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30 Cards in this Set

  • Front
  • Back
Prostate Anatomy
Walnut sized gland below bladder
Part muscle, part gland
Secretes seminal fluid
Normally 20gms, surrounds the urethra
Divided in 3 zones; peripheral, transitional and central
Definition of BPH
Enlargement of the prostate gland
Hypertrophy: increase in size of cells
Hyperplasia: increase in the number of cells
Increase in number of stromal and epithelial cells in inner prostate
Can double or triple in size
Incidence of BPH
Rarely occurs in men <40 years
50% of men >50 years are affected
80% of men >80 years are affected
25% of men will need surgery by 80
Pathophysiology
Cellular overgrowth blocks urethra
No relationship between size of prostate and degree of obstruction
Obstruction can be partial or complete
Complete obstruction requires medical treatment immediately
Urinary Obstruction Complications
Hydronephrosis - stretching of the renal pelvis
Hydroureter - stretching of ureter wall "Fishhooking" of ureter
Thickening of bladder wall
Urinary tract infections
Renal damage leading to kidney failure
Clinical Manifestations
Usually begin gradually and advance as obstruction becomes worse
Two classes of symptoms:
Classic voiding symptoms
Irritative symptoms
Classic Voiding Symptoms
Decreased force and caliber of stream
Difficulty initiating urination
Intermittency
Dribbling at end of urination
Incomplete bladder emptying because of obstruction
Irritative Symptoms
Urinary frequency
Urgency
Dysuria
Bladder pain
Nocturia
Incontinence
Diagnostic Studies
History and physical exam
Digital rectal exam (DRE)(Men over forty)
Urinalysis
Prostate specific antigen - may or may not be elevated
Transrectal ultrasound (TRUS)
Uroflometry
Treatment
Based on severity of American Urological Assoc. Symptom Index (AUA symptom index score)
See attached table
-Mild: 0-7
-Moderate: 8-19
-Severe: 2-35
Helps determine appropriate treatment
Treatment
Mild BPH:
Watchful waiting
Self-care behavior modifications such as: avoiding alcohol, spicy foods, caffeine, decongestants, liquids late at night and making sure to void regularly (timed)
Treatment
Moderate BPH - between 12-26 on AUA
Medical interventions:
May require intermittent or indwelling catheterization
Medications:
Alpha blockers
5-alpha-Reductase inhibitors
Alpha Adrenergic Receptor Blockers
Alpha blockers work by promoting smooth muscle relaxation
Facilitates urinary flow through urethra
50-70% efficiency
-Tamsulosin (Flomax)
-Doxazosin (Cardura)
-Terazosin (Hytrin)
5 Alpha-reductase Inhibitor
(Used for larger prostates)
Decreases size of prostate by blocking hormone(s) - needed for prostate tissue growth
40-50% effective, takes 3-6 months
Finasteride (Proscar)
Dutasteride (Duagen)
See attached
Saw Palmetto
Herb can decrease S&S of BPH
Compare with effect of Proscar
Few SE
Not regulated
Not standardized
Other Treatments
TUMT (Transurethral microwave thermotherapy)-
*Reduce urinary frequency, urgency, straining, intermittent urine flow
TUNA (Transurethral needle ablation)
*also reduces urine outflow problems
Invasive Therapy
Indicated when medical therapy ineffective and:
*Decreased urine flow causing pain
*Persistent urinary retention
*Hydronephrosis - stretching of the renal pelvis as a result of obstruction to urinary outflow
Usually TURP
Resectoscope
Instrument inserted through resectoscope to remove the prostate gland
TURP - Transurethral Resection of Prostate
General Anesthesia
Resectoscope through penis
Narrowed area of urethra is cut
Pieces of tissue are flushed out of the bladder after surgery
NO INCISION
Other surgeries
Laser Surgery
*Same approach as TURP
*Compared to Turp=decreased blood flow and quicker recovery
Open Prostatectomy (Prostate Cancer)
*suprapubic
*retropubic
Preparation for Surgery
Restore urinary drainage (foley in place)
Pre-operative antibiotics
Encourage fluids
Client education re: post-op complications
TURP Post-op Complications
Bleeding and clots (foley catheter with irrigation running)
Bladder spasms (increase irrigation)
Urinary incontinence
Infection (urine-cloudy)
Bloody urine is normal after a TURP - watch for hemorrhage
Bleeding
Client will have foley or 3-way foley
Continuous bladder irrigation (CBI)
*monitor output, notify MD if output is less then amount of irrigation solution
*monitor for hemorrhage - drainage will be blood tinged or have clots, not frank blood
*Should be closed system, maintain sterility
Urinary Incontinence
Common, but distressing
Sphincter tone is poor after surgery
Teach kegal exercises
Improvement may take place over weeks to months
Bladder Spasms
Common after surgery
Distressing symptom - result from irritation of bladder mucosa
Medications:
*Belladonna
*Opium suppositories (NO other rectal medications or procedures!)
*Oxybutin (Ditropan) - spasms
Infection
Monitor for infection:
External wound - with open prostatectomy
Urinary tract infection - greater risk due to indwelling urinary catheter
Ensure adequate fluid intake 2-3 liters per day if not contraindicated
Newer Treatments
Used when drug therapy is ineffective and client is not a surgical candidate:
*Balloon urethroplasty
*Prostatic urethral stents
Home Care Instructions
Teach client not to lift >5lbs
Avoid prolonged periods of travel
No rectal procedures, avoid straining
Surgeon needs to approve:
-Resumption of sexual activity
-Driving
-Stair climbing
Home Care Instructions
Retrograde ejaculation due to sphincter trauma is common and reversible
Possibility of erectile dysfunction
May experience decreased self-esteem or loss of client's sex role
May need sexual counseling and offering of treatment options
Summary of Nursing Role
Post-op assessment
True urinary output
Monitor 3-way irrigation infusion
Monitor for clots, hemorrhage
Monitor for s/s infection
Assess wound drainage
Interpret test results
Educate client and partner re: home catheter care
Psychosocial needs