benign prostatic hyperplasia (BPH)

what is BPH?

prostate gland enlargement that disrupts urine flow form bladder to urethra

50% of people will have what kind of symptoms?

lower urinary tract symptoms

• difficulty starting urine stream

• dec urine flow

• frequency

how do hormonal changes contribute to BPH?

• excess DHT stimulates prostatic cell growth even

• inc estrogen over testosterone

what factor contributes to the development of obstructive symptoms?

location of enlargement!!!

what are the risk factors for BPH?

• aging

• obesity (inc waist circumference)

• no physical activity

• alcohol

• erectile dysfxn

• smoking

• DM

• first degree relative

what are the clinical manifestations of BPH?

• gradual

• bladder will compensate for small amount of urine flow resistance

• symptoms worsen with inc obstruction

irritative symptoms

from inflammation or infection

• nocturia (first)

• frequency

• urgency

• dysuria

• bladder pain

• incontinence

obstructive symptoms

from enlargement

• dec caliber and force of stream

• can’t start stream

• intermittency

• dribbling at end 

what are five complications of BPH?

1. urinary retention → catheter or surgery

2. UTI/sepsis/bladder calculi

3. renal failure (from hydronephrosis)

4. pyelonephritis

5. bladder damage (delayed retention Tx)

what diagnostic studies are performed?

• history and PE

• digital rectal exam (DRE)

• UA and culture

• PSA

• serum creat (r/o renal insufficiency)

• neurologic exam (r/o neurogenic bladder)

• postvoid residual

• TRUS (differentiate BPH from prostate cancer, get biopsy)

• cystoscopy

what kind of conservative therapy can be used?

• active surveillance

• diet changes (no caf, artificial sweetener, spicy, acidic)

• avoid decongestants and anticholinergics

• restrict evening fluid intake

• timed voiding schedule 

5 alpha reducatse inhibitor MOA and indication

• block enzyme that converts testosterone to DHT to dec size

• for larger prostates with bothersome symptoms

• lowers risk of prostate cancer

how long should finasteride be taken?

• up to six months on a regular basis

PSA levels mnust be reduced by what percent in order for finasteride to be taken?

50%

name three examples of 5a-reductase inhibitors

• finasteride

• dutasteride

• jalyn (finasteride + tamsulosin)

why shouldn’t pregnant women handle finasteride tablets"?

risk to male fetus

a-adrenergic receptor blocker MOA

promote smooth muscle relaxation and facilitate urine flow, but does not dec prostate size

name a few examples of a-adrenergic receptor blcokers

• tamsulosin

• silodosin

• doxazosin

(ends in -zosin or -osin)

which erectogenic drug reduces symptoms of BPH and ED?

tadafil (cialis)

is herbal therapy beneficial?

saw palmetto has not benefit over a placebo

name three minimally invasive therapies

1. transurethral microwave thermotherapy (TUMT)

2. transurethral needle ablation (TUNA)

3. laser prostatectomy

what is a TUMT?

an 90 min outpt procedure where microwaves are deliver to the prostate via probe that uses heat to cause tissue death. rectum temp is kept below 110 F

what is ia common postop complication of a TUMT?

urinary retention

• send home with cath for 2-7 day

what is a TUNA?

a 30 min outpt procedure that increase temp of prostate tissue for necrosis used low-wave radiofrequency using local anesthestic

what complications arise from TUNA?

• urinary retention (cath use)

• UTI

• irritative voiding for several weeks

• hematuria for a week

what is a laser prostatectomy?

laser beam used for cutting, coagulation, and vaporization of the prostate

what is visual laser ablation of prostate (VLAP)?

a procedure that gradually sloughs off ttisue in the urinary stream that may take several weeks for optimal results. cath is inserted for drainage.

how do contact laser techniques work?

direct contact of laser to prostate tissue to produce tissue vaporization, blood vessels near laser tip are cauterized, and a three way cath with slow drip irrigation is placed and removed after 6-8 hrs

name three advantages of contact laser technique over TURP?

• minimal bleeding

• fast recovery

• can be on anticoagulants

what is photovaporization of the prostate (PVP)?

high-power green laser light used to vaporize tissue usually for larger prostate glands. bleeding is minimal, cath inserted for 28-48 hrs, irritative voiding symptoms may occur

what is interstitial laser coagulation (ILC)?

cytoscope used to view prostate and a laser is used for quick and precise treatment

what are the indications for invasive therapy?

• dec urine flow causing discomfort

• residual urine

• urinary retention d/t obstruction and no reversible cause

• hydronephrosis

TURP disadvantages

• required hospital stay

• costly

what are the s/s of TURP syndrome?

N/V, confusion, bradycardia, htn

what causes TUR syndrome?

d/t hyponatremia caused by long operating time and prolonged intraoperative bladder irrigation

what medications need to be held prior to TURP?

• anticoagulants

• BPH meds 

what is a transurethral incision of prostate (TUIP)?

small incisions made into the prostate to expand urethra, relieving pressure and improving flow. usually used for men with moderate-severe symptom

what is the focus of health promotion?

early detection and treatment

• PSA screen q 2 years esp 55-69

what nursing education should be provided for obstructive symptoms?

urinate q2-3 hours when they first feel each. teach adequate fluid intake

what preop care is provided for TURP?

• abx → treat UTI, encourage 2-3 L/day

• restore urinary drainage

  • coude (curve tip cath), filiform (rigid cath)

• express sexual fxn concerns

• teach possible complications (dec/absent ejaculate, retrograde ejaculation)

what should be assessed postop TURP?

• hemorrhage

• bladder spasm

• urinary incontinence

• infection

what postop TURP care is provided?

• intermittent bladder irrigation

  • instill 50 mL then withdraw to remove clots

  • causes bladder clots

• continuous bladder irrigation (CBI)

  • rate of infusion based on drainage color → light pink w/o clots

  • outflow less than inflow → assess patency. stop if patency cannot be reestablished. 

  • use aseptic technique

• cath care

• kegel exercise

• monitor for s/s of infection

• stool softeners, high fiber to prevent strain

• treat bladder spasm

postop prostate surgery ambulatory care

• several weeks to achieve urinary continence

• refer to continence clinical if not normal w/in 12 mths

post prostate surgery home care

teach

• penile clamp, condom cath, incontinence pads/briefs for dribbling

• how to continue socializing

discharge planning

• indwelling cath care

• urinary incontinence management 

• adequate fluid intake

• s/s of uti/infection

• prevent constipation

• avoid heavy lifting 

• refrain from driving/intercourse