Prostate Problems Flashcards
what is benign prostatic hyperplasia (BPH)?
Prostate gland increases in size, gland grows inward, causing narrowing of urethra & disruption of urine output.
Due to age + influence of androgens
increased prevalence with increased age
what are the irritative symptoms of the clinical manifestations of BPH?
Irritative symptoms:
Due to inflammation or infection.
Nocturia (often first symptom), frequency, urgency, dysuria, bladder pain & incontinence
what are the obstructive symptoms of the clinical manifestations of BPH?
Obstructive symptoms:
Due to increased effort of the bladder as it tries to empty through the decreased diameter of urethra.
Decrease in caliber & force of urine stream, difficulty initiating a stream, intermittency (stopping & starting stream several times while voiding) & dribbling at the end of urination.
what are the irritative and obstructive symptoms of BPH termed?
LUTS - lower urinary tract symptoms
BPH treatment - not including the drug therapy
Based on symptoms
Mild
“Watchful waiting”
Avoid decongestants (like pseudoephedrine) and certain antihistamines (like diphenhydramine)
Restrict evening fluids
Double void (literally wait a moment and try to go again)
BPH drug and herbal therapy
Drug Therapy:
5-alpha-reductase inhibitors → finasteride (Proscar)
Alpha blockers → tamsulosin (Flomax)
Combination therapy
Herbal Therapy: Saw Palmetto (however, currently no evidence to support)
invasive therapies for BPH
Transurethral Resection of the Prostate (TURP): Gold standard surgical treatment
Removal of prostate tissue
Resectoscope inserted into urethra
what type of anesthesia is involved with TURP?
spinal or general
Describe the post-procedure continuous bladder irrigation(CBI) with TURP?
Large 3-way indwelling catheter w/ 30 mL balloon – w/ continuous bladder irrigation
Purpose:
Prevent obstruction – clots or mucus.
Rate of the infusion is based on the color of the urine:
Blood clots expected first 24-36 hrs.
However, large amounts of bright red blood may indicate hemorrhage.
Urine flow should continuous, be light pink without many clots.
With CBI, what do you do if you see increase of clots?
increase infusion
what will you see when you first ambulate after TURP and what is the best nursing action? what will you do when the color of the bag lightens?
you will see increased blood clots
best RN action - increase infusion
decrease infusion rate
controversy of prostate cancer
Incidence increases rapidly after 50:
> 80% of all cases in men > 65 years old
The controversy with prostate cancer:
Prostate cancer is among the most common cancers in men.
BUT – many cases of prostate cancer never become clinically relevant.
Most prostate cancers grow so slow that men die of other causes.
PSA screening was widely adopted before we had evidence for supporting its use…
what is some related health promotion for prostate cancer?
Men should make an informed decision about whether to have prostate cancer screening.
Start at age 50 years, men should discuss options.
Men at higher risk (first degree relatives with cancer before 65 years old, and African Americans) should have this discussion at 45 years.
Screening typically involves (1) PSA, with or without (2) DRE.
treatment of prostate cancer?
Early-stage cancer
- Conservative approach – “watchful waiting”
- Repeated digital rectal exam and PSA follow up
Surgical Therapy (Radical Prostatectomy):
- Two related adverse outcomes:
- Erectile dysfunction – tends to return gradually over 24 months or so
- Urinary incontinence – tends to return to normal in a few months.
drug and radiation therapy of prostate cancer?
Radiation Therapy:
Used alone or in combination with surgery & with hormone therapy.
External or brachytherapy - implanted seeds in prostate
Drug Therapy:
Androgen deprivation therapy
Chemotherapy for metastasis
