21 terms

Benign Prostatic Hyperplasia (BPH)

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Benign Prostatic Hyperplasia
Age-related, common, nonmalignant enlargement of the prostate gland
Benign Hyperplasia begins at 40-45 y.o. thru rest of life
Estimated > 50% of men over 60 have BPH
Manifests as urinary dysfunction
Benign Hyperplasia
Increased number of cells, nonmalignant
Risk Factors
Age
Family hx
Race
Diet high in meat and fats
Necessary Preconditions
> 48 y.o.
Presence of testes
Pathophysiology
↑ sensitivitiy to DHT (testosterone)
Estrogen sensitizes prostate to effects of DHT
Begins as small nodules in periurethral glands (inner layer of prostate)
Prostate enlarges thru formation/growth of nodules (hyperplasia) and enlargement of glandular cells (hypertrophy)
Manifestations
Enlarged prostatic tissue compresses urethra and obstructs urine outflow.
Detrusor muscles hypertrophy to conpensate for increased resistance
Chronic urinary retention
Overflow incontinence
Complications
Happen if enlarging mass is not reduced
↑ bladder distention
Diverticula (outpouchings) in bladder wall
Ureter obstuctions
Infection in bladder may go to kidneys
Hydroureter, hydronephrosis, renal insufficiency
Diagnostics
DRE - Digital rectal exam - Prostate enlarged, asymmetrical
UA - WBC, RBC & bacteria
Blood - Creatinine for kidney damage
Prostate-specific antigen (PSA) - Rule out prostate cancer
Uroflometry - Determine degree of urinary obstruction
Post-Voide Cath - Residual >100 mL is considered high
US
Cystoscopy
Proscar (finasteride)
Antiandrogen agent that inhibit converstion of destrosterone to DHT and cause enlarged prostate to shrink
SE: Impotence, ↓libido, ↓volume ejaculate
Crushed tabs not handled by pregnant women!
Only effective if prostate is 40mL or greater in size
Androgen
Increases hyperplasia
DHT is an androgen
Flomax, Cardura
Alpha-adrenergic blockers
Blocks excessive smooth muscle contraction
Results in decrease straining on urination
May cause orthostatic hypotension
Nonsurgical Managment
Heat
Balloon dilation - Intro balloon tipped cath inserted into urethra, inflated to stretch urethra
Laser ablation
Sents or coils in prostatic urethra
Saw Palmetto - plant, herbal remedy
Surgical Interventions
Transurethral microwave thermotherapy - heat and destroy excess prostate tissue
Transurethral needle ablation (TUNA) - Radio frequencies to burn away enlarged area
Transurethral resection of prostate (TURP) - Resection thru penis (uretra)
Transurethral incision of prostate (TUIP) - Small incision in smooth muscle where prostate is attached to bladder, gland split, nothing removed. Outpatient.
Retrograde Ejaculation
Semen redirected to urinary bladder, instead of being ejaculated out the urethra
Transurethral resection of prostate (TURP)
Resection of prostate thru penis (uretra) -
Rarely = ED
Retrograde ejaculation
No abdo incision
Safer
Shorter stay
Lower morbidity rate
Less pain
Requires highly skilled surgeon
Recurrent obstruction, urethral trauma, and stricture may develop.
Delayed bleeding may occur
RN: Monitor for hemorrhage, S/S urethral stricture, dysuria, strainig, weak urinary stream
TURP Syndrome
Post-op TURP w/Continuous bladder irrigation
Body absorbs irrigant causing fluid shift and dilutional hyponatremia
S&S = Bradycardia, N/V, Low sodium, Low Hbg & Hct, Volume excess - hypertension and confusion
Monitor Urine Characteristics
Post-op = Urine clear to pale pink
Light red to red = Normal day of surgery and first post op day, should be pale pink 24 post surgery
Very dark red, Bright red = Check CBI rate to prevent obstruction, VS, inform doctor
Blood clots = Occasional is normal, increase CBI rate to prevent obstruction
RN Diagnoses
Pre = Anxiety, Acute Pain, Deficient Knowledge
Post = Acute Pain, Deficient Knowledge
RN Planning
Tx based on severity
Monitor meds including pain meds
Encourage fluids
Avoid drugs w/SE of urinary retention
Monitor VS & temp
DVTs
Infection
Signs of hemorrhage = Bladder spasms & frank bloody output
RN Teaching
Sex 6 wks postop helps ↓ prostatic congestion
Fluids slowly, no big amounts at once to avoid bladder distension
↑ Fluids to 2000-3000 mL daily
Urinate at first urge
Avoid drugs that cause urinary retention = Anticholinergics, antidepressants, decongestants, tranquilizers
RN Evaluation
Voids w/o difficulty
Steady stream
Free of S&S of UTI
Understands meds
Increases intake
Lists class of drugs that cause retention
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