NU 310: Urolithiasis, BPH, prostate cancer

What is urolithiasis?

The formation of stones anywhere in the urinary tract, including kidneys (nephrolithiasis), ureters, bladder, and urethra.

What percentage of people are affected by urolithiasis in their lifetime?

About 5-10%.

What is the recurrence rate of urolithiasis?

Approximately 50%.

Which demographic is more commonly affected by urolithiasis?

Men, usually aged 20-30.

What are some lifestyle risk factors for urolithiasis?

Sedentary lifestyle, immobility, obesity, and low fluid intake.

What dietary factors can increase the risk of urolithiasis?

High animal protein, high vitamin C, high purines, high oxalates, and calcium supplements.

What medical conditions are associated with an increased risk of urolithiasis?

Hyperparathyroidism, metabolic disturbances, neurogenic bladder, and dehydration.

What is the pathophysiological cause of stone formation in urolithiasis?

Urinary stasis, obstruction, supersaturation of urine, changes in urine pH, and deficiency of stone-forming inhibitors.

What types of stones account for approximately 70% of urolithiasis cases?

Calcium oxalate and calcium phosphate stones.

What type of stone is associated with urea-splitting bacteria?

Struvite stones (magnesium ammonium phosphate).

What are the classic clinical manifestations of urolithiasis?

Sudden, severe unilateral colicky flank pain, nausea/vomiting, and hematuria.

What imaging technique is considered the gold standard for diagnosing urolithiasis?

Non-contrast CT.

What is the goal of metabolic workup in recurrent urolithiasis?

To identify underlying metabolic disorders to prevent recurrence.

What are the short-term treatment goals for an acute episode of urolithiasis?

Relieve pain, facilitate stone passage, treat infection, and prevent complications.

What is the recommended fluid intake for managing urolithiasis?

Encourage 3-4 L of fluids per day to produce 2.5-3 L of urine.

What are some treatment options for stones that won't pass?

Shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.

What dietary modifications are suggested for calcium oxalate stones?

Oxalate-restricted diet, increased fluids, and acidifying urine.

How should uric acid stones be managed dietarily?

Purine-restricted diet and alkalinizing urine with citrus fruits or potassium citrate.

What is a common treatment for struvite stones?

Long-term antibiotics to control infection.

What is a recommended treatment for cystine stones?

Very high fluid intake and alkalinizing urine.

What should be monitored closely in patients with kidney stones?

Intake and output (I&O) of fluids.

What dietary changes should be encouraged for patients with kidney stones?

Increased clear fluid intake and dietary modifications based on stone type.

What is a common symptom after lithotripsy?

Hematuria (blood in urine) for 24-48 hours.

What should be monitored after lithotripsy for potential complications?

Obstruction by stone fragments, indicated by sudden decrease in urine output and severe pain.

What is benign prostatic hyperplasia (BPH)?

Nonmalignant enlargement of the prostate gland due to cellular hyperplasia.

What are lower urinary tract symptoms (LUTS)?

Symptoms caused by BPH, including difficulty urinating and incomplete bladder emptying.

What is the prevalence of BPH in men aged 71-80?

80% of men in this age group are affected by BPH.

What are voiding symptoms of BPH?

Hesitancy, intermittency, weak stream, straining to void, and prolonged urination.

What are storage symptoms of BPH?

Urgency, frequency, nocturia, and urge incontinence.

What is the purpose of a Digital Rectal Exam (DRE) in BPH assessment?

To evaluate prostate size and consistency and rule out prostate cancer.

What does a high post-void residual (PVR) indicate?

Poor bladder emptying.

What is the role of alpha-blockers in BPH treatment?

To relax smooth muscle in the bladder neck and prostate, improving urine flow.

What is the 'gold standard' surgical procedure for BPH?

Transurethral Resection of the Prostate (TURP).

What lifestyle modifications can help manage BPH symptoms?

Healthy diet, regular exercise, fluid management, and avoiding bladder irritants.

What should be monitored in patients after TURP?

Urine color and output, ensuring it transitions from reddish to clear.

What is the purpose of continuous bladder irrigation (CBI) after TURP?

To prevent clot formation, maintain catheter patency, and promote urine drainage.

What should be done if large clots or bright red bleeding is observed after TURP?

Report immediately as it may indicate a complication.

What medications may worsen BPH symptoms?

Anticholinergics, narcotics, skeletal muscle relaxants, and some decongestants.

What is the significance of PSA levels in BPH diagnosis?

To help differentiate BPH from prostate cancer, although PSA can be elevated in both.

What is the International Prostate Symptom Score (IPSS)?

A symptom questionnaire that scores severity of LUTS.

What is the expected urine output after TURP?

Initially reddish, gradually becoming pink and then clear.

What are the two main groups of symptoms associated with BPH?

Voiding (obstructive) symptoms and storage (irritative) symptoms.

What is the primary goal of nursing care after lithotripsy?

To manage pain and monitor for complications.

What should patients be educated about regarding signs of infection?

Symptoms like fever, chills, and decreased urine output warrant urgent care.

What is the role of 5α-reductase inhibitors in BPH treatment?

To reduce prostate volume by blocking the conversion of testosterone to dihydrotestosterone.

What are common symptoms of bladder spasms?

Suprapubic pain or urge to void around the catheter.

How should bladder spasms be treated?

With prescribed antispasmodics.

What signs should be monitored for infection after catheterization?

Fever, cloudy urine, and odor.

What should be encouraged to avoid straining after catheter removal?

Deep breathing, ambulation, and stool softeners.

What is the purpose of Continuous Bladder Irrigation (CBI)?

To maintain a closed system and reduce infection risk.

What should be monitored in patients receiving CBI?

Intake and output, signs of hyponatremia, and fluid overload.

What is the prevalence of prostate cancer in men?

Accounts for around 28% of cancer incidence in men.

What is the lifetime risk of developing prostate cancer?

About 1 in 6 men will develop prostate cancer.

What is the 5-year relative survival rate for localized prostate cancer?

Nearly 100%.

At what age do approximately 65% of prostate cancer cases occur?

In men over 65.

Which race has a higher incidence and more aggressive form of prostate cancer?

African-American men.

What dietary factors may increase the risk of prostate cancer?

A high-fat diet.

What is the recommended age to start annual PSA + DRE screening for prostate cancer?

Starting at age 50 if life expectancy is ≥10 years.

What does an elevated PSA level (>4 ng/mL) indicate?

Triggers further evaluation for prostate cancer.

What is the definitive method for diagnosing prostate cancer?

Transrectal ultrasound (TRUS) with biopsies.

What is the Gleason score used for?

To grade the aggressiveness of prostate cancer based on biopsy results.

What are the treatment options for prostate cancer?

Surgery, radiation therapy, hormonal therapy, watchful waiting, and cryotherapy.

What are common side effects of prostate cancer treatment?

Sexual dysfunction, urinary incontinence, and bowel incontinence.

What nursing care is required after a TURP procedure?

Monitor bleeding, maintain catheter patency, and educate on urinary incontinence.

What post-biopsy care instructions should be given to patients?

Increase fluid intake, avoid strenuous activity, and take antibiotics as prescribed.

What should patients avoid after a prostate biopsy to reduce bleeding risk?

Aspirin, NSAIDs, and sexual activity for 7 days.

What are the signs to monitor after a prostate biopsy?

Gross hematuria, fever, difficulty urinating, and severe pain.