Med-Surg Assignment Name: Ezenwosu Adaobi Pamela Matric no:17/mhs07/010 Department:Nursing Level:300 1)The different disorders of the prostrate gland? a) Benign Prostatic Hyperplasia Often called BPH, benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. It is very common, but rarely causes symptoms before age 40. According to the American Urological Association, about half of men between ages 51 and 60 and up to 90% of men older than age 80 have BPH. Symptoms of BPH include: • Difficulty urinating • An urge to urinate even when the bladder is empty • Frequent urination, especially at night • A weak or intermittent stream of urine and a sense of incomplete emptying when urinating b) Prostatitis Prostatitis is an inflammation of the prostate. This can be caused by a bacterial infection. Men of all ages can get prostatitis, and it can occur in any size prostate (enlarged or not). Symptoms of prostatitis include: • Difficulty urinating • Frequent urination, especially at night • Pain or burning during urination • Chills and fever along with urinating problems c) Prostate Cancer Prostate cancer, in its early stages, may not cause any symptoms. But as it progresses, symptoms often appear. Symptoms of prostate cancer include: • A need to urinate frequently, especially at night • Difficulty starting urination • Inability to urinate • Weak or interrupted flow of urine (dribbling) • Painful or burning urination • Painful ejaculation • Blood in urine or semen • Frequent pain or stiffness in the back, hips, or upper thighs. 2)The Aetiologies a)Benign Prostatic Hyperplasia Aetiology: BPH is considered a normal condition of male aging, and many men older than 80 years have BPH symptoms. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor. Any family history of prostate problems or any abnormalities with your testicles may raise your risk of BPH. Men who’ve had their testicles removed at a young age don’t develop BPH. b)Prostatis Aetiology: Prostatitis can be caused by bacteria that leak into the prostate gland from the urinary tract (the most common bacterial cause) and from direct extension or lymphatic spread from the rectum. It can also result from various sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, or HIV. Other organisms responsible for infection are the same found most frequently in urinary tract infections, such as Escherichia coli. In many instances (especially in the chronic form of prostatitis), no specific cause of prostatitis can be found. c)Prostrate Cancer Aetiology: It's not clear what causes prostate cancer. Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body. 3)The therapeutic Interventions as well as surgeries a) Benign prostatic hyperplasia Therapeutics intervention: Treatment A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including: • The size of your prostate • Your age • Your overall health • The amount of discomfort or bother you are experiencing If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment. Medication Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include: • Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation). • 5-alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation. • Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective. • Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement. Minimally invasive or surgical therapy Minimally invasive or surgical therapy might be recommended if: • Your symptoms are moderate to severe • Medication hasn't relieved your symptoms • You have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems • You prefer definitive treatment There are several types of minimally invasive or surgical therapies. Transurethral resection of the prostate (TURP) A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder. Transurethral incision of the prostate (TUIP) A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky. Transurethral microwave thermotherapy (TUMT) Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary. Transurethral needle ablation (TUNA) In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that's blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer. Laser therapy A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn't have other prostate procedures because they take blood-thinning medications. The options for laser therapy include: • Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point. • Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy. Prostatic urethral lift (PUL) Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL that it is with TURP. Embolization In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren't available. Open or robot-assisted prostatectomy The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion. b) Prostatis Therapeutic Intervention: Treatments include the following: • Anti-inflammatory medicines, along with warm sitz baths (sitting in 2-3 inches of warm water). This is the most conservative treatment for chronic prostatitis. • Avoiding food that triggers symptoms, such as caffeine, spicy foods, and alcohol • Using a cushion if you will be sitting for a long time • Antibiotic medicine for infectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 7-14 days. Almost all acute infections can be cured with this treatment. • For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time — usually 6-12 weeks. About 60% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't respond to this treatment, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms. • The natural antioxidant bioflavonoid quercetin has been shown to improve inflammation and symptoms in men with nonbacterial prostatitis/chronic pelvic pain syndrome. • Alpha blocking agents can improve the urinary stream and often reduce the other voiding symptoms in patients with chronic prostatitis. Alpha blocking agents include tamsulosin (Flomax®) or alfusozin (Uroxatral®) for patients with voiding symptoms and those who do not empty their bladders well. Other treatments for chronic noninfectious prostatitis include the drugs finasteride (Proscar®, terazosin®), and doxazosin. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Many cases of nonbacterial prostatitis respond to such treatments as exercise, myofascial trigger point release physical therapy, progressive relaxation, and counseling. c) Prostrate cancer Therapeutic Intervention: Surgery Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, a urologist or urologic oncologist is the surgical oncologist involved in treatment. The type of surgery depends on the stage of the disease, the man’s overall health, and other factors. • Radical (open) prostatectomy. A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of affecting sexual function. Nerve-sparing surgery, when possible, increases the chance that a man can maintain his sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut because these are separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, another surgery can fix urinary incontinence. • Robotic or laparoscopic prostatectomy. This type of surgery is less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects are similar to those of a radical (open) prostatectomy. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the radical (open) prostatectomy. • Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It is described in detail in “Systemic treatments” below. • Transurethral resection of the prostate (TURP). TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue. Radiation therapy Radiation therapy is the use of high-energy rays to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy. External-beam radiation therapy is the most common type of radiation treatment. The radiation oncologist uses a machine located outside the body to focus a beam of x-rays on the area with the cancer. Some cancer centers use conformal radiation therapy (CRT), in which computers help precisely map the location and shape of the cancer. CRT reduces radiation damage to healthy tissues and organs around the tumor. One method of external-beam radiation therapy used to treat prostate cancer is called hypofractionated radiation therapy. This is when a person receives a higher daily dose of radiation therapy given over a shorter period instead of lower doses given over a longer period. According to recommendations from ASCO, American Society for Radiation Oncology, and American Urological Association, hypofractionated radiation therapy may be an option for the following people with early-stage prostate cancer that has not spread to other parts of the body: • Men with low-risk prostate cancer who need or prefer treatment instead of active surveillance. • Men with intermediate or high-risk prostate cancer receiving external-beam radiation therapy to the prostate but not to the pelvic lymph nodes. • People who receive hypofractionated radiation therapy may have a slightly higher risk of some short-term side effects after treatment compared with those who receive regular external-beam radiation therapy. This may include gastrointestinal side effects. Based on current research, people who receive hypofractionated radiation therapy are not at a higher risk of side effects in the long term. Talk with your health care team if you have questions about your risk for side effects. 4)Nursing care and client teaching a) Benign prostatic hyperplasia : • Reduce anxiety. The nurse should familiarize the patient with the preoperative and postoperative routines and initiate measures to reduce anxiety. • Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort. • Provide instruction. Before the surgery, the nurse reviews with the patient the anatomy of the affected structures and their function in relation to the urinary and reproductive systems. • Maintain fluid balance. Fluid balance should be restored to normal. • Explain the symptoms and complication of BPH (a) Urinary retention ((b) Cystitis (c) Increase in irritative voiding symptoms by encouraging patient to report the symptoms. • •Teach patient to do Kegel (Perineal exercise) after surgery to help gain control of voiding. • •Contract perineal muscle for 10-15 secs, then relax. Repeat 15 times. • •Do 15 sets per day • •Advice and tell patient to avoid sexual intercourse, straining at stool, heavy lifting and long periods of sitting for 6 to 8 weeks after surgery until Prostatic fossa is healed. • •Advice follow-up visits as urethra stricture may occur and regrowth of prostate is possible. b) Prostatis: Acute Prostatis: — Administration of prescribed antibiotics —Provision of comfort (analgesic,sits baths) Chronic Prostatis: — Outpatient teaching: continuing antibiotic therapy . — Increase fluid intake. —Recognizing recurrent signs and symptoms of prostatis. c) Prostate Cancer • Monitor input and out put • Teach kegel exercise • Encourage patient to continue with activities of daily living • Teach follow up care • Have vitamin D level checked. A low level is associated with more aggressive prostate cancer. • Eat a completely or mostly plant-based diet, avoid all processed foods, and limit sugar intake, which fuels cancer growth. Studies show that excess fat, primarily red meat and high-fat dairy, stimulates prostate cancer growth. • Avoid trans fatty acids, which are known to promote cancer growth; these are high in margarines and fried and baked foods. • Exercise to maintain overall health and weight. Being overweight or obese is a factor in prostate cancer development and progression. • Manage stress, which can jeopardize the immune system and promote cancer progression, perhaps by interfering with neuroendocrine mechanisms involved in control of reproduction. • Avoid environmental exposure to household and personal care products.