Male Reproductive

After the urinary catheter is removed in the TURP client, what are 3 priority nursing actions?

Continued strict I&O. Continued observations for hematuria. Inform client brning and frequency may last for a week.

Following discharge teaching for a patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, _______________

"I should call the doctor if I have any incontinence at home."

Discharge teaching

Avoid strenuous activity and heavy lifting Blood in urine common but should get lighter Avoid ASA and NSAIDs May go home with catheter - teach cath care Urine may leak and burn for several weaks Teach double voiding Avoid decongestants Avoid bm straining No sex for 6 wks Return to work 4 wks

What is considered the most common urologic problem for adult males?

Benign Prostatic Hyperplasia (BPH)

The nurse hangs a new 3000 mL bag of irrigating fluid for a postoperative client who has had a transurethral resection of the prostate and sets the irrigation rate based on:

Color of the client's urine.

What type of physical exam needs be performed to check the prostate?

DRE

What medications should patients with BPH avoid?

Decongestants, it casues vasoconstriction so it is going to stop the flow of urine out of the bladder. Also antihistamines and diuretics.

Diagnosis of BPH?

Digital Rectal Exam (DRE) Uninalysis and Urine C&S Post-Void Residuals (PVR) CBC BUN/Creatinine Prostatic Specific Antigen (PSA) Transrectal Ultrasound (TRUS) Cytoscopy

What are the side effects of alpha-adrenergic blockers when used for BPH?

Dizziness; hypotension; tachycardia; orthostatic hypotension; sexual dysfunction

What is BPH commonly known as?

Enlarged prostate

What are the functions of the prostate?

Secrete fluids that make up portion of ejaculate that carries sperm and makes the vaginal canal less acidic. These secretions are antibacterial due to high concentration of zinc.

Complications of BPH?

Stones (calculi) in the bladder Damage to bladder Hydronephrosis Pyelonephritis Renal failure Incomplete bladder emptying UTI and sepsis

What are some alpha-adrenergic blockers?

Terazosin (Hytrin); Doxazosin (Cardura); Tamulosin (Flomax); alfuzosin (Xatral); and Silodosin (Rapaflo)

After having a transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

The client reports bladder spasms and the urge to void; bladder feels distended

A client with benign prostatic hyperplasia (BPH) doesn't respond to medical treatment and is admitted to the facility for surgical intervention. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for treatment of BPH?

Transurethral resection of the prostate (TURP)

What labs need to be run to check prostate?

Urinalysis and PSA

S/S of BPH?

Urinary frequency / urgency / dysuria Nocturia / incontinence Decrease in force of urinary stream Difficulty initiating urination Intermittency (stopping and starting) Dribbling at end of voiding Incomplete emptying of the bladder (retention) Prostate gland is enlarged & rubbery

What are examples of 5 alpha reductase inhibitors?

finasteride (Proscar) and dutasteride (Avodart)

The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml?

600

A 55-year old client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate

Answer A. TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; they all require an incision.

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? a. The urine in the drainage bag appears red to pink. b. The client reports bladder spasms and the urge to void. c. The normal saline irrigant is infusing at a rate of 60 drops/minute. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

Answer B. Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. The nurse is aware that the following nursing interventions is appropriate? a. Tell the client to try to urinate around the catheter to remove blood clots. b. Restrict fluids to prevent the client's bladder from becoming distended. c. Prepare to remove the catheter. d. Use aseptic technique when irrigating the catheter.

Answer D. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. Encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician's order.

Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching? A. TURP is the most common operation for BPH. B. Explain the purpose and function of a continuous bladder irrigation system. C. Expect bloody urine, which will clear as healing takes place. D. He will be pain free.

D Surgical interventions involve an experience of pain for the client which can come in varying degrees. Telling the pain that he will be pain free is giving him false reassurance.

A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because he is afraid it might affect his ability to have intercourse. Which action should the nurse take?

Teach that ED is not a common complication following a TURP.

Testicular Cancer Clinical Presentation

Testicular Cancer Clinical Presentation Painless mass or swelling of the gonads (50%) This causes delay in diagnosis (most young men brush it off) Scrotal pain in 30-40% (can be misdiagnosed as epididymitis= infection) Signs or symptoms from metastatic dx (20%) Gynecomastia (5%)

Prostate Surgery: Long-term Complications

1) retrograde ejaculation (semen enters bladder instead of penis) 2) sexual dysfunction (may take one year for function to return) 3) urinary incontinence (alleviation: Kegels, increase fluids--may take one year for continence)

Treatment options for prostate cancer

1) watchful waiting 2) prostatectomy, 3) radiation (external beam--for CA confined to prostate--almost as good as surgery--done over several visits) or (brachytherapy--one time tx) 4) cryotherapy, 5) hormone therapy: androgen deprivation 6) orchiectomy (removal of testes): when mets as testosterone stimulates cancer growth; may be done alone or with prostate removal 7) chemotherapy (poor response; reserved for mets usually)

What are the 2 complications of BPH?

Acute Renal Failure - Bladder is getting so full it's backing up into the kidneys. Hematuria - you're having to strain so hard that you cause inflammation

Prostate Cancer: Diagnostic

Elevated PSA (normal is 0-4 ng/mL), a glycoprotein, is not indicative of cancer; SCREENING: consistently elevated PSA with abnormal DRE indicates biopsy. Biopsy of tissue + transrectal ultrasound is only definitive diagnosis

What are the 2 most common surgeries for BPH?

Transurethral microwave therapy (TUMT) and Transurethral resection of the prostate (TURP).

TUMT

Transurethral microwave therapy - destroys excess prostate tissue with heat therapy

TUNA

Transurethral needle ablation Localized necrosis of prostate tissue with thermal treatment

TURP

Transurethral resection of the prostate Removal of prostate tissue through urethral wall

A 3-way indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to inflating the balloon, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution.

Radical prostatectomy

treatment option for prostate cancer; the entire prostate gland, seminal vesicles and part of the bladder neck (ampulla) are removed. There are three approaches—retropubic (abdominal with lymphectomy), perineal( no lymph node resection, requires careful dressing changes), & suprapubic. TWO MAJOR COMPLICATIONS: 1) ED 2) urinary incontinence

What are the 3 main symptoms of BPH?

Frequency, urgency, and nocturia

When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation, which information will the nurse include?

Bladder irrigation prevents obstruction of the catheter after surgery.

Testicular Cancer Risk Factors

Cryptochordism, prior testicular cancer or family hx; race (Caucasian 5X greater risk than African American)

After a transurethral resection of the prostate (TURP), a patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which action should the nurse take first?

Manually instill and then withdraw (irrigate) approximately 60 mL of saline into the catheter.

Post op care

Monitor catheter and urinary drainage Catheter irrigations Monitor urinary status after cath removal Strict I and O Monitor incisions, dressings, bleeding Pain management - bladder spasms common Increased fluids to 2-3 liters a day Monitor for fluid excess and hyponatremia (turp syndrome - decreased sodium and hct, bradycardia, nausea, confusion - due to absorption of irrigating fluid during and after surgery. Call md immediately) Cardiac dysrythmias and seizures

BPH vs Prostate Cancer: Differences

Prostate cancer is an androgen-dependent adenocarcinoma (starts in peripheral tissue) and BPH is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue (in internal portion of prostate). Prostate cancer tends to form on the outside of the prostate while BPH is on the inside of the prostate causing constriction of the urethra. A combination of PSA and DRE can exclude prostate cancer as a diagnosis. BPH by DRE is symmetrically firm (rubbery) and enlarged prostate. Prostate cancer by DRE are characteristically hard, nodular, and irregular. Biopsy of the prostate with analysis of the tissue provides the most definitive diagnostic procedure.

BPH is thought to be from what?

Thought to be from endocrine changes associated with the aging process Overgrowth of prostatic tissue leading to compression of the urethra

BPH is thought to be from what? Thought to be from endocrine changes associated with the aging process Overgrowth of prostatic tissue leading to compression of the urethra

Thought to be from endocrine changes associated with the aging process; overgrowth of prostatic tissue leading to compression of the urethra

What category are 5 alpha-reductase inibitors?

X, women can't touch or dispense them.

BPH Treatment

watchful waiting Medication (alpha blockers, 5a-reductase inhibitors Minimally invasive procedures (TUMT, TUNA, etc.) Surgical removal of prostate tissue