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Benign Prostatic Hyperplasia and Prostate Cancer

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Describe pathophysiology, symptoms and care of patients with prostate cancer. 6/25/09 ... Prostate Cancer Staging. Stage A tumor microscopic and intracapsular ... – PowerPoint PPT presentation

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Title: Benign Prostatic Hyperplasia and Prostate Cancer


1
Benign Prostatic HyperplasiaandProstate Cancer
  • 11/7/05
  • N125
  • Colleen OLeary-Kelley, RN, PhD, CCRN

2
Overview
  • Describe pathophysiology, symptoms and care of
    benign prostatic hypertrophy
  • Describe pathophysiology, symptoms and care of
    patients with prostate cancer

3
Benign Prostatic Hyperplasia
  • Enlargement of the prostate gland resulting from
    an increase in the number of epithelial cells and
    stromal tissue

4
Location of the Prostate Gland
5
Etiology of BPH
  • Cause not completely understood
  • Increase in number of cells resulting from
    endocrine changes associated with aging
  • Accumulation of dihydroxytestosterone,
    stimulation by estrogen and prostatic growth
    hormone actions

6
BPH facts
  • Occurs in 50 of men over 50 and in 80 of men
    over 80 have BPH
  • BPH progresses differently in every individual
  • Many men with BPH may have mild symptoms and may
    never need treatment
  • BPH does not predispose to the development of
    prostate cancer

7
Benign Prostatic Hyperplasia
8
Clinical manifestations
  • Voiding symptoms
  • decrease in force and size of urinary stream
  • difficulty in initiating voiding
  • intermittency stopping and starting stream
  • dribbling at the end of urination
  • incomplete bladder emptying due to urinary
    retention

9
Clinical manifestations
  • Irritative symptoms
  • urinary frequency
  • urgency
  • dysuria
  • bladder pain
  • nocturia
  • incontinence
  • symptoms associated with infection

10
Complications
  • Urinary retention
  • UTI
  • Sepsis secondary to UTI
  • Residual urine
  • Calculi
  • Renal failure

11
Diagnostic Tests
  • History Physical
  • Digital rectal exam (DRE)
  • Urinalysis
  • Urine culture
  • BUN, Cr
  • Prostate specific antigen (PSA)
  • Transrectal ultrasound biopsy
  • Uroflometry
  • Postvoid residual

12
DRE
13
PSA
  • Elevated levels of PSA
  • 0 4 ng/ml
  • Prostatic pathology
  • Correlates with tumor mass
  • Some men with prostate cancer have normal PSA
    levels

14
Medical Management
  • 5 alpha reductase inhibitor reduce size of
    prostate gland Proscar
  • Blocks the enzyme of 5 alpha reductase which is
    nec, for the conversion of testosterone to
    dihydroxytestostersone
  • Regression of hyperplastic growth
  • Side effects decreased libido, decrease volume
    of ejaculation, and erectile dysfunction

15
Medical Management
  • Alpha adrenergic receptor blockers promote
    smooth muscle relaxation in the prostate
  • Relaxation of the muscles facilitates urinary
    flow
  • Cardura, Hytrin, Flomax
  • Side effects postural hypotension, dizziness,
    fatigue,
  • Other problems can occur when pt is also taking
    cardiac or other hypertensive drugs

16
Medical Management
  • Herbal therapy saw palmetto fruit use to
    improve urinary symptoms and urinary flow
  • Problem with herbal therapy long term
    effectiveness

17
Medical Management
  • Avoid taking large amounts of fluid over a short
    period of time
  • Avoid alcohol and caffeine because of its
    diuretic effect
  • Void whenever the urge is present, every 2-3
    hours
  • Maintain normal fluid intake, do not restrict
    fluid

18
Invasive therapy
  • Transurethral resection of the prostate
  • Transurethral microwave thermotherapy
  • Transurethral incision of the prostate
  • Transurethral needle ablation
  • Prostatectomy
  • Laser Prostatectomy
  • Urethral stents

19
Transurethral resection of the prostate (TURP)
  • Surgical procedure involving removal of prostate
    tissue using a resectoscope inserted into the
    urethra
  • Spinal or general anesthesia
  • 3 way catheter inserted after procedure
  • Bladder continuous irrigation
  • Postoperative complications bleeding, clots

20
Transurethral Resection of the Prostate (TURP)
21
Preoperative Goals
  • Restoration of urinary drainage
  • Treatment of any urinary tract infection
  • Understanding of procedure, implications for
    sexual functioning and urinary control

22
Preoperative care
  • Antibiotics
  • Allow pt to discuss concerns about surgery on
    sexual functioning
  • Prostatic surgery may result in retrograde
    ejaculation

23
Postoperative Goals
  • No complications
  • Restoration of urinary control
  • Complete bladder emptying
  • Satisfying sexual expression

24
Postoperative Care
  • Complications- hemorrhage, bladder spasms,
    urinary incontinence, and infection
  • TURP continuous bladder irrigation with sterile
    normal saline

25
TURP post-operative care
  • Monitor IO
  • Maintain patency of catheter
  • Follow MD order to irrigate catheter
  • If resistance is felt when introducing fluid into
    the catheter or if there is no return of fluid,
    call the MD DO NOT FORCE THE FLUID
  • Blood clots and hematuria are expected for the
    first 24-36 hours

26
TURP
  • Monitor for signs of bleeding
  • Ask MD for specific guidelines in monitoring the
    pt
  • Bladder spasms check patency of catheter, meds.
    Belladonna, Ditropan
  • Clots can cause obstruction and pain catheter
    may need to be irrigate
  • Narcotics for pain
  • After catheter is removed check for urinary
    retention and urinary stream

27
TURP
  • Sphincter tone may be poor after catheter is
    removed. Kegal exercise pelvic muscle floor
    technique is encouraged. Starting and stopping
    the urinary stream is helpful.
  • Stool softeners to avoid straining
  • Sitting and walking for long periods should be
    avoided

28
Laser Prostatectomy
  • A laser beam is used to destroy part of the
    prostate
  • A laser beam is delivered transurethrally through
    a fiber instrument
  • Pt send home with catheter

29
Post- Laser Prostatectomy
  • Monitor for infection- redness, heat, swelling,
    drainage
  • Avoid straining

30
Discharge planning
  • Catheter care
  • Managing urinary incontinence
  • Oral fluid intake 2,000-3,000 cc per day
  • Observe for s/s of urinary tract and wound
    infection
  • Prevent constipation
  • Avoid lifting
  • No driving or intercourse after surgery as
    ordered by MD
  • Assess need for home care nurse

31
Nursing Diagnosis
  • Preoperative
  • Acute pain
  • Risk for infection
  • Fear
  • Postoperative
  • Acute pain
  • Urinary incontinence
  • Risk for infection
  • Potential complication
  • hemorrhage

32
PROSTATE CANCER
33
Prostate Cancer
  • Most common cancer among men
  • One of every five men will develop prostate
    cancer
  • Second leading cause of cancer death
  • Incidence of cancer rises after age 50
  • African American men have a higher incidence than
    Caucasian men

34
Prostate Cancer
  • Is an androgen-dependent adenocarcinoma
  • Slow growing
  • Spread by direct extension, lymph system, and
    bloodstream
  • Heredity

35
Clinical Manifestations
  • Asymptomatic in early stages
  • May experience symptoms similar to BPH- dysuria,
    hesitancy, dribbling, frequency, urgency,
    hematuria, nocturia, poor urinary stream,
    inability to urinate
  • Low back, hip and leg pain
  • Cancer can spread to pelvic lymph nodes, bones,
    bladder, lungs and liver.

36
Diagnostic Studies
  • History Physical
  • DRE
  • PSA
  • Prostatic Acid Phosphatase
  • Biopsy
  • Transrectal ultrasound
  • CT scan
  • MRI
  • Bone scan

37
Prostate Cancer Staging
  • Stage A tumor microscopic and intracapsular
  • Stage B tumor palpable on rectal exam but
    confined to prostate
  • Stage C tumor extended beyond the capsule of
    prostate
  • Stage D tumor met. to distant organs

38
Medical Management
  • Drug therapy
  • Radiation
  • Surgery

39
Hormones or Antiandrogens
  • Luteinizing hormone-releasing hormone agonist
    Lupron, Eligard, Viadure
  • Androgen receptor blocker Eulexin, Nilandron
  • Estrogen

40
Side Effects of Hormones
  • Hot flashes
  • Loss of libido
  • Erectile dysfunction
  • Breast pain
  • Gynecomastia
  • Estrogen side effects- DVT, CVA, MI

41
Chemotherapy
  • Mitoxantrone, Cytoxan, Idamycin, Ellence
  • Biphosphonates pt with advanced cancer develop
    bone complications such as fractures and spinal
    cord compression, Actonel, Fosamax, Zomex

42
Radiation
  • External radiation 5 days a week for 6-8weeks
  • Side effects skin (redness, irritation, pain,
    GI tract ( diarrhea, abd. Cramping, bleed),
    Urinary track (dysuria, frequency, hesitancy,
    fatigue, urgency, nocturia), fatigue, bone marrow
    suppression,

43
Brachytherapy
  • Implantation of radioactive implants in to the
    prostate
  • Side effect - urinary irritative or obstruction
    problems
  • Effective with Stage A and Stage B
  • See notes from cancer lectures

44
Prostate Brachytherapy
45
Surgery
  • Radical prostatectomy
  • Removal or prostate, seminal vesicles and part of
    the bladder neck
  • Orchiectomy removal of testis, side effects
    hot flashes, erectile dysfunction, loss of
    libido, irritability
  • Cryosurgery freezing tissue

46
Prostatectomy
  • Surgery of choice for men with large prostates
  • Involves external incision with three possible
    choices retropubic midline abd. incision,
    perineal an incision between the scrotum and
    anus, suprapubic- an abd. incision
  • Complications bleeding, postoperative pain, risk
    for infection, erectile dysfunction

47
Surgical approaches for prostatectomy
  • Retropubic
  • Midline abd. incision
  • Perineal
  • Incision between the scrotum and anus
  • Suprapubic
  • Abdominal incision

48
Prostate Screening
  • prostate screening guidelines
  • PSA and DRE starting at the age of 50 or younger
    if risk factors present

49
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