Rectal Exam
Make sure pts void before rectal exam. They’ll feel like they have to urinate even if they don’t have to.
Prostate Carcinoma
- Stone hard, regular fixed nodules. As prostate gland grows, it obstructs the urethra so they have trouble urinating.
- Normal prostate is moveable
Bladder stones
Bladder stones can develop when urine sits in the bladder. Overflow incontinence occurs. It causes dribbling of urine. The inability to void is an emergency.
You do which test to determine which organ and what antibiotics to use, and if the antibiotic is working?
Culture and sensitivity
PSA: prostate specific antigen
P-rostate-specific antigen (PSA) is a protein produced by the prostate and found in the blood.
-If the PSA level is high for your age or is steadily increasing (with or without an abnormal physical exam), a biopsy may be recommended.
What tests kidney function?
BUN and Creatinine
Why do a C&S of prostatic fluid?
To check for prostatitis
First line therapy for BPH and why
5-alpha reductase inhibitor (5-ARI), because high DHT levels cause prostate to enlarge. These drugs block the conversion of testosterone to DHT, so levels fall and the prostate shrinks. It takes a long time for a pt to feel effects. Maybe 6 months>leads to noncompliance. Tell them not to stop. SE: erectile dysfunction, decreased libido, dizziness, orthostatic hypotension
-Dutasteride (Avodart), Finasteride (Proscar)
Alpha-1 selective blocking agents for BPH
Alpha 1s are in smooth muscle of prostate glands, also in peripheral muscle vessels. Causes smooth muscle relaxation and vasoconstriction. Take pill at bedtime to sleep through bad
SE: Don’t take viagra bc it also vasoconstricts, it could be nonreversible.
-Tamulosin (Flomax), Doxazosin (Cardura), Terazosin (Hytrin
CAM therapy for BPH
Saw palmetto extract: studies haven’t shown effectiveness. Make sure pt knows that if they take that it may not work. Warn them about drug interactions.
Thermotherapy for BPH
Outpatient technique using heat to destroy tissue, temporary fix. .p. 1635
Hydronephrosis
Swelling of fluid backing up in kidneys
TURP
Transurethral Resection of the Prostate
- Surgeon inserts a resectoscope through the urethra and into the bladder and removes pieces of tissue from the prostate gland.
- Not a permanent fix. It could grow again and have to be removed again.
- Turps don’t cause sexual dysfunction, neither does prostatectomy
Preop for TURP
- Correct misconceptions
- Assess anxiety
- Anesthesia – usually epidural and spinal anesthesia
- Prepare pt for postop indwelling uretheral catheter and urge to void
2 misconceptions with prostate surgery
Erectile dysfunction (nerves) and incontinence (sphincters)
Post op for TURP
see p. 1636 Chart 75-1
Critical Rescue – monitor urine output, VS, pain
Arterial bleed
Bright red urine, not good, may have clots in it. Admin more fluid to flush it out, call surgeon if it doesn’t stop. Venous blood would be brown.
Where can prostate cancer spread?
Lymph nodes, lungs, pelvis, and liver.
What increases the risk for prostate cancer?
Family history in first degree relatives
Assessment of Prostate Cancer
Bladder outlet obstruction symptoms Hematuria Nocturia Pain during intercourse Other pain (bone pain – pelvis, spine, hips) Unexpected weight loss Swollen lymph nodes in groin Digital Rectal Exam Psychosocial assessment PSA Transrectal ultrasound
Early stage Prostate Cancer
“Watchful waiting”
- TURP if obstruction
- Surgery for cure
Home care and management for Prostate Cancer
- Collaborate with case manager, home care nurse, and other care providers
- Urinary catheter care p. 1641
- Activity
- Shower, don’t bathe
- Refer to health care resources
- American Cancer Society’s Man to Man program
- Us TOO International (www.ustoo.com)
- Prostate Cancer and Support Network
- Prostate Cancer Foundation
- National Prostate Cancer Coalition
Advanced dz Prostate Cancer
Palliative surgery: bilateral orchiectomy
Nonsurgical management for Prostate Cancer
- Radiation Therapy
- Drug Therapy
- Hormone Therapy
- Chemotherapy
