Week 9 - BPH Flashcards
1
Q
what is benign protastic hyperplasia (BPH
A
- enlargement of the prostate gland d/t an increase in the number of epithelial cells & amt of stromal tissue
2
Q
what are causes of BPH
A
- thought to be associated w endocrine changes associated w aging
3
Q
what are risk factors for BPH (4)
A
- FHx
- enviro
- diet
- obesity
4
Q
describe the impact that diet has on BPH
A
- high in fruits & veggies = lower risk
- high in zinc, butter, and margarin = higher risk
5
Q
what does BPH lead to
A
- compression of the urethra = partial or complete obstruction
6
Q
the symptoms of BPH result from?
A
- urinary obstruction
7
Q
describe symptoms of BPH
A
- gradual onset
- may not be noticed until BPH has been present for some time
- early symptoms = minimal bc bladder can compensate for a small amt of resistance
- symptoms worsen as degree of urethral obstruction increases
8
Q
what are the 2 groups of symptoms of BPH
A
- obstructive
- irritative
9
Q
what are obstructive symptoms of BPH (4)
A
- decrease in calibre and force of urinary stream
- difficulty in voiding
- intermittency (stoppinf and starting the stream several times while voiding)
- dribbing at the end of urination
10
Q
what are irritative symptoms of BPH (6)
A
- urinaru freq
- urgency
- dysuria
- bladder pain
- nocturia
- incont
11
Q
complications d/t BPH result from
A
- urinary obstruction
12
Q
what are complications of BPH (7)
A
- acute urinary retention
- UTI (d/t incomplete bladder emptying)
- sepsis secondary to UTI
- calculi in the bladder (d/t alkalinization of residual urine)
- hydronephrosis
- pyelonephritis
- bladder damage
13
Q
what is included in diagnostic studies for BPH (10)
A
- history
- physical exam
- digital rectal exam
- urinalysis w culture
- PSA lvl
- creatinine (to rule out renal insufficiency)
- TRUS
- uroflowmetry
- cystourethroscopy
- post-void residual volume
14
Q
why is DRE used as a diagnostic for BPH
A
- the prostate can be palpated using DRE
- can estimate the size, symmetry, and consistency of the prostate gland
15
Q
describe the prostate gland during BPH (3)
A
- symmetrically enlarged
- firm
- smooth
16
Q
what is PSA
A
- prostate specific antigen
17
Q
why is PSA measured w BPH
A
- to rule out prostate cancer
- however, PSA may be slightly elevated w BPH
18
Q
what is a TRUS scan
A
- transrectal ultrasonography
- US that allows for accurate assessment of prostate size
- helpful in differentiating between BPH and prostate cancer
19
Q
what is a uroflowmetry? why is it useful?
A
- study that measures the vol of urine expelled from the bladder per second
- determines the extent of urethral blockage and thus the type of treatment needed
20
Q
what is a cystourethroscopy
A
- a procedure allowing internal visualization of the urethra and bladder
21
Q
what are the goals of collaborative care for BPH (3)
A
- restore bladder drainage
- relieve pt’s symptoms
- prevent complications of BPH
22
Q
what is treatment of BPH based on
A
- the degree to which symptoms bother the pt
- presence of complications
23
Q
what is included in collab care for BPH (5)
A
- “watchful waiting”
- lifestyle changes
- drug therapy
- invasive therapy
- minimally invasive therapy
24
Q
what lifestyle changes are included in treatment of BPH (4)
A
- dietary changes
- avoid certain meds
- restrict evening fluid intake
- timed voiding schedule
- urinate every 2-3 hr and when first feeling the urge
- maintain fluid intake at normal lvl (prevent dehydration or fluid retention)
25
what dietary changes are included in treatment of BPH (4)
decrease:
- caffeine and alcohol (increase symptoms d/t diruetic effect)
- artifical sweeteners
- spicy foods
- acidic foods
26
what meds should be avoided in a pt w BPH (2)
- decongestants (worsen symptoms bc are alpha adrenergic agonists = sm. m contraction)
- anticholinergics
27
what meds are used for treatment of BPH (3)
- 5a-reductase inhibitor
- a-adrenergic receptor blockers
- herbal therapy
28
how do 5a-reductase inhibitors work as treatment for BPH? what is an example?
- decrease the size of the prostate
| ex. finsteride (proscar)
29
how do 5a-reductase inhibitors work as treatment for BPH? what is an example?
- decrease the size of the prostate
| ex. finsteride (proscar)
30
how do a-adrenergic receptor blockers work as treatment for BPH? what is an example?
- promote smooth muscle relaxation in the prostate
| ex. flomax
31
describe pre-op care for BPH surgery (4)
- urinary drainage must be restored before thru insertion of a urethral catheter (ex. coude)
- antibiotics before any invasive procedure
- treat any infections of the urinary tract before surgery
- inform pt that it may impact sexual functioning
32
what is invasive therapy for treatment of BPH
- involves resection or ablation of the prostate
33
when is invasive treatment indicated for treatment of BPH (4)
- decrease in urine flow sufficient to cause discomfort
- persistent residual urine
- acute urinary retention
- hydronephrosis
34
what can temporarily reduce symptoms of BPH and bypass the obstruction
- intermittent or indwelling cath
| should not be used long term tho d/t r/o infection
35
what are 3 examples of invasive therapies for BPH (3)
- transurethral resection of the prostate (TURP)
- transurethral incision of the prostate (TUIP)
- prostatectomy
36
what is TURP
- a surgical procedure involving the removal of prostate tissue using a rectoscope inserted thru the urethra
- considered the gold standard for treatment of obstructive BPH
37
how is TURP performed (3)
- under spinal or general anasthesia
- no external incision
- rectoscope inserted thru urethra
38
what is done after TURP
- large, 3-way indwelling cath inserted thru the bladder to provide hemostasis and facilitate urinary drainage
- for first 24-h, the bladder is irrigated continuously or intermittently
39
why is the bladder irrigated post-TURP
- prevent obstruction from mucus and blood clots
| - removes clotted blood from the bladder & ensure drainage of the urine
40
describe how bladder irrigation is done
- instill 50 mL of the irrigating slution (usually NS)
| - then withdraw w a syringe to remove clots that may be in the bladder and catheter
41
what are potential complications post-TURP (6)
- bleeding & hemorrhage
- clot retention
- bladder spasms
- urinary incont.
- infection
- dilutional hyponatremia d/t irrigation
42
due to the potential complication of bleeding post-TURP, what must pts do
- d/c of aspirin or anticoagulants several days before surgery
43
what is included in post-op care for BPH surgery
- cath and continuous irrigation
- monitor inflow and outflow of irrigants
- careful aseptic technique
- manage pain
- manage bladder spasms
-
44
ideally, the color of urine drainage post-op is? what color may indicate hemorrhage?
- light pink w no clots
| - lrg amts of bright red can indicate hemorrhage
45
if the outflow of irrigants is less than inflow, what should be done (2)
- assess the bladder
| - check patency of the cath
46
if the outflow is blocked post-op, what should be done
- stop continuous bladder irrigation and notify the physician
47
blood clots are expected after prostate surgery at which time?
- first 24-36 hours
48
FINISH
