Week 9 BPH

Question 1

What is BPH?

Answer 1

Enlargement of the prostate gland

Question 2

What is PSA level?

Answer 2

• Blood work that is taken from a patient

- PSA will increase if theres something going on with the prostate and it needs to be investigated further

Question 3

What is BPH pathology?

Answer 3

• there is an increase in number of epithelial cells in the inner part of the prostate and because of that it compressed the urethra
• non- malignant and not cancerous

Question 4

What are the treatments for BPH

Answer 4

removing part of the tissue that is compressing the urethra

Question 5

what is the main problem with BPH?

Answer 5

Obstruction

Question 6

what usually brings the patient to see the Doctor?

Answer 6

Patient having problem urinating. Patient will have problem with frequency, dribbling, and continents

Question 7

What are the S&S of BPH?

Answer 7

Urinary elimination symptoms

• frequency
• dribling
• decrease urinary stream force
• UTI symptoms

Question 8

How is BPH Diagnosed?(3)

Answer 8

• PSA level blood work
• Digital rectal exam
• TRUS scan and biopsy

Question 9

PSA level result

Answer 9

Higher = BPH

Question 10

Who can do Digital rectal exam

Answer 10

Nurse Practitioner or Doctor

Question 11

what is the result for rectal exam if patient have BPH?

Answer 11

• Prostate feels abnormal

- If patient have BPH the prostate will feel symmetrically large, firm and smooth

Question 12

How does TRUS scan used to DX?

Answer 12

Tissue is taken and sent off the see if its cancerous or just normal
BPH

Question 13

how does TRUS scan work?

Answer 13

Ultrasound probe is inserted to the anus and with the probe, they can send a bot of needle biopsy through and take a tissue sample

Question 14

What does is mean by watch-full waiting?

Answer 14

Can use lifestyle changing or medication treatments

Question 15

what type of lifestyle changes does person with BPH should do (3)

Answer 15

• Decrease/ avoid caffeine
• Avoid decongestants and anticholinergics
• restrict fluid in the evening to reduce peeing

Question 16

What kind of meds are used for BPH treatments? (2)

Answer 16

• 5a reductase inhibitor (Proscar)

- a- adenergic receptor blocker (Flomax)

Question 17

what does 5-a reductase inhibitor ( Proscar ) do?

Answer 17

Decrease size of prostate gland.

Question 18

How long does proscar work?

Answer 18

Takes 6 months

Question 19

what does a - adenergic receptor blocker (Flomax) do?

Answer 19

Promotes smooth muscle relaxation and helps facilitate urine flow.

Question 20

what is the improvement time and rate of Flomax?

Answer 20

• 50-60% improvement just after taking 2-3 weeks.

Question 21

What is minimally invasive therapy?

Answer 21

its an outpatient procedure - takes only a day

Question 22

What kind of minimally invasive procedures are done for BPH? (3)

Answer 22

1) Transurethral microwave thermotherapy
2) Transurethral needle ablation
3) laser prostectormy

Question 23

what is transurethral microwave thermotherapy

Answer 23

• uses microwaves and putting them directly to the prostate trough a probe.
• the heat of the microwave causes death of prostate tissue which relieves the obstruction

Question 24

Post - procedure of transurethral microwave thermotherapy

Answer 24

• patient will go home with indwelling foley 2-7 days to make sure the flow of urine continues out and to facilitate the passing of small clots or necrotic tissue
• patient is given antibiotics, pain medications and anti spasm

Question 25

transurethral needle ablation

Answer 25

- uses low wave radio frequency through a needle at a high temperature - it uses a needle to go through the transurethra ( goes through urethra) and uses the needle to to locally burn off or cause necrosis to the prostate.

Question 26

post procedure of transurethral needle ablation

Answer 26

- Patient will have foley for a short time. | - patient can also have hematuria for about a week due to burning

Question 27

laser prostatectomy

Answer 27

- laser is used for cutting, coagulation, and vaporization of prostatic tissues.

Question 28

laser prostatectomy post op

Answer 28

- takes several weeks for optimal effect | - patient will go home with foley for a few days

Question 29

What are the invasive therapy? (2)

Answer 29

- Transurethral resection of the prostate (TURP) | - Prostectomy

Question 30

what is prostectomy?

Answer 30

Removal of the prostate

Question 31

what is Transurethral resection of the prostate (TURP)

Answer 31

- Known to be the "goal standard' of treatment - surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. ( NO EXTERNAL INCISION) - it is done with general or spinal anaesthesia - They excise and cauterize obstructing prostate tissue

Question 32

Is TURP good for older adults?

Answer 32

No, because it is very invasive and risky

Question 33

TURP post op

Answer 33

- patient will have 3- way foley catheter with 30mL ballon to provide hemostasis and to facilitate urinary drainage. - Bladder is irrigated for the first 24hrs, the bladder is either irrigated continuously or intermittently, to prevent obstruction from mucus and blood clots.

Question 34

what is the outcome of TURP?

Answer 34

the outcome for 80 - 90% is excellent, with marked improvement of symptoms and urinary flow rates.

Question 35

What is complication of TURP?

Answer 35

-Bleeding!!

Question 36

Continuous bladder irrigation

Answer 36

- Constant flush of normal saline which is irrigating solution - whatever is in the bladder will drain out to the drainage bag

Question 37

Continuous bladder irrigation important things to do (4)

Answer 37

- keep an eye on the solution on the top (3L) - There is a clamp to change rate of irrigating fluid going into the bladder - Watch closely of the drainage bag. we need to see that the bladder is constantly draining out both urine - Look at the contents of drainage bag. Note colour, blood and clots.

Question 38

TURP POST OP Care (5)

Answer 38

- Manage pain - Mange continuous bladder irrigation - I&O - Control Bladder spasms - Follow-up care

Question 39

what is the normal urine colour after TURP?

Answer 39

Pinkish or pink is normal. if theres frank blood then we need to call the doctor because its bleeding

Question 40

Bladder irrigation clamps rate

Answer 40

- A rapid infusion can cause bladder spasms | - Slow infusions will not prevent clot formations

Question 41

what do we do if 3 way folley is clotted?

Answer 41

1) stop irrigation with roller clamp | 2) flush bladder through foley

Question 42

why do we tell patient not to void around catheter?

Answer 42

it can result in increase spasms which can increase pain

Question 43

why is monitoring I&O hard for 3 way foley?

Answer 43

- because its not just urine coming out. theres also some irrigating fluid. - its not going to be accurate

Question 44

what else do we have to monitor when patient had TURP?

Answer 44

Monitor for BUN and Cr for kidney and do a bladder scan if worried about distention

Question 45

what is good to give for bladder spasms after TURP

Answer 45

- Ditropan | - start patient with flomax to help urine flow better

Question 46

what do patient that had TURP have to avoid

Answer 46

- avoid activity that increase intra abdominal pressure which increase chances of bleeding ( sitting or walking for prolonged time) - avoid heavy lifting over 4.5 kg - avoid straining - use stool softener - avoid sexual intercourse - avoid driving - avoid climbing the stairs - avoid travelling Avoid all until doctor approves

Question 47

what does patient have to do if theyre having urinary continence or poor sphincter control? (Post foley removal)

Answer 47

- kegel exercise - limit fluids 2-3h before bed - avoid bladder irritants such as coffee and tea, citrus juice and alcohol - void immediately when they have urgency to void