Kidney Stones & Benign Prostatic Hyperplasia

Interventional Procedure Extracorporeal Shock Wave Lithotripsy (ESWL)

-Break stone usually larger stone -After broken into small grains, stones are voided -High energy amplitude of pressure is generated by abrupt release of energy and transmitted thru water and soft tissues -When shock encounters substance of different intensity, a compression wave causes surface of stone to fragment

S/S of Kidney Stones

-Pain -Hematuria (from spikey stones) -N/V, diarrhea (d/t shared nerves) -Ureteral colic (back tenderness/costovertebral) -Renal colic (if pt has n/v, pain becomes acute, tenderness @ back) -Urinary retention (not much pee would come out)

Interventional Procedures Percutaneous Nephrolithotomy

-Percutaneous route into renal parenchyma -Depending on size, stone may be extracted w/ forceps or by stone retrieval basket -If stone is too large = US probe inserted thru nephrostomy tube to fragment stone

Pathophysiology of Kidney Stones

-Substance deficiencies -Dehydration -Infection, urinary stasis, immobility -Increased blood calcium -Meds (vit D, calcium supplement) -Anatomic probs (kidney deformity, inflammatory bowel disease, polycystic kidney disease) *anything that changes the gut = changes absorption

Interventional Procedures Ureteroscopy

-Visualizing stone and then destroying it -Inserting ureteroscope into ureter and then inserting laser, electrohydraulic lithotriptor, or US device thru ureteroscope to fragment stones -Stent placed in for 48 hrs+ to keep ureter patent

Pharm Therapy

Alpha-adrenergic blockers: relax smooth muscle of bladder neck and prostate (improves urine flow and relieves s/s of BPH) S/E: dizziness, HA, fatigue, postural hypotension, rhinitis, sexual dysfunction 5-Alpha-reductase inhibitors: prevent conversion of testosterone to DHT and decrease prostate size S/E: libido, ejaculatory dysfunction, gynecomastia

Surgical Management Surgical Resection

Another choice for pts w/ mod to severe lower UT s/s of BPH and for those w/ acute urinary retention Transurethral resection of prostate (TURP)- resection of prostate thru endoscopy; instrument is introduced directly thru urethra to prostate, and gland is then removed in small chips w/ an electrical cutting loop ^surgical tx for BPH ^tissue becomes necrotic Transurethral electrovaporization- one/two cuts made in prostate to reduce constriction of urethra and decrease resistance to flow of urine out of bladder; NO tissue removed Open prostatectomy- remove entire prostate, seminal vesicles, vas deferens

Types of Kidney Stones

Calcium Stones (mainly this) Uric Acid Stones Struvite Stones Cystine Stones

Define Kidney Stones

Calculi stones found anywhere in urinary tract

Dx Tests for Kidney Stones

Confirmed through noncontrast CT scan Blood chemistry & 24 hr urine test- measure calcium, uric acid, creatinine, sodium, pH, and total vol Chemical analysis- determine stone composition

Pathophysiology of Benign Prostatic Hyperplasia

Dihydrotestosterone (DHT), a metabolite of testosterone, is important for prostatic growth Estrogens play a role in cause BPH; usually occurs when men have elevated estrogen levels and less responsive to DHT

Goal of Kidney Stone

Get rid of stone Determine stone type Prevent kidney damage Control infection Relieve any obstruction

Med Management

Immediate cath w/ stylet or metal cath Cystostomy- incision into bladder to provide urine drainage Watchful waiting for mild s/s

S/S of BPH

Increased urinary freq Urgency Decreased force of stream Hesitancy Abd straining w/ urination Nocturia Dysuria Hematuria Double/triple voiding Recurrent UTIs Normal <50 mL Large residual vol = leads to azotemia (accumulation of nitrogenous waste products) & kidney failure

Nutrition Therapy for Oxalate Stones

Limit oxalate Diluted urine Foods that contain oxalate: spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran

Nutrition Therapy for Cystine Stones

Low protein Fluids

Nutrition Therapy for Uric Acid stones

Low-purine diet (reduce excretion of uric acid) Foods high in purine are shellfish, anchovies, asparagus, mushrooms, organ meats, some proteins Allopurinol (to reduce serum uric acid and urinary uric acid excretion)

Define Benign Prostatic Hyperplasia

Noncancerous enlargement or hypertrophy of prostate

Nutrition Therapy for Kidney Stones Calcium Stone

Restrict calcium diet except for type II absorptive hypercalciuria Fluid Thiazide diuretics (reduce calcium and lowers PTH) Ammonia meds

Risk Factors for BPH

Smoking Heavy alcohol Obesity Reduced activity level Age HTN Heart disease or DM Diet

Surgical Management Minimally Invasive Therapy

Transurethral microwave thermotherapy (TUMT) involves application of heat to prostatic tissue Transurethral probe inserted into urethra and microwaves are directed to prostate tissue *Targeted tissue becomes necrotic and sloughs *Minimize damage to urethra

Other Minimally Invasive Therapy

Transurethral needle ablation- uses low-level radiofrequencies delivered by thin needles placed in prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues *Prostatic stents = significant complications

Dx of BPH

Urinalysis to screen for hematuria and UTI PSA (prostate specific antigen) usually elevated Digital Rectal Exam (DRE) reveals large, rubbery, and nontender prostate gland Post-void residual vol- assess what's left in bladder postvoid Cytoscopy- ?