Care of Patients with Benign Prostatic Hyperplasia (BPH)

Question 1

Means is an Enlarged prostate gland
Cause:
Risk Factors:
Prevention:

Answer 1

Benign prostatic hyperplasia/hypertrophy (BPH)

Question 2

Prostate gland (surrounds urethra) enlarges and extends inward
Causes bladder outlet obstruction
50% if men over 60 are affected - seen lot in healthcare; consider with urinary retention; consider preop/postop or with urinary catheter issue

Answer 2

Means is an Enlarged prostate gland

Question 3

Unclear
Likely the result of aging (huge influence) and the influence of androgens (male hormones) that are present in the prostate tissue - lot male hormones in prostate tissue so can affect enlargement of gland

Answer 3

Cause:

Question 4

Obesity - modifiable
Diabetes Mellitus - modifiable and not; get under control less risk factor
Testosterone and androgen supplements - male hormones; taking them lot higher risk
Inactivity - modifiable

Answer 4

Risk Factors:

Question 5

Avoid/decrease any drugs that can cause urinary retention - exacerbate it
Ex. anticholinergics, antihistamines, and decongestants

Answer 5

Prevention:

Question 6

History
Clinical manifestations - big; compression of prostate
Physical assessment by provider

Answer 6

BPH assessment

Question 7

Urinary frequency and urgency
Nocturia
Difficulty in starting (hesitancy) and continuing urination - cannot start or start a little bit then stop
Reduced force and size of the urinary stream (“weak” stream) - big
Sensation of incomplete bladder emptying - because do have incomplete bladder emptying so big risk of urinary retention
Straining to begin urination
Post-void (after voiding) dribbling or leaking - have urinary retention
Hematuria - bad enough

Answer 7

Clinical manifestations - big; compression of prostate

Question 8

Inspection, palpation, and percussion of the abdomen
Digital rectal examination (DRE) - primary phys assessment by HCP

Answer 8

Physical assessment by provider

Question 9

Feel prostate better from rectum
BPH is uniform, elastic non-tender enlargement versus hard nodule with prostate cancer; evaluate with biopsy if concerned about cancer

Answer 9

Digital rectal examination (DRE) - primary phys assessment by HCP

Question 10

Urinalysis and culture
Prostate-specific antigen (PSA)
Other labs to rule out other causes: - CBC, BUN and serum creatinine, Culture and sensitivity of prostatic fluid

Answer 10

BPH lab assessment

Question 11

Rule out infection; WBCs - check for infection of UT
Increased WBCs if infection present
Microscopic hematuria - blood in urine

Answer 11

Urinalysis and culture

Question 12

Can be elevated in BPH but also other prostate issues (cancers)
Age also
Not definitive)

Answer 12

Prostate-specific antigen (PSA)

Question 13

Systemic infection (elevated WBC’s)
Anemia (decreased RBC’s from hematuria)
Low RBC, Hgb

Answer 13

CBC

Question 14

Both elevated if leads to kidney disease
For renal issues
Sig urinary retention can lead to issues with kidney

Answer 14

BUN and serum creatinine

Question 15

Could be expressed/done during the DRE to check for prostatitis - infection/inflammation of prostate
Monitor these

Answer 15

Culture and sensitivity of prostatic fluid

Question 16

Transabdominal ultrasound - US on abd
Transrectal ultrasound - more common: get better pic of prostate; put in rectum
Tissue biopsy
Cystoscopy
Bladder ultrasound scan - bladder scan

Answer 16

Imaging- BPH diagnostics

Question 17

Used to rule out prostate cancer or think malignancy

Answer 17

Tissue biopsy

Question 18

Scope used to evaluate for bladder neck obstruction
Common if not sure what going on and eval UT and checking for obstruction which can happen with prostate cancer
Scope into urethra and check UT

Answer 18

Cystoscopy

Question 19

Evaluates for post void residual (PVR)
Good to do before go invasive
Scan bladder to see how much left after void

Answer 19

Bladder ultrasound scan - bladder scan

Question 20

Evaluates for post void residual (PVR)
Good to do before go invasive
Scan bladder to see how much left after void

Answer 20

Bladder ultrasound scan - bladder scan

Question 21

First treatment is drug therapy

Answer 21

BPH interventions-medications

Question 22

Decreases Dihydrotestosterone (DHT) which reduces size of the prostate
Relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
Most effective drug therapy approach is a combination of the two - lot times try both

Answer 22

First treatment is drug therapy

Question 23

Decreases androgen/male hormone decreasing size of prostate
May need to take for as long as 6 months before improvement noticed - care for pat; not notice it suddenly
Side effects: erectile dysfunction, decreased libido, dizziness due to orthostatic hypotension

Answer 23

Decreases Dihydrotestosterone (DHT) which reduces size of the prostate

Question 24

Not have immediate response
Hopefully helps symp and better flow of urine
Also causes vasodilation and reduced peripheral vascular resistance
Side effects: assess for orthostatic hypotension, tachycardia, syncope and dizziness

Answer 24

Relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow

Question 25

Avoid drinking large volumes of fluid at one time - stress bladder and UT Avoid alcohol, caffeine and diuretics - going dehydrate them Void as soon as they feel the urge - not hold it; causes trouble with urinary symp Avoid drugs that cause urinary retention - exacerbate symp worse; not take those; let provider know that issues with that if prescribed these meds Lot more Noninvasive techniques to destroy excess prostate tissue than cervical management - destroying prostate tissue so excessive enlargement: heat, laser, radiation to destroy tissue and affect blood supply Surgical management Postoperative care for TURP

Answer 25

BPH interventions

Question 26

Ex. anticholinergics, antihistamines and decongestants

Answer 26

Avoid drugs that cause urinary retention - exacerbate symp worse; not take those; let provider know that issues with that if prescribed these meds

Question 27

Transurethral resection of the prostate (TURP) Holmium laser enucleation of the prostate (HoLEP) Open prostatectomy

Answer 27

Surgical management

Question 28

Gold standard Enlarged portion of the prostate is removed Epidural and spinal anesthesia are typically used; sometimes gen anesthesia but need have anesthesia Most often seen Go through urethra and resect portion of prostate

Answer 28

Transurethral resection of the prostate (TURP)

Question 29

Minimally invasive and newer procedure Less invasive

Answer 29

Holmium laser enucleation of the prostate (HoLEP)

Question 30

Entire prostate removed; more invasive

Answer 30

Entire prostate removed; more invasive

Question 31

Possible trauma to UT, urethra, bladder, etc; going into urethra Continuous Bladder Irrigation (CBI) in place after surgery Constantly Assess color, consistency, and amount of urine output Check the drainage tube frequently After catheter is removed, may experience burning on urination, urinary frequency, dribbling, leakage - catheter larger and doing lot irrigant to UT - make aware of that Increase fluid intake Monitor for infection - some funny feelings with urine because irrigation and trauma of surgery; increased WBC, drainage, redness, swelling Prevent complications of immobility - monitor for clots, pneumonia Assess pain and VS q 2-4 hours - frequently assess pain

Answer 31

Postoperative care for TURP

Question 32

3 way urinary catheter in place with continuous irrigation - continually irrigate UT One port where urine drains out; another where instilling NS; one where balloon for indwelling cathether Normal saline used to irrigate - hand up high and continually infuses into bladder through urethra and out; prevents clots from forming so not cause as much damage and keeps it clear Typ good for 24 hr but sometimes need longer Feel continuous urge to void because continually filling bladder and emptying it - aware of that and not force void around it and irritate it Adjust bladder irrigation as much as want but goal is clear urine without clots and bleeding - sometimes pink; not want red blood; if clots: clot off urethra and have severe retention: very uncomfy and has damage to kidneys so keep really well Will feel the urge to void continuously Maintain the rate of the continuous bladder irrigation (CBI) to ensure clear urine without clots and bleeding

Answer 32

Continuous Bladder Irrigation (CBI) in place after surgery

Question 33

Constantly irrigating and output because not include irrigation into I&O because not urine produced; emptying catheters often and looking at it so can adjust it so irrigate as min as necessary to keep urine clear without clots/bleeding Normal for the urine to be blood-tinged after surgery

Answer 33

Constantly Assess color, consistency, and amount of urine output

Question 34

Monitor for external obstructions (kinks) - retention; often have bladder spasms - monitoring for that Monitor internal obstructions (blood clots, decreased output, bladder spasms) - do become obstructed: go in and manually irrigate to dislodge clot - very uncomfy for pat so want avoid - messy so want stay on stop If becomes obstructed will have to manually irrigate with normal saline

Answer 34

Check the drainage tube frequently

Question 35

Symptoms are normal and will decrease May also pass small clots and tissue debris for several days

Answer 35

After catheter is removed, may experience burning on urination, urinary frequency, dribbling, leakage - catheter larger and doing lot irrigant to UT - make aware of that

Question 36

At least 2000 to 2500 mL daily - couple L fluids a day - keeps urine clear and decreases risk of UT Will decrease dysuria and keeps the urine clear Adequate fluid intake I&O very imp - keeping well hydrated

Answer 36

Increase fluid intake