Week 9 - BPH

Question 1

what is benign protastic hyperplasia (BPH

Answer 1

• enlargement of the prostate gland d/t an increase in the number of epithelial cells & amt of stromal tissue

Question 2

what are causes of BPH

Answer 2

• thought to be associated w endocrine changes associated w aging

Question 3

what are risk factors for BPH (4)

Answer 3

• FHx
• enviro
• diet
• obesity

Question 4

describe the impact that diet has on BPH

Answer 4

• high in fruits & veggies = lower risk

- high in zinc, butter, and margarin = higher risk

Question 5

what does BPH lead to

Answer 5

• compression of the urethra = partial or complete obstruction

Question 6

the symptoms of BPH result from?

Answer 6

• urinary obstruction

Question 7

describe symptoms of BPH

Answer 7

• gradual onset
• may not be noticed until BPH has been present for some time
• early symptoms = minimal bc bladder can compensate for a small amt of resistance
• symptoms worsen as degree of urethral obstruction increases

Question 8

what are the 2 groups of symptoms of BPH

Answer 8

• obstructive

- irritative

Question 9

what are obstructive symptoms of BPH (4)

Answer 9

• decrease in calibre and force of urinary stream
• difficulty in voiding
• intermittency (stoppinf and starting the stream several times while voiding)
• dribbing at the end of urination

Question 10

what are irritative symptoms of BPH (6)

Answer 10

• urinaru freq
• urgency
• dysuria
• bladder pain
• nocturia
• incont

Question 11

complications d/t BPH result from

Answer 11

• urinary obstruction

Question 12

what are complications of BPH (7)

Answer 12

• acute urinary retention
• UTI (d/t incomplete bladder emptying)
• sepsis secondary to UTI
• calculi in the bladder (d/t alkalinization of residual urine)
• hydronephrosis
• pyelonephritis
• bladder damage

Question 13

what is included in diagnostic studies for BPH (10)

Answer 13

• history
• physical exam
• digital rectal exam
• urinalysis w culture
• PSA lvl
• creatinine (to rule out renal insufficiency)
• TRUS
• uroflowmetry
• cystourethroscopy
• post-void residual volume

Question 14

why is DRE used as a diagnostic for BPH

Answer 14

• the prostate can be palpated using DRE

- can estimate the size, symmetry, and consistency of the prostate gland

Question 15

describe the prostate gland during BPH (3)

Answer 15

• symmetrically enlarged
• firm
• smooth

Question 16

what is PSA

Answer 16

• prostate specific antigen

Question 17

why is PSA measured w BPH

Answer 17

• to rule out prostate cancer

- however, PSA may be slightly elevated w BPH

Question 18

what is a TRUS scan

Answer 18

• transrectal ultrasonography
• US that allows for accurate assessment of prostate size
• helpful in differentiating between BPH and prostate cancer

Question 19

what is a uroflowmetry? why is it useful?

Answer 19

• study that measures the vol of urine expelled from the bladder per second
• determines the extent of urethral blockage and thus the type of treatment needed

Question 20

what is a cystourethroscopy

Answer 20

• a procedure allowing internal visualization of the urethra and bladder

Question 21

what are the goals of collaborative care for BPH (3)

Answer 21

• restore bladder drainage
• relieve pt’s symptoms
• prevent complications of BPH

Question 22

what is treatment of BPH based on

Answer 22

• the degree to which symptoms bother the pt

- presence of complications

Question 23

what is included in collab care for BPH (5)

Answer 23

• “watchful waiting”
• lifestyle changes
• drug therapy
• invasive therapy
• minimally invasive therapy

Question 24

what lifestyle changes are included in treatment of BPH (4)

Answer 24

• dietary changes
• avoid certain meds
• restrict evening fluid intake
• timed voiding schedule
• urinate every 2-3 hr and when first feeling the urge
• maintain fluid intake at normal lvl (prevent dehydration or fluid retention)

Question 25

what dietary changes are included in treatment of BPH (4)

Answer 25

decrease: - caffeine and alcohol (increase symptoms d/t diruetic effect) - artifical sweeteners - spicy foods - acidic foods

Question 26

what meds should be avoided in a pt w BPH (2)

Answer 26

- decongestants (worsen symptoms bc are alpha adrenergic agonists = sm. m contraction) - anticholinergics

Question 27

what meds are used for treatment of BPH (3)

Answer 27

- 5a-reductase inhibitor - a-adrenergic receptor blockers - herbal therapy

Question 28

how do 5a-reductase inhibitors work as treatment for BPH? what is an example?

Answer 28

- decrease the size of the prostate | ex. finsteride (proscar)

Question 29

how do 5a-reductase inhibitors work as treatment for BPH? what is an example?

Answer 29

- decrease the size of the prostate | ex. finsteride (proscar)

Question 30

how do a-adrenergic receptor blockers work as treatment for BPH? what is an example?

Answer 30

- promote smooth muscle relaxation in the prostate | ex. flomax

Question 31

describe pre-op care for BPH surgery (4)

Answer 31

- urinary drainage must be restored before thru insertion of a urethral catheter (ex. coude) - antibiotics before any invasive procedure - treat any infections of the urinary tract before surgery - inform pt that it may impact sexual functioning

Question 32

what is invasive therapy for treatment of BPH

Answer 32

- involves resection or ablation of the prostate

Question 33

when is invasive treatment indicated for treatment of BPH (4)

Answer 33

- decrease in urine flow sufficient to cause discomfort - persistent residual urine - acute urinary retention - hydronephrosis

Question 34

what can temporarily reduce symptoms of BPH and bypass the obstruction

Answer 34

- intermittent or indwelling cath | should not be used long term tho d/t r/o infection

Question 35

what are 3 examples of invasive therapies for BPH (3)

Answer 35

- transurethral resection of the prostate (TURP) - transurethral incision of the prostate (TUIP) - prostatectomy

Question 36

what is TURP

Answer 36

- a surgical procedure involving the removal of prostate tissue using a rectoscope inserted thru the urethra - considered the gold standard for treatment of obstructive BPH

Question 37

how is TURP performed (3)

Answer 37

- under spinal or general anasthesia - no external incision - rectoscope inserted thru urethra

Question 38

what is done after TURP

Answer 38

- large, 3-way indwelling cath inserted thru the bladder to provide hemostasis and facilitate urinary drainage - for first 24-h, the bladder is irrigated continuously or intermittently

Question 39

why is the bladder irrigated post-TURP

Answer 39

- prevent obstruction from mucus and blood clots | - removes clotted blood from the bladder & ensure drainage of the urine

Question 40

describe how bladder irrigation is done

Answer 40

- instill 50 mL of the irrigating slution (usually NS) | - then withdraw w a syringe to remove clots that may be in the bladder and catheter

Question 41

what are potential complications post-TURP (6)

Answer 41

- bleeding & hemorrhage - clot retention - bladder spasms - urinary incont. - infection - dilutional hyponatremia d/t irrigation

Question 42

due to the potential complication of bleeding post-TURP, what must pts do

Answer 42

- d/c of aspirin or anticoagulants several days before surgery

Question 43

what is included in post-op care for BPH surgery

Answer 43

- cath and continuous irrigation - monitor inflow and outflow of irrigants - careful aseptic technique - manage pain - manage bladder spasms -

Question 44

ideally, the color of urine drainage post-op is? what color may indicate hemorrhage?

Answer 44

- light pink w no clots | - lrg amts of bright red can indicate hemorrhage

Question 45

if the outflow of irrigants is less than inflow, what should be done (2)

Answer 45

- assess the bladder | - check patency of the cath

Question 46

if the outflow is blocked post-op, what should be done

Answer 46

- stop continuous bladder irrigation and notify the physician

Question 47

blood clots are expected after prostate surgery at which time?

Answer 47

- first 24-36 hours

Question 48

FINISH