Week 9 BPH Flashcards
What is BPH?
Enlargement of the prostate gland
What is PSA level?
- Blood work that is taken from a patient
- PSA will increase if theres something going on with the prostate and it needs to be investigated further
What is BPH pathology?
- there is an increase in number of epithelial cells in the inner part of the prostate and because of that it compressed the urethra
- non- malignant and not cancerous
What are the treatments for BPH
removing part of the tissue that is compressing the urethra
what is the main problem with BPH?
Obstruction
what usually brings the patient to see the Doctor?
Patient having problem urinating. Patient will have problem with frequency, dribbling, and continents
What are the S&S of BPH?
Urinary elimination symptoms
- frequency
- dribling
- decrease urinary stream force
- UTI symptoms
How is BPH Diagnosed?(3)
- PSA level blood work
- Digital rectal exam
- TRUS scan and biopsy
PSA level result
Higher = BPH
Who can do Digital rectal exam
Nurse Practitioner or Doctor
what is the result for rectal exam if patient have BPH?
- Prostate feels abnormal
- If patient have BPH the prostate will feel symmetrically large, firm and smooth
How does TRUS scan used to DX?
Tissue is taken and sent off the see if its cancerous or just normal
BPH
how does TRUS scan work?
Ultrasound probe is inserted to the anus and with the probe, they can send a bot of needle biopsy through and take a tissue sample
What does is mean by watch-full waiting?
Can use lifestyle changing or medication treatments
what type of lifestyle changes does person with BPH should do (3)
- Decrease/ avoid caffeine
- Avoid decongestants and anticholinergics
- restrict fluid in the evening to reduce peeing
What kind of meds are used for BPH treatments? (2)
- 5a reductase inhibitor (Proscar)
- a- adenergic receptor blocker (Flomax)
what does 5-a reductase inhibitor ( Proscar ) do?
Decrease size of prostate gland.
How long does proscar work?
Takes 6 months
what does a - adenergic receptor blocker (Flomax) do?
Promotes smooth muscle relaxation and helps facilitate urine flow.
what is the improvement time and rate of Flomax?
- 50-60% improvement just after taking 2-3 weeks.
What is minimally invasive therapy?
its an outpatient procedure - takes only a day
What kind of minimally invasive procedures are done for BPH? (3)
1) Transurethral microwave thermotherapy
2) Transurethral needle ablation
3) laser prostectormy
what is transurethral microwave thermotherapy
- uses microwaves and putting them directly to the prostate trough a probe.
- the heat of the microwave causes death of prostate tissue which relieves the obstruction
Post - procedure of transurethral microwave thermotherapy
- patient will go home with indwelling foley 2-7 days to make sure the flow of urine continues out and to facilitate the passing of small clots or necrotic tissue
- patient is given antibiotics, pain medications and anti spasm
transurethral needle ablation
- uses low wave radio frequency through a needle at a high temperature
- it uses a needle to go through the transurethra ( goes through urethra) and uses the needle to to locally burn off or cause necrosis to the prostate.
post procedure of transurethral needle ablation
- Patient will have foley for a short time.
- patient can also have hematuria for about a week due to burning
laser prostatectomy
- laser is used for cutting, coagulation, and vaporization of prostatic tissues.
laser prostatectomy post op
- takes several weeks for optimal effect
- patient will go home with foley for a few days
What are the invasive therapy? (2)
- Transurethral resection of the prostate (TURP)
- Prostectomy
what is prostectomy?
Removal of the prostate
what is Transurethral resection of the prostate (TURP)
- Known to be the “goal standard’ of treatment
- surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. ( NO EXTERNAL INCISION)
- it is done with general or spinal anaesthesia
- They excise and cauterize obstructing prostate tissue
Is TURP good for older adults?
No, because it is very invasive and risky
TURP post op
- patient will have 3- way foley catheter with 30mL ballon to provide hemostasis and to facilitate urinary drainage.
- Bladder is irrigated for the first 24hrs, the bladder is either irrigated continuously or intermittently, to prevent obstruction from mucus and blood clots.
what is the outcome of TURP?
the outcome for 80 - 90% is excellent, with marked improvement of symptoms and urinary flow rates.
What is complication of TURP?
-Bleeding!!
Continuous bladder irrigation
- Constant flush of normal saline which is irrigating solution
- whatever is in the bladder will drain out to the drainage bag
Continuous bladder irrigation important things to do (4)
- keep an eye on the solution on the top (3L)
- There is a clamp to change rate of irrigating fluid going into the bladder
- Watch closely of the drainage bag. we need to see that the bladder is constantly draining out both urine
- Look at the contents of drainage bag. Note colour, blood and clots.
TURP POST OP Care (5)
- Manage pain
- Mange continuous bladder irrigation
- I&O
- Control Bladder spasms
- Follow-up care
what is the normal urine colour after TURP?
Pinkish or pink is normal. if theres frank blood then we need to call the doctor because its bleeding
Bladder irrigation clamps rate
- A rapid infusion can cause bladder spasms
- Slow infusions will not prevent clot formations
what do we do if 3 way folley is clotted?
1) stop irrigation with roller clamp
2) flush bladder through foley
why do we tell patient not to void around catheter?
it can result in increase spasms which can increase pain
why is monitoring I&O hard for 3 way foley?
- because its not just urine coming out. theres also some irrigating fluid.
- its not going to be accurate
what else do we have to monitor when patient had TURP?
Monitor for BUN and Cr for kidney and do a bladder scan if worried about distention
what is good to give for bladder spasms after TURP
- Ditropan
- start patient with flomax to help urine flow better
what do patient that had TURP have to avoid
- avoid activity that increase intra abdominal pressure which increase chances of bleeding ( sitting or walking for prolonged time)
- avoid heavy lifting over 4.5 kg
- avoid straining - use stool softener
- avoid sexual intercourse
- avoid driving
- avoid climbing the stairs
- avoid travelling
Avoid all until doctor approves
what does patient have to do if theyre having urinary continence or poor sphincter control? (Post foley removal)
- kegel exercise
- limit fluids 2-3h before bed
- avoid bladder irritants such as coffee and tea, citrus juice and alcohol
- void immediately when they have urgency to void
