Med-Surg - Reproductive System, part 4: BPH & TURP
by Cathy Parkes December 06, 2022 Updated: August 10, 2023 4 min read
Full transcript and video captions coming soon!
Hi, I'm Cathy with Level Up RN. In this video, I will be talking about BPH, which is benign prostatic hyperplasia, as well as a TURP surgery, which is transurethral resection of the prostate. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And I will be following along with our Level Up RN Medical-Surgical Nursing flashcards. If you have our flashcards, definitely pull those out so you can follow along with me. And if you are new to our channel, welcome. I'm so happy to have you. We have hundreds of free videos to help you learn the most important stuff you need to know in nursing school and to be successful on your exams and in your nursing practice, so I invite you to subscribe. Benign prostatic hyperplasia or BPH is enlargement of the prostate gland. This is a very common disorder in older men and is associated with a change in hormone levels. As a reminder, the prostate gland sits below the bladder and surrounds the urethra. So if we have enlargement of the prostate gland like we do with BPH, then that can actually block the outflow of urine, and we can end up with urinary symptoms such as urinary frequency, urinary incontinence, urgency, as well as urinary retention. We can end up with post-void dribbling, hematuria, as well as frequent UTIs.
In terms of diagnosis of BPH, we can perform a digital rectal exam or DRE. This is where the provider inserts a finger into the rectum and palpates the prostate gland through the rectal wall and checks for enlargement. We can also run some labs. A prostate-specific antigen level will be drawn. So PSA levels are expected to be under 4. If they are over 4, then that may be indicative of BPH. However, it may also be elevated in the presence of prostate cancer, so anybody who has an elevated PSA level will require further evaluation. Other labs that may be elevated with BPH include white blood cells if the patient has a urinary tract infection. In addition, creatinine and BUN may be elevated with kidney involvement. Three key medications that are used in the treatment of BPH include finasteride, tamsulosin, as well as tadalafil. Finasteride is an androgen inhibitor that prevents conversion of testosterone, and this in turn results in a decreased size of the prostate gland. Tamsulosin is an alpha-1 blocker that relaxes the muscles in the prostate gland, which helps to improve urine flow. And then tadalafil is actually an erectile dysfunction medication that is also used in the treatment of BPH, and it works by relaxing the muscle cells in the prostate gland.
So if medications are unsuccessful in treating the urinary symptoms associated with BPH, surgery is also an option. So the surgical intervention we're going to talk about next is transurethral resection of the prostate or TURP surgery. In this surgery, an instrument is inserted into the urethra and excess tissue is cut away from the prostate in order to restore urine flow. Then a three-way urinary catheter is placed in order to provide continuous bladder irrigation or CBI. As the nurse, if you are caring for a patient following a TURP surgery, your goal is to keep this irrigation outflow a light pink color. If the outflow is bright red, resembles ketchup, or contains clots, then we want to increase the CBI rate. If the patient has signs and symptoms of a catheter obstruction such as bladder spasms or a decrease in outflow is noted, then you'll want to turn off the CBI and irrigate using a large piston syringe. So following TURP surgery, it is normal and expected that your patient will have a continuous feeling of needing to urinate, so you'll definitely want to educate your patient about that. In terms of medications that we would provide the patient following a TURP surgery, we will be giving analgesics as well as antispasmodics such as oxybutynin, prophylactic antibiotics, as well as stool softeners to help prevent straining. As your patient is recovering from their TURP surgery, they're going to want to drink at least two liters of water per day in order to flush out the bladder. They should also avoid alcohol and caffeine as those are bladder stimulants. And then if they have blood in their urine, they should stop whatever activity they're doing. They should rest and increase their fluid intake.
All right. It's quiz time. I've got three questions for you. First question, blank is an androgen inhibitor used to treat BPH by blocking conversion of testosterone to decrease the size of the prostate. The answer is finasteride. Question number two, your patient with continuous bladder irrigation following a TURP surgery has bright red output. As the nurse, what should you do? The answer is increase the CBI rate or continuous bladder irrigation rate. Question number three, if the catheter becomes obstructed following a TURP surgery, as the nurse, what should you do? The answer is turn off the CBI and irrigate with a large piston syringe. All right. That is it. I hope you did good on that quiz. If not, you can always review the flashcards or go back and watch the video again. Take care and good luck with studying.
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