The document discusses benign prostatic hyperplasia (BPH), its causes, symptoms, and treatments. BPH involves the gradual enlargement of the prostate gland due to hormonal imbalances in aging males. This causes compression of the urethra and urinary obstruction, which can lead to complications like urinary tract infections and renal failure if left untreated. Diagnostic tests and treatments include medications to reduce obstruction and surgical procedures like TURP.

1. ANATOMY AND PHYSIOLOGY OF THE SYSTEM

2. URINARY SYSTEM The major role of the urinary system is to maintain homeostasis by maintaining body fluid composition and volume. The components of the Urinary System are as follows: kidneys, ureters, urinary bladder and urethra.

3. BPH (Benign Prostatic Hyperplasia) *It is gradual enlargement of the prostate gland with hypertrophy and hyperplasia of normal tissues. *The cause is unknown. It usually occurs among men over 50 years of age.

4. Aging process in males results to hormonal imbalance . The estrogen levels become higher than the androgen levels. This cause hyperplasia of the prostate gland. The enlargement causes compression of the urethra and base of the bladder. This leads to urinary obstruction. If untreated, it results to a serious complication – renal failure .

5. Two processes produce this obstruction: hyperplasia and hypertrophy: Enlargement of the prostate (hyperplasia of the prostate gland) Narrowing of the lumen of the segment of the prostate that courses to the prostate (the prostatic urethra ) When it encroaches upon the bladder neck, it reduces its ability to funnel in response to micturition Growth of the so-called median lobe of the prostate extends into the proximal urethra OBSTRUCTION

6. Enlargement of the prostate (hyperplasia of the prostate gland) Accompanied by hypertrophy of the smooth muscle of the gland Mechanically adding to the tissue constricting the urethral lumen that courses to the prostate (the prostatic urethra ) Increased muscle tone in the bladder neck reducing then its ability to funnel in response to micturition Increased muscle tone at the proximal (prostatic) urethra EXACERBATION OF URINARY OBSTRUCTION

7. Nocturia ( frequent voiding at night) the frequent manifestation that occurs. The other manifestations are frequency, urgency, hesitancy (difficulty in initiating urination, takes few minutes before urine flows), decreased caliber of urinary stream and force, increased residual urine, hematuria, UTI. Abdominal straining with urination, volume and force of urinary stream. Sensation that bladder has not completely emptied. Recurrent urinary tract infection It is validated by rectal examination, cystoscopy and ultrasound. ASSESSMENT

8. DIAGNOSTICS Digital Rectal Examination (DRE) - reveals a large, rubbery, and non tender prostate gland. Urinalysis and Urodynamic studies - to assess urine flow Renal function tests including serum-creatinine level (complete blood studies) - to determine wether there is renal impairment. Ultrasound Cystoscopy – visualization of urinary bladder Biopsy

9. Preoperative Care Ultrasonography - reassure client that ultrasound is painless and not invasive - fleet enema 45 minutes before procedure Cystoscopy - preop protocol; obtain consent - urine culture or Gram stain must be negative - place client in lithotomy position - urethra is prepared with a water-soluble lubricant containing 2% lidocaine - ext. Genetelia are prepped w/ antiseptic sol’n e.g., povidone/iodine. Postoperative Care Cystoscopy – hematuria is expected - instruct client to force fluids - report any frank bleeding or clots in the urine or manifestations of UTI - warm baths and NSAIDS Biopsy – immediately apply pressure to the puncture site - apply sterile dressing - check puncture site for bleeding , V/S - force fluids to promote urination and to prevent clot formation - limited activity for the first 24 hrs.

10. Complications Nursing Diagnosis Urinary elimination, alteration in pattern related to surgery Pain related to bladder spasm Infection/injury (hemorrhage), potential for, related to surgery Sexual dysfunction, potential related to surgery Knowledge deficit (activity restriction, prevention of complications) related to lack of information with advanced BPH, urinary tract obstruction may occur as urine is unable to pass through the prostate. Urinary obstruction can lead to UTI’s and, if unrelieved, renal failure

11. Interventions Medical - ongoing assessment of a symptom - reducing urethral obstruction by relaxing smooth muscle w/in the prostate, proximal urethra & bladder neck (Alpha-1-adrenergic blockers) - 5-alpha-reductase (finasteride (Proscar) and dutasteride) Surgical - TURP, Suprapubic Prostatectomy, Retropubic Prostatectomy, and Perineal Prostatectomy Nursing Care Promotive - balance and healthy diet - regular exercise - health teachings Preventive - teach men to report any lower urinary tract symptoms that may be indicative of BPH - teach men on how to perform TSE - teach men to practice safer sex to prevent infections of the reproductive organs

12. Curative - Medications that reduces urethral obstruction by relaxing smooth muscle w/in the prostate, proximal urethra & bladder neck (Alpha-1- adrenergic blockers) - Surgery: TURP, Suprapubic Prostatectomy, Retropubic Prostatectomy, and Perineal Prostatectomy Rehabilitative - reassure clients that loss of control in urination is almost always temporary and will resolve - teach and encourage Kegel exercises

13. is an inflammation of the kidney and upper urinary tract that usually results from non contagious bacterial infection of the bladder (cystitis) the cause may be an active infection in the kidney or the remnants of a previous infection There two types: acute and chronic pyelonephritis. PYELONEPHRITIS

14. bacteria enters the renal pelvis Inflammation WBCs Edema and swelling of the involved tissue (papillae – cortex) (if treated) Fibrosis and scar tissue may develop (w/ altered tubular reabsorption & secretion) RENAL FUNCTION

15. Acute Pyelonephritis Client seems to be in acute distress fever, chills, nausea, flank pain on the affected side, headache, muscle pain, and in general prostration Dysuria, frequency, urgency Urine is cloudy/bloody, foul-smelling ASSESSMENT Chronic Pyelonephritis Discovered incidentally when the client is evaluated for hpn. Hypertension itself is the most frequent manifestation of the disease. Lab results may show azotemia, pyuria, anemia, &proteinuria. Demonstrates poor urine-concentrrating ability

16. DIAGNOSTICS X-ray studies, intravenous pyelography (IVP) cystourethrogram Ultrasound, CT scan, MRI Radionuclide imaging w/ gallium citrate and indium-111 (In 111 ) Urine culture and sensitiviy tests IV urogram, measurements of creatinine clearance, BUN & Crea. levels

17. Preoparative Care - screening for allergies or sensitivity - instruct px about necessary bowel prep. - tell client that there is sensation of flushing and warmth, salty taste, nausea. If occurs, take deep, full breath Intraoparative Care - assess for allergic reactions immediately after injection of the contrast medium (urticaria, itching, diaphoresis, and resp. distress or failure) - antihistamines, steroids and emergency cart must be ready available

18. Postoperative Care: Monitor hydration status after IVP to reduce the risk of renal failure in susceptible clients If not contraindicated, force fluids to promote renal clearance of the contrast medium. Monitor output Observe for mild reactions for iodine, such as hives, nausea or parotid swelling. Complications End Stage Renal Disease (ESRD) – for Chronic pyelonephritis Hypertension, formation of kidney stones

19. NURSING DIAGNOSIS Risk for Deficient Fluid Volume related to fever, nausea, vomiting, and possible diarrhea Acute pain related to an inflammatory process in the kidney and possible colic. Readiness for enhanced therapeutic regimen management

20. Interventions Medical Prepare client for antibiotic thrapy IV fluid for client w/ severe nausea and vomiting Pain reliever as indicated, antipyretics for fever, urinary analgesics Nursing Care Promotive Healthy lifestyle Health teachings Preventive Provision of information on lifestyle measures: Perineal hygiene-wiping front-back Acidification of the urine(take ascorbic acid and other juice) Ensuring adequate fluid intake

21. Curative Give antibiotics as indicated (2-3 weeks course) Ciprofloxacin (Cipro) Ampicillin (Omnipen) trimethoprim-sulfamethoxazole (Bactrim, Septra May require hospitalization if the patient is severely ill For chronic p., 6 mos course of antibiotics until infection is clear Fluid intake Rehabilitative Health maintenance Importance of completing the course of antibiotics Follow-up cultures to ensure that infection has been eradicated

22. CYSTITIS Is the inflammation of the urinary bladder Sometimes cystitis and urethritis are referred to collectively as a lower urinary tract infection, or UTI Most of the time, the inflammation is caused by a bacterial infection common female problem, esp. to pregnant ones (no prostatic fluid and short urethra) uncommon in younger and middle-aged men, but may occur as complications of bacterial infections of the kidney or prostate gland In children, cystitis is often caused by congenital abnormalities (present at birth) of the urinary tract

23. Ascending and invading Bacteria Inflammatory response in the lining of the urinary tract triggers IRRITATION Pain Frequent voiding Other clinical manifestations

24. ASSESSMENT Frequency (voiding at close intervals) Urgency (strong desire to void) Dysuria Foul-smelling urine Suprapubic pain Malaise, fever, chills, nausea and vomiting Low back pain Routine urinalysis and Creatinine and Sensitivity test of urine support presence of UTI (rbc, wbs, pus, and bacteria in the urine For elderly, lethargy, altered sensorium, anorexia, new incontinence, hyperventilation, grade fever

25. DIAGNOSTICS Urinalysis (presence of rbc, wbc, pus and bacteria) Urine cultures Bacterial colony counts Cellular studies Preoperative Care advise client to obtain a urine midstream give adequate instructions to the client regarding antibiotic therapy & dietary & activity restrictions needed during antibiotic therapy for surgery, do preop protocol

26. Postoperative Care Maintain hydration status IV Fluids Adequate fluid intake Complications Urethrovesical reflux Urosepsis Pyelonephritis

27. NURSING DIAGNOSIS Impaired Urinary Elimination Acute Pain related to infection within the urinary tract Deficient Knowledge about factors predisposing the patient to infection and recurrence, detection and prevention of recurrence, and pharmacvologic therapy

28. INTERVENTIONS Medical Acute Pharmacologic Therapy ( Antibacterial agents) Long-term Pharmacologic Therapy (another short course -3 to 4 days of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed) Patient Education Surgical - are performed only to address structural anomalies that cause repeated infections

29. NURSING CARE Promotive Healthy lifestyle Teaching Patients Self Care Preventive Practicing Careful Personal Hygiene Practice “3 W’s” Wash hands before and after using the toilet Wear cotton underwear Wipe perineum from front to back Increasing fluid intake to promote voiding and dilution of urind Urinating regularly and more frequently Drink cranberry juice!

30. Curative Administer medications as prescribed Urinary Tract Analgesics Urinary Antiseptics Fluoroquinolones Sulfonamides Cholinergic Antispasmodics Rehabilitative Recognition of lifestyle changes-to dec. Risk factors Ability to restate the medication protocol

31. WILM’S TUMOR Is the type of childhood cancer that begins in the kidney It is a malignant tumor Most common type of kidney cancer among children Can develop in both (bilateral) or in one (unilateral) kidney. Is only often found after it has grown to a size of 8 oz Risk factor- hemihypertrphy for children It accounts for 6% of all childhood cancers. • It generally grows to a large size before it is diagnosed, usually before the child reaches age 5. • The tumor expands the renal parenchyma, and the capsule of the kidney becomes stretched over the surface of the tumor. • Staging if from I (limited to kidney) to IV (matastasis) and stage V, which indicates bilateral involvement (rare). • The tumor may metastasize to the lymph nodes , lungs, liver, and brain.

32. Undeferentiated cluster of primordial cell grow into Large solitary well-circumscribed mass growth and behavior becomes more aggressive METASTASIZE (occurs via venous or lymphatic routes)

33. ASSESSMENT Firm, non tender abdominal mass Hematuria Low grade fever HPN Possible anemia Weight loss Malaise Anorexia Stomach pain Nausea and vomiting

34. DIAGNOSTICS IVP Chest CT scan Chest MRI Sonogram Chest Xray

35. COMPLICATION Spread of the Tumor to the vitsl organs HPN Kidney damage may occur

36. INTERVENTION Medical IV combination chemo Analgesic for pain Radiotherapy SURGICAL - Nephroureterectomy - resection of involved abdominal structure - kidney transplant

37. NURSING CARE Preventive/Curative/Rehabilitative do not palpate the abdomen as palpation and handling aids in metastasis provide care for a client with nephrectomy provide care for client receiving chemo and radiation therapy continue follow-up care