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BENIGN PROSTATIC HYPERPLASIA - Coggle Diagram

- - - - Upcoming procedure
      - Implications for sexual functioning
      - Urinary control
- - - - Inflammation or infection
        
        Nocturia—often first
        
        Urinary frequency
        
        Urgency
        
        Dysuria
        
        Bladder pain
        
        Incontinence
    - - Caused by prostate enlargement— decrease diameter of urethra
        
        Decrease in caliber and force of urinary stream
        
        Difficulty initiating a stream
        
        Intermittency
        
        Starting and stopping stream several times while voiding
        
        Dribbling at the end of urination
- - - - Mild symptoms (AUA score of 0-7)
      - Lifestyle changes
        
        Decrease bladder irritants
        
        Restrict evening fluid intake
      - Timed voiding schedule—bladder retraining
- - - - 5a-Reductase Inhibitors
        
        Blocks enzyme necessary for conversion of testosterone to DHT
        
        Decrease size of prostate gland
        
        More effective for larger prostates with bothersome symptoms
        
        Finasteride (Proscar): see drug alert
        
        Dutasteride (Avodart)
        
        Jalyn (finasteride plus tamsulosin)
        
        May lower risk of prostate cancer; not preventive
      - a-Adrenergic receptor blockers
        
        Promote smooth muscle relaxation and facilitate urinary flow through urethra
        
        DO NOT DECREASE SIZE OF PROSTATE
        
        Alfuzosin (Uroxatral)
        
        Doxazosin (Cardura)
        
        Prazosin (Minipress)
        
        Terazosin (Hytrin)
        
        Tamsulosin (Flomax)
        
        Silodosin (Rapaflo)
        
        Side effect: retrograde ejaculation (semen backs into bladder)
    - - One erectogenic drug—helps to treat BPH and ED
        
        Tadafil (Cialis)
    - - Research does not support beneficial effects
      - Tell HCP about use of herbal therapy
  - - - Outpatient procedure; hold anticoagulants for 10 days before procedure; ~90 minutes
      - Delivers heat via microwaves directly to prostate. Through a transurethral probe
      - Heat (113 F or 45 C) causes death of tissue and relief of obstruction
        
        Rectal temperature monitored to prevent rectal tissue damage
    - - Heat delivered from low-wave radio frequency via needle to prostatic tissue leads to localized necrosis
        
        Only tissue in contact with needle affected
      - Outpatient procedure; ~30 minutes
        
        Local anesthesia and IV or oral sedation
        
        Very little pain
    - - Electrosurgical modification of TURP
      - Vaporization and desiccation destroy obstructive prostatic tissue
      - Various energy delivery mediums can be used
      - Results, side effects, and long term outcomes are the same as TURP
      - Uses bipolar energy deliver surface
        
        Energy current not passed through body to grounding surface
      - Saline used for irrigation results in decreased risk for TUR syndrome
  - - - Low risk but caregivers must watch for
        
        TUR or TURP syndrome
        
        Nausea, vomiting, confusion, bradycardia, HTN
        
        Results from hyponatremia due to longer operative times and prolonged intraoperative bladder irrigation with iso-osmolar fluid; now use bipolar resectoscope and saline to reduced risk
        
        Bleeding and clot retention—other possible postoperative complications
    - - Factors for choice of treatment depend on:
        
        Size and location of prostatic enlargement
        
        Age and surgical risk
    - - Decreased urine flow causes discomfort
      - Persistent residual urine
      - Acute urinary retention
      - Hydronephrosis
    - - Considered “gold standard” for obstructing BPH; previously required hospitalization but may be done as an outpatient procedure
      - Surgical removal of prostate tissue through urethra using a resectoscope
      - Postprocedure: 3-way indwelling catheter with 30 mL balloon inserted for hemostasis and to facilitate urinary drainage
        
        Continuous or intermittent irrigation for first 24 hours if large amount of hematuria with clots
      - Excellent outcome for most; decreased symptoms, increased urine flow
      - Preoperative Care for TURP
        
        Treat and manage UTI
        
        Administer antibiotics
        
        Encourages high fluid intake; 2-3 L/day (unless contraindicated)
        
        Restore urinary drainage
        
        Coude—curved-tip catheter
        
        Filiform—rigid catheter
        
        Use aseptic technique to prevent infection
        
        Provide patient and partner the opportunity to express concerns about sexual function
        
        Inform patient of possible complications of procedures
        
        Decreased or absent ejaculate volume
        
        Retrograde ejaculation
      - Postoperative care for TURP
        
        Assess for complications
        
        Hemorrhage
        
        Bladder spasms
        
        Urinary incontinence
        
        Infection
        
        Postoperative bladder irrigation
        
        Remove blood clots and ensure drainage of urine
        
        Manual, intermittent irrigation
        
        Instill and withdraw 50 mL irrigation solution; have cause bladder spasms
        
        Continuous bladder irrigation (CBI)
        
        Infusion rate based on color of urine; ideally light pink without clots
        
        Assess patency, monitor intake and output; if blocked, stop CBI and notify HCP