BPH Quiz 1

Prostate Basics & Pathophysiology

• The prostate gland primarily produces alkaline fluid to aid sperm motility and neutralize the acidic vaginal environment.
• Benign Prostatic Hyperplasia (BPH) development involves hyperplasia (increase in number) of both stromal and epithelial cells, forming nodules that compress the urethra.
• Clinical manifestations of BPH include weak urinary stream, urinary urgency, nocturia, and urinary retention. Polyuria is not a typical symptom.
• Difficulty starting urination, weak stream, and nocturia are hallmark symptoms, suggesting BPH due to urethral compression from prostate enlargement.
• Urinary retention in BPH patients is caused by compression of the urethra by hyperplastic prostate tissue.
• Hematuria and overflow incontinence can result from BPH. Fever and CVA tenderness suggest infection, not BPH specifically.
• Incomplete bladder emptying from BPH, leads to dribbling and distention.
• BPH can cause urinary retention, creating an environment for bacterial growth and increasing the risk for UTIs.

Diagnostics & Medications

• A digital rectal exam (DRE) is a common and immediate method to evaluate prostate enlargement.
• In BPH, the prostate can block the urethra, leading to retention of significant urine volumes even after voiding, which can be confirmed with post-void residual measurements >200mL.
• Prostate-specific antigen (PSA) levels help distinguish BPH from prostate cancer, elevated PSA can indicate cancer, but useful for screening.
• Urinalysis in suspected BPH cases will detect hematuria or signs of infection due to urinary retention.
• Medications for managing BPH symptoms include tamsulosin and terazosin (alpha-blockers to relax the prostate and bladder neck), and finasteride (a 5-alpha reductase inhibitor to shrink the prostate).
• Tamsulosin can cause orthostatic hypotension; patients should be taught to change positions slowly.
• Finasteride can take 3–6 months to have a full effect by shrinking the prostate over time.
• Improved urinary stream after taking finasteride and tamsulosin indicates the medications are effectively reducing prostate size or relaxing the prostate/bladder neck.
• The risk for complications with alpha-blockers increases with a history of orthostatic hypotension, concurrent antihypertensive use, or use of erectile dysfunction medication.
• Finasteride may cause decreased libido or erectile dysfunction, which are often reversible after discontinuation.
• 5-alpha-reductase inhibitors treat BPH by blocking the conversion of testosterone to DHT and reducing prostate size.
• Effective BPH treatment should result in reduced symptoms like nocturia and improved urine flow.

Surgery, TURP, and Post-Op Complications

• Transurethral Resection of the Prostate (TURP) is the gold-standard surgical intervention for relieving BPH symptoms by removing obstructive prostate tissue.
• Continuous bladder irrigation (CBI) following a TURP helps flush blood clots from the bladder and keeps the urinary catheter from becoming blocked.
• Complications following a TURP procedure include hemorrhage, urinary tract infection, retrograde ejaculation, and clot retention. Testicular torsion is unrelated to TURP.
• Burning sensation in the hands and face, restlessness, and headache in a post-TURP patient indicate TURP syndrome caused by hyponatremia due to absorption of irrigating fluid.
• A discrepancy in I&Os during CBI may indicate catheter blockage; gentle irrigation can dislodge clots and restore flow.
• If a patient's sodium drops to 125 mEq/L post-TURP, expect confusion and muscle twitching, as hyponatremia affects neuro function.
• Appropriate nursing interventions to monitor or prevent complications related to TURP surgery include monitoring H&H for signs of bleeding, monitoring sodium levels for dilutional hyponatremia, keeping irrigation bag <100 cm above patient, and encouraging early ambulation.
• To be avoided post TURP is NSAIDs, due to their increased bleeding risk.
• Avoid NSAIDs to minimize bleeding risk.
• Pinkish urine is expected after TURP. Bright red blood or large clots would be concerning.
• Assess for bladder distention if a post-TURP patient reports an urgent need to void despite having a catheter in place, as it could indicate clot retention or catheter blockage.

Nursing Care, Patient Education & Evaluation

• Post-op hemorrhage is the most common and most serious complication immediately after a TURP and requires vigilant monitoring.
• Encouraging coughing and deep breathing exercises post-TURP is important to prevent atelectasis and pneumonia.
• Post-op instructions after a TURP procedure should include avoiding constipation and straining, drinking 2000–3000 mL of fluids per day, avoiding alcohol and caffeine, and reporting bright red bleeding.
• Cloudy urine with small clots is an expected finding in the early recovery period post-TURP, persistent heavy bleeding is not.
• CBI must be stopped before removing the catheter to prevent uncontrolled irrigation fluid drainage and discomfort.
• A drop in H&H is a red flag requiring immediate intervention and may indicate internal bleeding.
• Nursing actions that help evaluate the effectiveness of BPH or TURP treatment include monitoring urine output and color, assessing for bladder distention, tracking sodium and H&H values, and assessing the patient's report of pain.
• NSAIDs inhibit platelet aggregation and increase the risk of post-op bleeding. Avoid after TURP.
• Discharge instructions for post-TURP patients should include avoiding activities that cause strain to promote healing and prevent complications.
• Signs of infection (fever, chills, and foul-smelling or cloudy urine) must be reported by patients discharged after TURP.