Benign Prostatic Hyperplasia

What are the postoperative risk for prostate surgery?

HEMORRHAGE INFECTION

NoNPharmacological Therapy

"Watchful Waiting" Lifestyle change -scheduled for regular checkups to monitor for early problems-

How long does a person fully regain control of their urine?

1 year with Kegal exercises.

What are the important role in providing nursing care for client diagnosed with BPH?

client education and support play

Prostatodynia

client experiences the symptoms of prostatitis buts shows no evidence inflammation or infection

What androgen mediates prostatic growth at all ages?

dihydrotestosterone (DHT) (formed in the prostate from testosterone)

Transurethral microwave thermotherapy

microwaves to heat and destroy excess prostate tissues. cooling system protects the urinary tract. 1 hour procedure can be performed on a outpatient basis DOTS NOT CURE REDUCE URINARY S/S DOES NOT CAUSE IMPOTENCE OR INCONTINENCE

Why do we teach the client postoperative not to strain?

straining to void or have a bowel movement may stimulate bladder spams an increase pain increase risk for bleeding

Diagnostic Testing

(MOST COMMON) Digital rectal examination (DRE) Several urine tests may be performed Urine flow rate test Postvoid residual urine test Pressure flow study Urinalysis Urine culture (check for blood and bacteria) **Test use to rule out other disease** PSA (prostate specific antigen (PSA)-prostate cancer Cystoscopy-other urinary symptoms

Preoperative Care

-Assess client's and family's knowledge about surgery -Teaching will reduce client anxiety related to fear of the unknown -Verify informed consent formed was signed -Wearing sequential pneumatic compression stockings -Bowel preparation with neomycin enema to cleanse the bowel

What to assess for client who had a RETROPUBIC PROSTATECTOMY

-Assess the abdominal incision for the presence of urine or increased or purulent drainage -assess urinary output from the suprapubic and the urethral catheters -Assess abdominal dressing and of from urethral catheter -Assess abdominal dressing for urinary drainage and change saturated dressing frequently -Assess residual urine by unclamping the suprapubic catheter and measuring urinary output after voiding if residual urine is 75 mL or less with several voiding, remove the suprapubc catheter.

Postoperative Perineal prostactesctomy

-Assessed perineal drainage and S/S infection -Use T-binder or padded scrotal support to hold the dressing in place Following removal of dressings: heat lamps sitz baths used to provide heat and promote healing -Teach client to perform perineal irrigation with sterile normal saline as ordered.

Home care teaching for care of fathers and drainage bags

-Change from daytime leg drainage bag to a larger night drainage bag -Avoid strapping on the leg bag too tightly -Place soft cloth between leg bag and thigh to decrease friction and to absorb dampness under the bag -Empty the leg bag every 3-4 hours during waking hours t prevent overfilling -Prompt report if changes in urine color, urine consistency, urine ordor, hematuria evidence frank bleeding, large blood clots, decrease urine output.

What should the patient be monitored for who had prostate (TURP) and should be reported to the physicians?

-Hmorrhage -Evidenced by frankly bloody urinary output, -presence of large blood clots -Decreased urinary output -Increased bladder spams.s -Decreased hemoglobin and hematocrit -Tachycardia and hypotention.

Postoperative care

-Pain manangment -Monitoring for complications Impementation of methods to prevent complications Hygiene care -Monitor vital signs closely for the first 24 hrs and regulary thereafter -client who had prostate surgery is at risk for hemorrhage and infection -Bladder spasms may be accompanied by strong urges to void and urine leakage, BELLADONNA AND OPIUM suppositories may be used to relive bladder spasms -Assist leg exercises and walking -Fluid intake 2-3 Ls a day -Explain the possibility of bladder spams, experiences as lower abdominal pressure or pain and a desire to urinate

What should be explained tot he client after the removal of the catheter?

-client may experience burning upon urination, dribbling after urination is common experience. urine may contain small blood clots after catheter removal.

What others factors are secondary to BPH that makes men candidates for surgical interventions?

-urinary retention recurrent urinary tract infection hematuria bladder stones renal insufficiency

What are some of the diagnostic tests used in assessments of BPH?

-white blood cells (WBCs) -red blood cells (RBCs) -bacterial -urinary function is assessed by measuring residual urine (amount of urine remaining in bladder after voiding) with ULTRASONOGRAPHY or POSTVOIDING CATHETERIZATION (more than 100 mL is considered high) -uroflometry (MEASURES URINE FLOW RATE; NORMALE IS GREATER THEN 14 ML/SEC; FINDINGS OF 10ML/SEC indicates OBSTRUCTION) -Creatinine levels of blood is assess for kidney damage -Prostate-specific antigen levels=obtained to rule out prostate cancer-glycoprotein produced only in the cytoplasm of benign and malignant prostate cells -Serum level corresponds it the volume of both benign and malignant prostate tissue.

When is CBI or conitnious bladder irrigation removed?

24-48 hours following surgery

If CBI is not prescribed, follow agency procedure and physician orders for irrigating the indwelling catheter.. how much irrigation should be used to irrigate to relieved obstruction or until urine is clear.

50 mL

AT WHAT AGE DOES bph SYMPTOMS MAKES ITSELF NOTICE?

70-80 less noticeable less symptoms before 40

What are the two main risk factors?

AGE PRESENSE OF TESTES

How does TURP resulted?

Absorption of irrigating fluids during and after surgery,

Medications

Alpha-blockers and 5-alpha reductase inhibitors (helps reduce pressure for urine to flow) have dramatically reduced the need for surgery to control the symptoms

the growth of the prostate is influenced by what?

Androgens and occurs mostly i the periurethral and transition zones of the prostate glands

What race develops symptoms later then white?

Asian

In BPH how is the prostate different?

Asymmetrical Enlarged

BPH patho?

Begins as small nodules in the periurethral glands which are the inner layers of the prostate. Nodules are formed from HYPERPLASIA (increased number of cells) of the stromal and epithelial cells in the prostate gland rather than hypertrophy (increase in the size of individual cells)

What is the most common benign neoplasm in men?

Benign prostatic hyperplasia

What race develop symptoms earlier than white?

Black Hispanic

What S/S indicate obstruction and bleeding

Bladder spams, urine frankly bloody contains blood clots decreased in amount.

What are the prevention that the nurse needs to do while taking the muscle relaxant (alpha-adrenergic antagonist)?

Change position slowly Taking and recording BP Checking with the healthcare provider before taking any medication for coughs, colds or allergies.

Care of the client is focused on?

DIAGNOSING THE DISORDER CORRECTING OR MINIMIZING THE URINARY OBSTRUCTION PREVENTING OR TREATING COMPLICATIONS

And increase in what hormone levels is associated with aging or a relative increase related to testosterone levels may contribute to prostatic hyperplasia?

ESTOGREN

What hormone produced in small amounts i;n men sensitizie the prostate gland to the effects of DHT?

Estrogen

Why is BPH more common in older men?

Hyperplasia of prostatic cells occurs for a long period of time

Treatment for medications are based on what 2 considerations?

Hyperplastic tissue is androgens-dependent Smooth muscle contraction ithin the prostate can exacerbate urinary obstruction

TURP is manifested by

Hyponatremia Decreased hematocrit Hypertension Bradycardia Nausea and confusion

Nursing diagnosis

Impaired urinary elimination Risk for infection elated to urinary retention Overflow urinary Incontinence related to sphincter blockage secondary to enlarged prostate acute pain deficient knowledge related to effect of prostate surgery and sexuality

the Patho effects results from a combination of factors?

Including urethral resistance to the effects of BPH Intravesical pressure during voiding Detrusor muscle strength Neurological functioning General physical health

TUIP

Small incisions are made in the smooth muscle where the prostate is attached to the bladder Gland is split to reduce pressure on urethra NO TISSUE IS REMOVED APPROPRIATE FOR MEN WITH SMALLER PROSTATE GLANDS Done on outpatient basis, LOWER RISK OF RETROGRADE EJACULATION.

is BPH a precursor to prostate cancer?

NO

Can BPH be reversed?

NOO!!!

BPH Benign prostatic hyperplasia is the most common

Nonmalignant enlargement of the prostate gland commonly seen in the aging male.

BPH is characterized by

Nonmalignant enlargement of the prostate gland that decrease the outflow of urine by obstruction the urethra causing difficult urination

What is the MAJOR SIDE AFFECT of the muscle relaxant?

ORTHOSTATIC HYPOTENSION

S/S

Obstruction of the outflow of urine from the urinary bladder Decreased bladder compliance and bladder instability results VOIDING (Weak urine stream Increased time to void Hesitancy Incomplete bladder emptying Postvoid dribbling) STORAGE (frequency, urgency, incontinence, nocturia dysuria and bladder pain) Bladder distention Diverticula Increased infection Hydroephrosis Hydroureters Renal insufficency

At what age does men need to be assessd for possible benign prostatic hyperplasia?

Over age 40

Complications of TURP

Postoperative hemorrhage clot retention Inablility to void UTI Incontinence Impotence and retrograde ejaculation

what do we determine to treat ?

Severity of the S/S Presence of complications

TURP

Surgical procedure used most often Obstructing prostate tissue is removed wtiht he wire loop of a resectoscope and electrocautery inserted through the urethra. nO external incision is necessary uses the resectoscope to remove obstructing tissue one piece at a time. PIECE FLUSHED INTO BLADDER WITH FLUID THEN FLUSHED OUT AT THE END OF THE OPERATION

How to improve urinary control?

Teach client to start and stop urine stream several times a day during voiding, practice KEGEL exercises.. to regain full control may take up to a year

Minimally Invasive surgery are

Transurethral microwave thermotherapy Transurethral needle ablation (TUNA)

Surgery Options

Transurethral microwave thermotherapy Transurethral needle ablation (TUNA) Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP)

Transurethral surgeries

Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP)

What are the lifestyle changes that may be appropriate for MILD BPH

Urinating at first urge Avoiding alcoho land caffeine Drinks small amounts of fluids spread through the day Avoiding drinking fluids within 2 hours of bedtime Avoiding over the counter cold and sinus medication that contain decongestants (causing restriction of urine flow)or antihistamines (causing anti cholinergic) Exercising regular KEGAL EXERCISE Reducing stress

Laser Surgery

Uses cystoscope to pass the YAG laser fiber through the urethra into the prostate and then vaporizes obstructing prostate tissue with several short bursts of energy Advantages: decreased blood loss, rapid recovery time Not effective for larger prostates

Transurethral needle ablation (TUNA)

Uses low level radio frequency through twin needles to burn away a region of the enlarged prostate Shields protect urethra -IMPROVED flow of urine through the urethra DOES NOT CAUSE IMPOTENCE OR INCONTINENCE

Why is a cystoscopy PERFORMED?

Visualize the bladder and urethra to rule out other causes of urinary symptoms and to visualize the degree of ureter obstruction.

Treatment for mild prostate enlargement with what medications

finasteride (Proscar) dutasteride (Avodart) 5-alpha reductase inhibitors (anti-androgen agents) inhibits the conversion of testosterone to DHT and cause the enlarged prostate to shrink in size.

TURP SYNDROME

fluid VOLUME EXCESS AND HYPONATREMIA

Androgens

hormone that stimulates the development and maintenance of male sex characteristics.

Prostatitis

inflammatory disorders of the prostate gland

Continuous bladder irrigation

prevents the formation of blood clothes can obstruct urinary output -Assess catheter and drainage tubing at regular intervals -Maintain rate of flow of irrigating fluid to keep the output light pink or colorless Assess urinary output every 1-2 hours for color consistency of amount and presence of blood cloth -Assess for signs of blood clot. -Assess client for bladder spasms -Assess bladder distention.. can result from output obstruction increase risk of bleeding -Irrigating fluids are continuously infused and drained at a rate that keeps urine light pink or colorless

Medications to relax smooth muscle of the prostate and bladder neck t relive obstructions and increase the flow of urine

terazosin (Hytrin) tamsulosin (FLOMAX) alfuzosin (Uroxatral) alpha-adrenergic antagonists relax the smooth muscles of the prostate and bladder neck to relieve obstruction and increase the flow of urine. **MAY CAUSE ORTHOSTATIC HYPOTENSION, STUFFY NOISE***

WHY IS PSA (prostate specific antigen) PERFORMED?

to rule out prostate cancer