L7 Flashcards
(28 cards)
Function of prostate
- Secrete seminal fluid
(Neutralise acidic vaginal environment; Provide carbohydrate and nutrients for sperms) - Prevent retrograde ejaculation
(Prostate close off the bladder neck during sexual climax)
Pathophysiology of benign prostatic hyperplasia
Age and hormonal related:
- dihydrotestosterone (DHT): metabolite of testosterone and mediator of prostatic growth
- increased estrogen level
Complications of benign prostatic hyperplasia
- Acute retention of urine
- Urinary tract infection
- Hydroureter (dilated ureter); Hydronephrosis
- Renal failure
- Bladder stones
- Incontinence
- Bleeding
- Difficulty in catheterization (compressed urethra)
Lower urinary tract symptoms
- Increased urination frequency and emergency; Nocturia
- Decreased and intermittent force; Reduced volume of urine
- Sensation of incomplete bladder emptying; Abdominal straining with urination
- Dribbling
Digital Rectal Examination
Assess prostate gland size, nodularity, mass, surface, tenderness, and anal tone
Size > 2 fingerbreadths
—> benign prostatic hyperplasia
Uroflowmetry
Monitor the flow of urine and assess the urinary tract functions
Urethrocystoscopy
Examine the inside of the bladder, urethra and prostatic urethra
Blood test
Test for Prostate Specific Antigen (PSA)
—> elevated in patient with benign prostate hyperplasia or prostate cancer
(Normal: < 4 ng/mL)
Further investigation, e.g. biopsy, to rule out prostatic cancer
Medical therapy
- Alpha-adrenergic blocker
- relax smooth muscle of the bladder neck and prostate to improve urine flow
- side effects: headache, dizziness, postural hypotension, fatigue, rhinitis, sexual dysfunction - 5-alpha reductase inhibitor
- prevent the conversion of testosterone into dihyrotestosterone (DHT) to reduce prostate size
- side effects: decreased libido, ejaculatory and erectile dysfunction, gynecomastia男性乳房發育症, flushing發紅
Surgical indications
- Acute retention of urine
- Recurrent gross hematuria
- Urinary tract infection
- Renal insufficiency secondary to obstruction
- Failure of medical therapy
Surgical for benign prostate hyperplasia
- Transurethral resection of prostate
(Remove inner portion of prostate) - Transurethral incision of prostate
(Reduce pressure on urethra and urethral constriction; for small prostate enlargement) - Transurethral microwave thermotherapy
(Use heat to destroy prostate tissue) - Prostatectomy
(Remove inner portion of prostate; for patient cannot position for transurethral and have very large prostate)
Pre-op care for transurethral resection of prostate
- Fasting for 8 hours; establish IV access
- Withhold anticoagulant
- Encourage fluid intake if no contraindications
- Inform the patient of the need of catheterization for continue bladder irrigation
Post-op care for transurethral resection of prostate
- Monitor vital signs, blood test results and I&O
- Continuous bladder irrigation
- Observe for lower abdomen distention and TUR syndrome
- Ensure patency of drainage system
- Administer antispasmodic medications, and analgesic if request
TUR syndrome
The fluid used to wash the prostate area is absorbed by the bloodstream, causing fluid overload and hyponatremia
Symptoms: confusion, headache, dizziness, abdomen distention, bradycardia, SOB
Indication for bladder irrigation
- Post-genitourinary surgery
- Occlusion of the catheter by small blood clots or mucus fragment
- Urinary tract infection
Continuous bladder irrigation
Use a three-way catheter and closed bladder irrigation system
Complications: TUR syndrome
Nursing care for bladder irrigation
- Monitor vital signs and I&O
(The amount of fluid in the drainage bag must be >= to that instilled; prevent overdistention of bladder) - Observe for abdomen distention
- Assess the catheter, drainage system and the drainage/urine output Q1–2H
- Monitor for any bleeding:
Drainage colour changes from reddish pink to light pink within 24 hours - Monitor s/s of TUR syndrome
- Maintain a closed drainage system below waist level, secure in the inner thigh
- Administer the prescribed type and rate of irrigation fluid
- Assure the urge to void
Xxx change catheter without doctor’s order
Problems associated with discontinuation of bladder irrigation
- cannot regain bladder control immediately
- urination problems, e.g. frequency, urgency, burning sensation
Prostate cancer
Androgen-dependent adenocarcinoma
Risk factor for prostate cancer
Races, age, family history, excessive intake of red meat and fat
Investigation of prostate cancer
- Digital rectal examination (DRE): hard, nodular, asymmetric
- Prostate specific antigen
- Prostatic acid phosphatase: specific for prostate cancer
- TRUS biopsy
- CT scan, PET scan, bone scan, MRI: access spread of cancer
Stage II prostate cancer
Felt on DRE; Seen in imaging; Tumor confined to prostate
Stage III prostate cancer
Cancer outside prostate, possible spread to seminal vesicles
Stage IV prostate cancer
Any size, any nodal involvement, metastasis
