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Common Prostate Problems
  • Benign prostatic hyperplasia (BPH)
  • Prostate Cancer
  • Prostatitis
  • Benign Prostatic Hyperplasia
  • most common urological problem in male adults
  • occurs in 50% of men over 50
  • Occers in 90% of men over 80
  • 25% of men require some form of treatment before 80
  • caused by an increase in the number of cells, not growth of existing cells
Pathophys of BPH
  • may result from endocrine changes associated with aging process (excessive accumulatin of dihydroxytestosterone)
  • develops in the inner part of the prostate
  • Enlargement compresses urethra, eventually leading to partial or complete obstruction
  • no direct relationship between size of prostate and degree of obstruction
Risk Factors for BPH
  • family history (1st° relatives)
  • enviroment
  • diet
  • physical activity
  • alcohol consumption
  • ↑ waist size/obesity = more problems
Clinical Manifestations of BPH
  • Urinary obstruction (gradual in onset)
  • Obstructive symptoms:
  • decrease in caliber and force
  • difficulty in initiating voiding
  • intermittency (stoping and starting)
  • dribbling at the end of urination
Common Complications of BPH
  • Urinary Obstruction
  • Acute Urinary Retention
  • UTI
  • Incomplete bladder emptying
  • calculi in the bladder d/t increased alkalinity
Less Common side effects
  • Hyrdonephrosis
  • Pyelonephritis
  • Bladder damage
Diagnostic Studies for BPH
  • H&P/DRE
  • UA/C
  • PSA
  • Sjerum Creatinine
  • Transrectal ultrasound w/ Possible biopsy
  • Uroflowmetry (volume of urine expelled from bladder/sec)
  • Cystourethroscopy (internal visualization of the urethrea and bladder)
Treatment of BPH
  • Watchful waiting
  • dietary changes (avoid caffeine, spicy food)
  • Avoid certain meds (decongestants, anticholinergics)
Drug and Herbal Tx of BPH
  • 5-a reductase inhibitors: Proscar/Avodart, cause regression of hyperplastic tissue, can cause severe birth defects, decreased libido, ejaculation volume, ED
  • A-adrenergic receptor blockers:UroXatral, Cardura, Hytrin, Flomax, promote smooth muscle relaxation (ca cause orthstatic hypotension, retrograde ejaculation, nasal congestion)
  • Saw Palmetto: herbal therapy, improves urinary symptoms and urinary flow measures
Transurethral Resection of the Prostate
  • TURP
  • Invasive therapy
  • Done under spinal/general
  • removal of the prostate tissue using a resectoscope inserted through the urethra to excise and cauterize prostatic tissue
  • S/E: bleeds, clots, Hyponatremia from irrigant
Transurethral Incision of the Prostate
  • Invasive therapy
  • TUIP
  • Transurethral slits or incisions into prostatic tissue to relieve obstructions
  • Done under local anesthesia
Minimally invasive Therapy for BPH
  • Transurethral Microwave therapy
  • Transurethral Neddle Ablation
  • Laser Prostateectomy (VLAP)
  • Intraprostatic Urethral Stents
  • Meds: pain, abx, antispasmodics
  • S/E: bladder spasms, bleeding, urinary retention
  • Pt will have foley for about a week.
BPH: Nursing Assessment
  • Assessment: P1419
BPH: Nursing Dx
BPH: Care Plan
BPH: Health Promotion
  • Decrease alcohol intake
  • decrease cafeine intake
  • do not use pseudoephedrine or phenylephrine
  • Urinate every 2-3 hr
BPH: ambulatory and home care teaching
  • care for catheter
  • managing incontinence (no catheter) common for several weeks after turp
  • oral intake of 2000-3000 ml
  • S/S of UTI and wound infection
  • constipation prevention
  • avoid heavy lifting
  • refrain from intercourse until cleared
  • teach about retrograde ejaculation
  • ED rarely occurs
  • urincate q 2-3hr
  • avoid caffeine, citrus juice, alcohol (bladder irritants)
Pre-op care
  • Coude catheter (curved tip)
  • Abx before any invasive procedure
  • address sexual functioning concerns
  • teach about retrograde ejaculation
Post-op care
  • triple lumen catheter
  • CBI: three way catheter with irrigation
  • blood clots expected for 24-36 hours
  • watch for hemorrhage
  • avoid strenuous activity and straining with BMs
  • pain releiver: belladonna/opium suppository
  • Antispasmodics: Ditropan
  • Kegel exersizes for shpincter control
  • S/S of infection
Prostate CA
  • A malignant tumor of the prostate gland
  • One in five men will develop prostate cancer
  • second leading cause of death in men
  • Occurs most often >65 yrs
Prostate CA: Etiology/Pathophys
  • Androgen dependant adrenocarcinoma
  • Occur in the outer aspect of the prostate
  • Spread by: direct extension, lymph extension, blood stream
  • African American men have more aggressive tumors and higher mortality rates
  • First degree relatives have increased risk
  • Associated with a high fat diet
Prostate CA: Clinical Manifestations
  • similar to BPH
  • dysuria
  • hesitancy
  • dribbling
  • frequency
  • hematuria
  • nocturia
  • retention
  • interruption of urinary stream
  • inability to urinate
Prostate CA: complications
  • Early recognition and tx: control growth, prevent mets, preserve quality of life
  • Once spread to distal sites: pain management
  • spread to bones: severe pain in back of legs and spinal cord
Prostate CA: diagnostic studies
  • DRE >50 yrs: may feel hard nodular, asymmetric
  • PSA: prostate specific antigen, glycoprotein produced by the prostate
  • Mild PSA elevation: d/t aging, recent ejac, drugs such as proscar, acute or chronic prostatitis, long bike rides
  • controversy on testing
  • early detection of aggressive cancers saves lives
  • abnormal > 4.0 ng/dl
  • used for detection and to monitor treatment
  • PSA levels usually elevated above normal in pts with prostate CA
  • success of treatment is determined by fall in PSA to undectetable level
Other diagnostic tests
  • US
  • CT
  • MRI
  • biopsy
  • PAP (CA indicator)
  • PET/bone scan for mets
Prostate CA: conservative therapy
  • early stage CA is curable
  • Tbl 55-6
  • Care depnds on stage and overall health of pt
  • Wait and Watch: life expectancy < 10 yrs, comorbitities, low grade/low stage tumor
  • Monitor: PSA, DRE
Prostate CA: Surgical therapy
  • Radical Prostatectomy: removal of entire prostate gland
  • retroperitoneal lymp node dissection
  • preferred tx for men < 70 in good health, stage 1/2
  • not an option for stage 4
  • Surgical approaches: retropubic, perineal, laproscopic
Post-op care
  • Pt will have large indwelling catheter w/ 30 cc balloon
  • Floey in place 1-2 weeks
  • drain left at surgical site
  • pt will stay in hosp 3 days post-op
  • careful dressing changes
  • good peri care
  • pt may experience ED
  • pt may experience urinary incontinence (kegel exercises)
Prostate CA: Radiation Care (external beam)
  • 5 days/wk for 6-8 weeks
  • skin dryness, irritation, and pain
  • diarrhea, abd cramping, irritation, pain
  • UTI, dysuria, frequency, hesitancy,urgency, nocturia
  • ED
  • fatigue
  • Bone marrow suppression
Prostate CA: radiation care (brachytherapy
  • Placing radioactive seed into prostate
  • best suited for A or B prostate
  • S/E: urinary retention, obstructive problems
Prostate CA: Drug Therapy p1426
  • Hormonal Therapy (prostate growth largely dependent on hormones): focused on reducing circulating levels of androgen to reduce tumor growth
  • Leutinizing hormone releasing hormone agonist and antagonist: decreases testosterone with continued administration, Lupron
  • Androgen receptor blockers: compete with circulating androgen at receptor sites, Casodex
  • Hormonal therapy blocks the effects of testosterone and decreases libido
  • Estrogen: used as a form of androgen deprivation therapy
  • Chemo: used in late stage disease
Prostate CA: assessment
  • p 1427
Prostate CA: Nursing dx
  • decisional conflict r/t surgery to numerous alternative treatment options
  • Acute pain r/t surgery, prostatic enlargement, bone mets, bladder spasms
  • Urinary retention r/t obstruction of urethra or bladder neck by prostate, blood clots, or loss of bladder tone
  • Acute bacterial
  • Chronic bacterial
  • chronic prostatis/chronic pelvic pain
  • asymptomatic inflammatory prostatitis
  • Both Acute and chronic result from organisms reaching the prostate by ascending the urethra, descending from the bladder, invasion from blood stream or lymphatic vessels
Prostatitis: clincial manifestations
  • fever
  • chills
  • back pain
  • perineal pain
  • Acute urinary symptoms: dysuria, frequency, urgency, cloudy urine, acute retention r/t swollen prostate
  • DRE: extremely swollen, very tender, firm
Prostatitis: diagnostic studies
  • UA/CS (wbc and bacteria present)
  • Pt fever: wbc count, blood cultures
  • PSA: elevation may be d/t the prostatitis
  • Transabdominal ultrasound
Prostatis: management
  • Acute prostatitis: abx for 4 weeks (bactrim, cipro, floxin, vibramycin)
  • Chronic prostatitis: 4-16 weeks abx
  • antinflammatory for pain
  • increased fluid intake
  • sexual intercourse and masturbation can relieve pain
Testicular CA
  • ages 15-34
  • 1% of all cancers
  • More common in R testicle than left
  • more common in men with undescended testes
  • Risk factors: orchitis, HIV, Maternal exposure to DES
  • Most cancers develop in the embryonic germ cells
  • Seminoma germ cells are most common and less aggressive
  • nonseminoma germ cels are less common and very aggressive
Testicular CA: clincial manifestations
  • slow or rapid onset
  • painless lumb in scrotum
  • scrotal swelling and a feeling of heaviness
  • mass is nontener and firm
Testicular CA: manifestations with mets
  • back pain
  • cough
  • dyspnea
  • hemoptysis
  • dysphagia
  • altered vision
  • change in mental status
  • papiledmea
  • seizures
Testicular CA: Diagnostic studies
  • Ultrasound of the testes
  • If neoplasm suspected: serum levls of tumor markers (AFP, LDH, hCH)
  • chest x-ray
  • CT f abd and pelvis
Testicular self exam
  • every male at puberty should be taught
  • should be done once a month
  • Testes should be warm (testes will hang lower in the scrotum and be easier to palpate)
  • Palpate testes and epididymis on exam
Testicular CA: collaborative care
  • orchiectomy
  • radical orchiectomy (remove of testis, spermatic cord, and regional lymph nodes)
  • retroperitoneal lymph node dissection
  • chemotherapy: BEP
  • Prognosis: 95% if disease detected in early stages
  • Follow up post disease to dectect other malignancies (CT scan, etc)
  • Infertility: bank sperm prior to tx
  • Ejaculatory dysfunction
  • talk to pt about fears r/t surgery and sexuality
  • Urological abnormality
  • 1 in 300 male newborns
  • urethral meatus is located on the ventral surface of the penis
  • surgical repair at 12-18 months
  • associated with chordee
  • opening of the urethra on the dorsal surface of the penis
  • complex birth defect
  • usually associated with othe GU tract defects
  • corrective surgery usually done in early childhood
  • a constriction of the uncircumcised foreskin around the head of the penis
  • caused by inflammation or edema of the foreskin
  • usually associated with poor hygeine
  • Edema of the retracted uncircumcised foreskin
  • prevents normal return over the glans
  • ulcers can develop if foreskin remains retracted
  • Ths can occur when the foreskin is pulled back for bathing, intercourse, or catheter palcement
  • Abx, warm soaks, circumcision, or dorsal slit of prepuce may be required.
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