Topic 9: BPH & TURP Flashcards
benign prostatic hypertrophy (BPH)
condition in which the prostate gland increases in size, disrupting the outflow of urine from the bladder through the urethra.
High levels of what result in prostate enlargement
DHT
risk factors for BPH
aging >50, obesity, lack of physical activity, high amount of dietary animal protein, alcohol use, ED, smoking, diabetes
irritative symptoms of BPH
o Nocturia
o Urinary frequency
o Urgency
o Dysuria
o Bladder pain
o Incontinence
obstructive symptoms of BPH
o Decrease force in urinary stream,
o Difficulty starting stream,
o Intermittency (starting and stopping several times while voiding)
o Dribbling at the end of urination
complications with BPH
· Acute urinary retention
· UTI
diagnostic assessment of BPH
· Digital rectal exam (DRE)
· Prostate specific antigen (PSA)
· Urinalysis and urine culture sensitivities
· Serum creatinine
· Post void residual (by ultrasound)
· Transrectal ultrasound (TRUS)
· Uroflowmetry
Cystoscopy
active surveillance of BPH
· Annual PSA and DRE
· Repeat IPPS. Score and post void residual if any symptoms change
health promotion for BPH
· TEACH patient to urinate every 2-3 hours and when they first feel he urge
· Intake normal fluid level
· PSA screening
what beverages are irritants and tend to increase prostatic voiding symptoms
Alcohol, caffeine
what medications cause smooth muscle contraction, so they often worsen symptoms of BPH
Common cough and cold remedies (adrenergic agonists)
Transurethral resection of the prostate (TURP)
· Removal of prostate tissue using a resectoscope inserted through the urethra
pre op care for TURP
o Antibiotics are usually given before
o Encourage high fluid intake
sexual function and TURP
o tell patient his ejaculate volume may be decreased or absent (retrograde ejaculation)- semen travels back into bladder during orgasm, will be voided during next urination
o May decrease orgasmic sensations felt during ejaculation
complications with TURP
hemorrhage, bladder spasms, urinary incontinence and infection
what is placed after TURP procedure
o : 3 way indwelling urinary catheter is inserted to provide hemostasis and urinary drainage
Bladder can be irrigated for
the first 24 hour period to prevent obstruction from blood clots and ensure drainage
what is the bladder irrigated with after TURP
sterile normal saline
urine appearance after TURP
light pink urine without clots is normal, but bright red urine is bad and may indicate a hemorrhage
blood clots are expected after prostate surgery for the first
24-36 hours after
Transurethral resection syndrome manifestations
N/V, confusion bradycardia, HTN
post op instruction for TURP
· Increase in abdominal pressure should be avoided in the recovery period (stool softeners and high fiber, avoid heavy lifting)
· After 2-4 days catheter can be removed and patient should try to void after removal
teach kegel exercises after cath removal
Bladder Irrigation Management
· Assess for bleeding and clots
· Assess catheter patency by measuring I&Os and presence of bladder spasms
· Manually irrigate catheter if bladder spasms or decreased outflow occurs
· Give antispasmodics and analgesics as needed
· Monitor catheter drainage for increased blood or clots
· Discontinue CBI and notify HCP if obstruction occurs
· Teach patient Kegel exercises after catheter removal
Provide care instructions for patient discharges with indwelling catheter
· Finasteride (Proscar) is used for
BPH to block DHT so prostate can decrease in size
· Finasteride (Proscar) takes..
up to 6 months to be effective
· Finasteride (Proscar) common SE
decreased libido
