Benign Prostatic Hyperplasia (BPH)
What is BPH? - CORRECT ANSWER-Benign enlargement of the prostate gland
-eventually compresses the urethra, partial or complete obstruction which causes
symptoms
Etiology BPH - CORRECT ANSWER--most common urologic problems in adult
males
-occurs in 50% of men over 51-60
-occurs in 90% of men over 80
-does not predispose individual to prostate cancer (not cancer)
BPH Symptoms - CORRECT ANSWER--initial symptoms can be minimal;
bladder can compensate for small amount of resistance
-obstructive symptoms: difficulty starting the flow of urine (even with straining),
decrease force of urinary stream, multiple interruptions during urination
(intermittency), dribbling at end of urination
Bladder Symptoms - CORRECT ANSWER--symptoms R/T to changes in bladder
(associated with inflammation or infection)
-urgency
-frequency
-feeling bladder has not completely emptied
-frequent awakening at night to urinate
-incontinence
American Urological Association Symptom Index (AUA) for BPH - CORRECT
ANSWER--High score indicates greater severity of symptoms
-scale 0-5 (0 being never, 5 being all the time)
-over the past month
1. How often do you have the sensation that your bladder is not completely
empty after you finish urinating?
2. How often do you have to urinate again, less than 2 hr after you finish
urinating?
3. How often do you stop and start again several times when you urinate?
, 4. How often do you find it difficult to postpone urination?
5. How often do you have a weak urinary stream?
6. How often do you have to push or strain to begin urination?
7. How many times do you usually get up to urinate from the time you go to bed
at night until the time you get up in the morning?
0-7: mild, 8-19: moderate, 20-35: severe.
Complication: Bladder Outlet Obstruction (BOO) - CORRECT ANSWER--acute
urinary retention: insert catheter to drain bladder
-urinary tract infection (UTI) and potential sepsis: incomplete bladder emptying
results in residual urine, provides favorable environment for bacterial growth
-calculi may develop R/T alkalization of residual urine
-renal failure caused by: hydronephrosis, pyelonephritis, bladder damage if
treatment of urinary retention is delayed
Hydronephrosis - CORRECT ANSWER--distended renal calyces
-blocked ureter
-distended renal pelvis
Diagnostic Studies - CORRECT ANSWER--history and physical
-digital rectal exam (DRE)
-prostatic-specific antigen (PSA)
-post-void residual (PVR)
-U/A and urine C&S
-serum creatinine: kidney damage
-transrectal ultrasound (TRUS): put in the rectum
-cystoscopy
Goals of BPH - CORRECT ANSWER--restore bladder drainage
-relieve patient's symptoms
-prevent or treat complications
-"Watchful Waiting" - no symptoms or only mild symptoms (AUA score of 0-7)
-these patients have a yearly exam with DRE
-dietary changes: limit caffeine and alc, spicy and acidic foods (diuretic effects)
-avoid excess fluids in the evening to decrease chances of nocturia
What is BPH? - CORRECT ANSWER-Benign enlargement of the prostate gland
-eventually compresses the urethra, partial or complete obstruction which causes
symptoms
Etiology BPH - CORRECT ANSWER--most common urologic problems in adult
males
-occurs in 50% of men over 51-60
-occurs in 90% of men over 80
-does not predispose individual to prostate cancer (not cancer)
BPH Symptoms - CORRECT ANSWER--initial symptoms can be minimal;
bladder can compensate for small amount of resistance
-obstructive symptoms: difficulty starting the flow of urine (even with straining),
decrease force of urinary stream, multiple interruptions during urination
(intermittency), dribbling at end of urination
Bladder Symptoms - CORRECT ANSWER--symptoms R/T to changes in bladder
(associated with inflammation or infection)
-urgency
-frequency
-feeling bladder has not completely emptied
-frequent awakening at night to urinate
-incontinence
American Urological Association Symptom Index (AUA) for BPH - CORRECT
ANSWER--High score indicates greater severity of symptoms
-scale 0-5 (0 being never, 5 being all the time)
-over the past month
1. How often do you have the sensation that your bladder is not completely
empty after you finish urinating?
2. How often do you have to urinate again, less than 2 hr after you finish
urinating?
3. How often do you stop and start again several times when you urinate?
, 4. How often do you find it difficult to postpone urination?
5. How often do you have a weak urinary stream?
6. How often do you have to push or strain to begin urination?
7. How many times do you usually get up to urinate from the time you go to bed
at night until the time you get up in the morning?
0-7: mild, 8-19: moderate, 20-35: severe.
Complication: Bladder Outlet Obstruction (BOO) - CORRECT ANSWER--acute
urinary retention: insert catheter to drain bladder
-urinary tract infection (UTI) and potential sepsis: incomplete bladder emptying
results in residual urine, provides favorable environment for bacterial growth
-calculi may develop R/T alkalization of residual urine
-renal failure caused by: hydronephrosis, pyelonephritis, bladder damage if
treatment of urinary retention is delayed
Hydronephrosis - CORRECT ANSWER--distended renal calyces
-blocked ureter
-distended renal pelvis
Diagnostic Studies - CORRECT ANSWER--history and physical
-digital rectal exam (DRE)
-prostatic-specific antigen (PSA)
-post-void residual (PVR)
-U/A and urine C&S
-serum creatinine: kidney damage
-transrectal ultrasound (TRUS): put in the rectum
-cystoscopy
Goals of BPH - CORRECT ANSWER--restore bladder drainage
-relieve patient's symptoms
-prevent or treat complications
-"Watchful Waiting" - no symptoms or only mild symptoms (AUA score of 0-7)
-these patients have a yearly exam with DRE
-dietary changes: limit caffeine and alc, spicy and acidic foods (diuretic effects)
-avoid excess fluids in the evening to decrease chances of nocturia
