. Brachytherapy: radioactive capsule is implanted through the perineum into the prostate and is left permanently — Abstain from sex for 2 weeks and use condoms thereafter to prevent radiation exposure
3. Cryotherapy: freezes prostatic cancerous tissue

Surgical management of prostate CA:
1. Radical prostatectomy: prostate and seminal vesicles are removed (open or laparoscopic); may remove lymph nodes — Almost always results in impotence (“nerve sparing” procedures are emerging)

Question 8

Prostate Cancer: Nursing Assessment & Interventions

Answer 8

Nursing assessment of patients with prostate CA:

1. Risk factors
2. PSA blood test (>4 requires further assessment)
3. DRE results
4. Urinary symptoms — i.e. Weak stream, distended bladder, etc.

Interventions of patients with prostate CA:

1. Med. admin. as ordered
2. Post-surgical wound care
3. Stool softener admin.

Education:

1. Treatment options
2. Signs of infection
3. Prevention/screening