Week 9 - BPH Flashcards
what is benign protastic hyperplasia (BPH
- enlargement of the prostate gland d/t an increase in the number of epithelial cells & amt of stromal tissue
what are causes of BPH
- thought to be associated w endocrine changes associated w aging
what are risk factors for BPH (4)
- FHx
- enviro
- diet
- obesity
describe the impact that diet has on BPH
- high in fruits & veggies = lower risk
- high in zinc, butter, and margarin = higher risk
what does BPH lead to
- compression of the urethra = partial or complete obstruction
the symptoms of BPH result from?
- urinary obstruction
describe symptoms of BPH
- 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
what are the 2 groups of symptoms of BPH
- obstructive
- irritative
what are obstructive symptoms of BPH (4)
- 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
what are irritative symptoms of BPH (6)
- urinaru freq
- urgency
- dysuria
- bladder pain
- nocturia
- incont
complications d/t BPH result from
- urinary obstruction
what are complications of BPH (7)
- 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
what is included in diagnostic studies for BPH (10)
- history
- physical exam
- digital rectal exam
- urinalysis w culture
- PSA lvl
- creatinine (to rule out renal insufficiency)
- TRUS
- uroflowmetry
- cystourethroscopy
- post-void residual volume
why is DRE used as a diagnostic for BPH
- the prostate can be palpated using DRE
- can estimate the size, symmetry, and consistency of the prostate gland
describe the prostate gland during BPH (3)
- symmetrically enlarged
- firm
- smooth
what is PSA
- prostate specific antigen
why is PSA measured w BPH
- to rule out prostate cancer
- however, PSA may be slightly elevated w BPH
what is a TRUS scan
- transrectal ultrasonography
- US that allows for accurate assessment of prostate size
- helpful in differentiating between BPH and prostate cancer
what is a uroflowmetry? why is it useful?
- 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
what is a cystourethroscopy
- a procedure allowing internal visualization of the urethra and bladder
what are the goals of collaborative care for BPH (3)
- restore bladder drainage
- relieve pt’s symptoms
- prevent complications of BPH
what is treatment of BPH based on
- the degree to which symptoms bother the pt
- presence of complications
what is included in collab care for BPH (5)
- “watchful waiting”
- lifestyle changes
- drug therapy
- invasive therapy
- minimally invasive therapy
what lifestyle changes are included in treatment of BPH (4)
- 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)
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
what meds should be avoided in a pt w BPH (2)
- decongestants (worsen symptoms bc are alpha adrenergic agonists = sm. m contraction)
- anticholinergics
what meds are used for treatment of BPH (3)
- 5a-reductase inhibitor
- a-adrenergic receptor blockers
- herbal therapy
how do 5a-reductase inhibitors work as treatment for BPH? what is an example?
- decrease the size of the prostate
ex. finsteride (proscar)
how do 5a-reductase inhibitors work as treatment for BPH? what is an example?
- decrease the size of the prostate
ex. finsteride (proscar)
how do a-adrenergic receptor blockers work as treatment for BPH? what is an example?
- promote smooth muscle relaxation in the prostate
ex. flomax
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
what is invasive therapy for treatment of BPH
- involves resection or ablation of the prostate
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
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
what are 3 examples of invasive therapies for BPH (3)
- transurethral resection of the prostate (TURP)
- transurethral incision of the prostate (TUIP)
- prostatectomy
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
how is TURP performed (3)
- under spinal or general anasthesia
- no external incision
- rectoscope inserted thru urethra
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
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
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
what are potential complications post-TURP (6)
- bleeding & hemorrhage
- clot retention
- bladder spasms
- urinary incont.
- infection
- dilutional hyponatremia d/t irrigation
due to the potential complication of bleeding post-TURP, what must pts do
- d/c of aspirin or anticoagulants several days before surgery
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
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
if the outflow of irrigants is less than inflow, what should be done (2)
- assess the bladder
- check patency of the cath
if the outflow is blocked post-op, what should be done
- stop continuous bladder irrigation and notify the physician
blood clots are expected after prostate surgery at which time?
- first 24-36 hours
FINISH
