Topic 9: BPH & TURP

Question 1

benign prostatic hypertrophy (BPH)

Answer 1

condition in which the prostate gland increases in size, disrupting the outflow of urine from the bladder through the urethra.

Question 2

High levels of what result in prostate enlargement

Answer 2

DHT

Question 3

risk factors for BPH

Answer 3

aging >50, obesity, lack of physical activity, high amount of dietary animal protein, alcohol use, ED, smoking, diabetes

Question 4

irritative symptoms of BPH

Answer 4

o Nocturia
o Urinary frequency
o Urgency
o Dysuria
o Bladder pain
o Incontinence

Question 5

obstructive symptoms of BPH

Answer 5

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

Question 6

complications with BPH

Answer 6

· Acute urinary retention
· UTI

Question 7

diagnostic assessment of BPH

Answer 7

· 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

Question 8

active surveillance of BPH

Answer 8

· Annual PSA and DRE
· Repeat IPPS. Score and post void residual if any symptoms change

Question 9

health promotion for BPH

Answer 9

· TEACH patient to urinate every 2-3 hours and when they first feel he urge
· Intake normal fluid level
· PSA screening

Question 10

what beverages are irritants and tend to increase prostatic voiding symptoms

Answer 10

Alcohol, caffeine

Question 11

what medications cause smooth muscle contraction, so they often worsen symptoms of BPH

Answer 11

Common cough and cold remedies (adrenergic agonists)

Question 12

Transurethral resection of the prostate (TURP)

Answer 12

· Removal of prostate tissue using a resectoscope inserted through the urethra

Question 13

pre op care for TURP

Answer 13

o Antibiotics are usually given before
o Encourage high fluid intake

Question 14

sexual function and TURP

Answer 14

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

Question 15

complications with TURP

Answer 15

hemorrhage, bladder spasms, urinary incontinence and infection

Question 16

what is placed after TURP procedure

Answer 16

o : 3 way indwelling urinary catheter is inserted to provide hemostasis and urinary drainage

Question 17

Bladder can be irrigated for

Answer 17

the first 24 hour period to prevent obstruction from blood clots and ensure drainage

Question 18

what is the bladder irrigated with after TURP

Answer 18

sterile normal saline

Question 19

urine appearance after TURP

Answer 19

light pink urine without clots is normal, but bright red urine is bad and may indicate a hemorrhage

Question 20

blood clots are expected after prostate surgery for the first

Answer 20

24-36 hours after

Question 21

Transurethral resection syndrome manifestations

Answer 21

N/V, confusion bradycardia, HTN

Question 22

post op instruction for TURP

Answer 22

· 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

Question 23

Bladder Irrigation Management

Answer 23

· 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

Question 24

· Finasteride (Proscar) is used for

Answer 24

BPH to block DHT so prostate can decrease in size

Question 25

· Finasteride (Proscar) takes..

Answer 25

up to 6 months to be effective

Question 26

· Finasteride (Proscar) common SE

Answer 26

decreased libido