Benign Prostatic Hyperplasia

Question 1

BPH

Answer 1

Benign Prostate Hyperplasia
Benign enlargement of prostate gland
Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue

Question 2

DHT

Answer 2

dihydroxytestosterone

principal intraprostatic androgen in the cells of the prostate

Question 3

Etiology and patho

Answer 3

Thought to result from hormonal changes from aging process

• excessive DHT accumulation in prostate cells that can stimulate overgrowth of prostate tissue
• increased proportion of estrogen over testosterone in blood

Question 4

Compression of urehtra leads to…

Answer 4

decrease in caliber and force of urinary stream
difficulty in initiating voiding
intermittency of voiding
dribbling

Question 5

Risk factors for BPH

Answer 5

Aging
Obesity (especially increased waist circumference like the apples)
Lack of physical activity
Alcohol consumption
Erectile dysfunction
Smoking
Diabetes

Question 6

What is a potential risk factor?

Answer 6

positive family hx of BPH in first-degree relatives

Question 7

Clinical manifestations

Answer 7

Many men usually have no symptoms
Symptoms gradual in onset
Nocturia often first symptom noticed
Frequency, urgency
Difficulty initiating and stopping stream
Dribbling at end of urination
Intermittency, incontinence
Signs of cystitis (dysuria, pyuria, fever)

Question 8

Complications

Answer 8

R/T urinary obstruction (acute urinary retention)
UTI and sepsis
Calculi (due to alkalinization of residual urine)
Renal failure (caused by hydronephrosis)
Pyelonephritis
Bladder damage

Question 9

Diagnostic studies

Answer 9

History and PE
DRE
Urinalysis with culture
PSA level
TRUS scan
Uroflometry
Post void residual
Cystoscopy

Question 10

PSA

Answer 10

Prostate-specific antigen
Blood test may be done to rule out prostate cancer
PSA levels may be slightly elevated in patients with BPH
Serum creatinine levels may be ordered to rule out renal insufficiency
Because symptoms of BPH are similar to those of neurogenic bladdeer, a neruological exam may be performed as well

Question 11

TRUS scan

Answer 11

Transrectal ultrasound
Scan allows for accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer.
Biopsies can be done during procedure
Done in patients with abnormal DRE and elevated PSA

Question 12

Minimally invasive therapies

Answer 12

Becoming more common
Destroy prostatic tissue
Intraprostatic urethral stents

Question 13

What minimally invasive therapies destroy prostatic tissue?

Answer 13

Lasers
Radiowaves
Ultrasound
Microwaves
Electrical current

Question 14

Invasive therapy is indicated when…

Answer 14

Decrease in urine flow sufficient to cause discomfort
Persistent residual urine
Acute urinary retention
Hydronephrosis

Question 15

TURP… what is it?

Answer 15

Transurethral resection

• removal of osbtructing prostate tissue using resectoscope inserted through urethra
• outcome for 80-90% is excellent
• relatively low risk
• performed under spinal or general anesthesia and requires hospital stay
• stop all anticoagulants a week before hand

Question 16

TURP information

Answer 16

Bladder irrigated for first 24 hours to prevent mucous and blood clots
Complications include bleeding, clot retention, dilutional hyponatremia, retrograde ejaculation
-patients must stop anticoagulants week before surgery
*does not increase hydration

Question 17

Goals for patient having invasive procedure

Answer 17

Restoration of urinary damage
Treatment of UTI
Understanding of...
-upcoming procedure
-implications for sexual functioning
-urinary control

Question 18

Focus: early detection and treatment…

Answer 18

Yearly physical exam and DRE for men over 50
Alcohol, caffeine, and cold and cough meds can increase symptoms
Urinate q 2-3 hours and when first feeling urge
Restricting fluids increases chance of infection

Question 19

Preoperative care of TURP

Answer 19

Restore urinary drainage
-coude: curved-tip catheter
-filiform - rigid catheter, need doctor’s order
-aseptic technique very important in preventing infection
Administer antibiotics
-treat UTIs
Concerns regarding sexual function

Question 20

Postoperative care for TURP

Answer 20

Assess for complications
-hemorrhage,bladder spasms, urinary incontinence, infection
Bladder irrigation to remove blood clots and ensure drainage or urine - CBI
Administer antispasmodics
Teach Kegel exercises
Observe pt for signs of infection
Dietary intervention
Stool softeners to prevent straining

Question 21

Instructions after prostate surgery

Answer 21

Care of indwelling catheter
Managing incontinence
Maintaining adequate fluid intake
Observing for signs and symptoms of UTI, wound infection
Preventing constipation
Avoid heavy lifting
-not more than 10 lb
Refraining from driving, intercourse after surgery as directed

Question 22

Bladder rules

Answer 22

may take up to 2 months to return to its normal capacity
instruct patient to drink at least 2 L of fluid per day
urinate q 2-3 hours to flush urinary tract