BPH AND PROSTATIS

CARING FOR THE PATIENT WITH BPH & PROSTATITIS

Instructor: Prof. Pino

OBJECTIVES

  • Describe the pathophysiology of prostatitis.

  • Describe the pathophysiology of benign prostatic hypertrophy (BPH).

  • Apply the nursing process in the care of patients experiencing BPH and prostatitis.

STRUCTURES OF THE MALE REPRODUCTIVE SYSTEM

  • Symphysis pubis

  • Vas deferens

  • Corpus cavernosum

  • Urinary bladder

  • Ampulla

  • Seminal vesicle

  • Ejaculatory duct

  • Prostate gland

  • Bulbourethral gland

  • Anus

  • Perineum

  • Penis

  • Urethra

  • Glans penis

  • Prepuce

  • Urethral meatus

  • Testes

  • Epididymis

  • Scrotum

PHYSICAL ASSESSMENT

Digital Rectal Exam

  • Recommended annually for men over 50 years old.

  • Recommended for men over 45 years of age if they are at high risk, including African-American men and men with a family history of prostate issues.

Testicular Exam

  • Instruct on testicular self-examination (TSE).

PROSTATITIS

  • Inflammation caused by an infectious agent, usually associated with:

    • Lower urinary tract symptoms

    • Sexual discomfort and/or dysfunction

  • Most common urologic diagnosis in men under the age of 50.

  • May be:

    • Infectious (bacterial)

    • Non-Infectious (caused by urethral stricture, BPH)

TYPES OF PROSTATITIS

1. Acute Bacterial

  • Sudden onset of fever, dysuria, and perineal prostatic pain.

2. Chronic Bacterial

  • Typically asymptomatic.

3. Chronic Prostatitis/Chronic Pelvic Pain Syndrome

  • Presents with genitourinary symptoms but no bacteria in urine.

4. Asymptomatic Inflammatory Prostatitis

  • Diagnosed incidentally with elevated PSA.

PHYSICAL EXAM FINDINGS IN PROSTATITIS

  • Boggy, tender prostate.

  • Urethral discharge (contains white blood cells).

  • Palpation of prostate may promote urethral discharge.

DIAGNOSTIC PROCEDURES

  • Send any discharge for analysis (Culture & Sensitivity).

  • PSA (blood sample) – will typically be elevated;

  • Urinalysis and C&S – will identify the causative agent.

  • WBC levels will likely be elevated due to infection and inflammation.

TREATMENT OF PROSTATITIS

  • Treatment includes:

    • Appropriate anti-infective agents (e.g., antibiotics).

    • Measures to alleviate pain (NSAIDs) and spasm (e.g., tamsulosin).

COMFORT MEASURES

  • Sitz baths.

  • NSAIDs for pain relief.

  • Muscle relaxants.

  • Avoid:

    • Alcohol

    • Tea

    • Coffee

    • Spicy foods

  • Encouraged practices:

    • Ejaculation may reduce symptoms.

    • Increase fluid intake.

    • Avoid sitting for long periods.

    • Stool softeners to prevent constipation.

BENIGN PROSTATIC HYPERTROPHY (BPH)

  • Benign prostatic hyperplasia (BPH) is an enlargement of the prostate.

  • Typically affects men over the age of 40; 50% of men over the age of 60 experience it.

  • Manifestations include:

    • Urinary obstruction

    • Urinary retention

    • Increased risk of urinary tract infections (UTIs)

  • Develops slowly; changes in urinary tract are insidious and progress over time.

  • Symptoms depend on severity:

    • Dysuria

    • Hesitancy

    • Sensation of incomplete bladder emptying

    • Typically a weak urine stream or difficulty starting a urine stream.

DIAGNOSTIC PROCEDURES FOR BPH

  • Digital Rectal Exam: The prostate may be enlarged and smooth.

  • Ultrasound Biopsy: To rule out prostate cancer.

  • PSA (blood test): To rule out prostate cancer.

  • Urinalysis/C&S: If UTI symptoms are present.

MANAGEMENT OF BPH

Medical Treatment

  • Medications:

    • Tamsulosin: Relaxes smooth muscle of prostate and bladder outlet.

    • Finasteride: Reduces the size of the prostate.

    • Tadalafil: Relaxes smooth muscle and acts as a vasodilator.

  • Catheterization for acute conditions if the patient is unable to void; may require either a wired or metal catheter if there is severe obstruction.

Surgical Treatment

  • Minimally Invasive Therapy

  • Surgical Resection

  • Transurethral Resection of the Prostate (TURP)

SURGICAL APPROACHES TO PROSTATECTOMY

  • Transurethral Resection of the Prostate (TURP)

  • Suprapubic Prostatectomy

  • Perineal Prostatectomy

  • Retropubic Prostatectomy

  • Transurethral Incision of the Prostate (TUIP)

  • Laparoscopic Radical Prostatectomy

  • Robotic-Assisted Laparoscopic Radical Prostatectomy

  • Pelvic Lymph Node Dissection

NURSING IMPLEMENTATION ACUTE CARE POSTOPERATIVE CARE FOR TURP

  • Monitor Vital Signs (VS) and Urine Output (UOP).

    • Maintain increased fluid intake.

    • Monitor for bleeding;

    • Watch for persistent bright red bleeding in Continuous Bladder Irrigation (CBI) or reduced Hemoglobin (Hgb) levels.

    • Ensure early ambulation.

    • Administer medications:

    • Analgesics

    • Antispasmodics

    • Antibiotics

    • Stool softeners

CONTINUOUS BLADDER IRRIGATION (CBI)

  • Infusion rate should be based on the color of urine; ideally, it should be light pink with small clots.

  • Assess patency and monitor intake and output.

    • If blocked, stop CBI and notify healthcare provider (HCP).

    • Manual, intermittent irrigation may be prescribed to remove clots.

ASSESS FOR COMPLICATIONS

  • Hemorrhage

  • Bladder Spasms

    • Medications such as oxybutynin and using warm compresses may help.

  • Urinary Incontinence

    • Some incontinence can be expected up to one year post-op.

  • Infection

CATHETER REMOVAL AND POSTOPERATIVE CARE FOR TURP

  • Catheter typically removed after 2 to 4 days.

  • Voiding Trial: Monitor for urinary incontinence or dribbling.

    • Recommend Kegel exercises to strengthen sphincter tone.

    • Continence may take up to 12 months.

    • Use of penile clips, condom catheters, or incontinence pads or briefs can reduce embarrassment.

THE END