Nursing Management of Erectile Dysfunction and Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) Management

BPH involves the enlargement of the prostate, which can obstruct urine flow. Management focuses on two different physiological goals: relaxing the muscle to improve flow or reducing the size of the gland itself.

Pharmacological Interventions

• Alpha-blockers: These include doxazosin (Cardura), silodosin (Rapaflo), and terazosin (Hytrin). They work by relaxing the smooth muscle in the bladder neck and prostate to improve urine flow.
• 5-alpha reductase inhibitors: Finasteride (Proscar) is used to help reduce the actual physical size of the prostate.

Nursing Safety: Orthostatic Hypotension

A significant nursing concern for patients taking alpha-blockers, particularly terazosin, is the risk of orthostatic hypotension. This is a sudden drop in blood pressure when changing positions.

Clinical manifestations include:

• Dizziness
• Somnolence (drowsiness)
• Significant drops in blood pressure (e.g., a reading of $101/42 \text{ mm Hg}$).

Nurses must monitor patients closely, especially during evening rounds or when the patient is transitioning from lying to sitting or standing, to prevent falls and injury. If pharmacological management is insufficient, a transurethral prostatectomy may be anticipated.

Urinary Function and the Parasympathetic Nervous System

Nurses must distinguish between medications used to treat urinary retention (stimulating the system) and those used for overactive bladder (inhibiting the system).

Urinary Retention (Parasympathomimetics)

Bethanechol (Urecholine) is used to treat urinary retention. However, it is contraindicated in patients with certain medical histories, such as asthma or gastroesophageal reflux.

Overactive Bladder (Anticholinergics/Muscarinic Antagonists)

Muscarinic antagonists, often delivered via transdermal patches, are used to treat overactive bladder (OAB). Because these drugs have anticholinergic effects, nurses should prepare patients for the following side effects:

• Dry mouth: Can be managed by using sugar-free gum.
• Constipation: May require the use of laxatives.
• Local skin reactions: Patients should be taught not to use medications like Benadryl on the patch site for itching without guidance.

Androgen and Testosterone Therapy

Testosterone therapy is used for various indications, including treating anemia by stimulating the synthesis of a renal hormone (erythropoietin).

Nursing Monitoring and Side Effects

When managing patients on testosterone, nurses must monitor for several systemic effects:

• Lipid Profile: Testosterone can impact cholesterol levels, typically decreasing high-density lipoprotein (HDL) and increasing low-density lipoprotein (LDL).
• Female Side Effects: In female patients, testosterone therapy may lead to increased breast size or the development of facial hair.
• Application Safety: For topical gels (e.g., AndroGel), patients should avoid direct skin-to-skin contact with others where the medication was applied and should not shower or swim for 5 to 6 hours after application.