Patient Undergoing TURP
Surgical Essay.
Care of a patient undergoing TURP.
Mr. Paul Fenech a 65 year old pensioner has been diagnosed with Prostatic Hypertrophy that requires surgery.
a. Describe the Anatomy and Physiology of the prostate gland including its functions.
b. Mention the disorders that could affect the prostate gland.
c. Describe the clinical manifestations of prostate hypertrophy.
d. Mention the investigations that are done to diagnose this condition.
e. Describe the possible surgical approaches for removal of the prostate gland.
f. Discuss the preoperative care required from admission until handover including the pre op assessment and physical and psychological care. (Holistic care).
g. Discuss the postoperative care required from handover in theatre until discharge.
h. What possible complications could occur post TURP and how are these prevented or dealt with?
i. Describe what advice should be given prior to discharge.
a. The prostate gland is a lobulated structure which lies in the pelvic cavity in …show more content…
front of the rectum and behind the syphilis pubis, surrounding the uppermost part of the urethra. It is palpable on rectal examination. The prostate gland secretes a thin, milky, alkaline fluid that makes up 60% of the seminal fluid; this fluid creates an environment more hospitable to sperm by giving protection from the normally acidic environment of the male urethra and female vagina. A neutral or slightly alkaline medium also increases sperm motility. The prostate is susceptible to hyperplasia, which, because of its proximity to the urethra can lead to urinary problems.
b. Three principal disease processes affect the prostate gland:
- Infection.
- Benign Prostatic Hypertrophy.
- Cancer.
Infection.
Bacteria that cause venereal, bladder and kidney infections may also infect the prostate. This may occur following an infection of the urinary tract, surgery or catheter insertion. Acute infection causes pain, tenderness, fever, chills, and burning urine. Chronic infection manifests as subtle or vague symptoms, such as pelvic pain and discomfort, low back pain or burning urine. So called ‘a bacterial prostatitis’ may be due either Chlamydia or Ureaplasm organisms. These are usually sexually transmitted. Infections of the prostate gland may be so mild that the male is unaware of it. Testing of Prostatic secretions and urine will lead to identification of the organism and appropriate antibiotic treatment.
Benign Prostatic Hypertrophy.
Benign enlargement of the prostate is extremely common in men over 50 years of age, with 70% of men by the age of 60 and 90% by the age of 70 having the condition. As a result, the prostate becomes a bumpy, rubbery mass that can be felt via a rectal examination. Such enlargement in the confined space of the pelvis, results in compression of the urethra and interference with passing urine. This produces the characteristic clinical symptoms of difficulty in starting micturition, difficulty in stopping micturition, frequency and urgency, poor flow and force in the urine passed, dribbling and incontinence and a feeling that the bladder is never completely emptied. This must be relieved by insertion of a catheter. As a result, bladder and kidney infections are much more common in men with this condition. Obstruction or infection, or both, may cause severe kidney damage in some people.
Cancer.
Cancer of the prostate gland is very common. Statistics indicate that it ranks among the most common cancer and cause of cancer death in men. The cause of prostate cancer is unknown; however it often occurs along with the benign (non-cancerous) enlargement of the prostate gland. Male sex hormones play a role in cancer growth. Drugs that reduce their levels or block their action are often used in the treatment of prostate cancer. In its early stage prostate cancer is usually an insidious, symptom less disease. Consequently it may not be discovered until it is quite advanced. Often the tumor is discovered incidentally after the removal of excessive benign tissue, which has been blocking urinary flow. Prostate cancer may spread to other pelvic areas, like the rectum, lymph glands and bones, where it can cause severe pain. If prostate cancer is diagnosed at an early stage, it is potentially curable.
c. The clinical manifestations of prostate hypertrophy are;
Nocturia, frequency, hesitancy in beginning of flow, stream of urine reduced in force and size and incomplete emptying of the bladder, reduction in bladder capacity, urgency, and cystitis.
The patient usually complains of; acute retention of urine and over distension of the bladder.
d. Investigations that are done to diagnose this condition are;
- IVU. This investigation involves the I.V. injection of an iodine-based contrast medium which is then excreted by the kidneys, allows a series of X-ray pictures of the kidneys, ureters and bladder to be taken. Prior to the IVU, a control X-ray of the kidneys, ureters and bladder (KUB) is taken. The patient is requested to abstain from fluid and foods several hours before the start of the X-rays. This helps the contrast medium to be excreted more quickly. The patient is also given an aperient to clear the bowel and thus ensure a clear image of the contrast medium on the X-ray.
Following the investigation, the patient is allowed to eat and drink again. The contrast medium will be passed when the patient voids urine, with no after-effects or change in colour of the urine.
The IVU X-rays may show:
Absence of kidney
Obstruction of kidney
Obstruction of the ureter
Irregularities of the bladder wall - this finding may indicate the presence of a bladder tumor, diverticulum, calculi or foreign body.
- Urinary flow rates.
- Renal function tests.
- Full Blood Count.
- Serum Acid Phosphate or Serum Prostate-Specific Antigen (PSA), to eliminate diagnosis of carcinoma.
- MSU
- Transurethral Ultrasound Scan and/or Biopsy.
e. Prostatectomy is indicated if there is significant outflow obstruction. Transurethral Resection of the Prostate Gland (TURP) is the operation of choice. Where the gland is too large to resect transurethral, an open procedure is used, most commonly taking the retro pubic or transvesical approach.
f. Pre-operative care.
Preoperative care is the preparation and management of a patient prior to surgery. It includes both physical and psychological preparation.
Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. The patient may feel psychologically excited or maybe fear regarding the surgery coming up. The preoperative teaching may help a lot of patients to alleviate their fear or excitement by being more informed about their surgery. Often patients who are more knowledgeable about what to expect after surgery and who have an opportunity to express their goals and opinions, may cope better with postoperative pain and deceased mobility.
Preoperative care is extremely important prior to any invasive procedure, regardless of whether the procedure is minimally invasive or a form of major surgery. Preoperative teaching must be individualized for each patient. Some people want as much information as possible, while others prefer only minimal information because too much knowledge may increase their anxiety. Patients have different abilities to comprehend medical procedures; some prefer printed information, while others learn more from oral presentations. It is important for the patient to ask questions during preoperative teaching. Preoperative care involves many components.
When Mr.Fenech is admitted to the ward for his preoperative care of prostatic hypertrophy, he is shown to his room, and is given a quick tour around the surgical ward. Mr.Fenech will be shown where to put his belongings and also introduced to the nursing staff. Physical assessment will be done. Physical assessment may consist of a complete medical history including the patient’s surgical and anesthesia background. The patient should inform the physician and nursing staff if he had any adverse reaction to anesthesia (such as anaphylactic shock), or if there is a family history of malignant hyperthermia. Routine preoperative laboratory assessments include CBC, electrolytes, prothrombin time and urinalysis. Since bleeding or hemorrhage, is a major risk after prostatectomy, preoperative care should involve determining baseline hematological values. Careful consideration must be given to those individuals receiving oral anticoagulants for other disease, since the risk of hemorrhage is so great. The patient will most likely have an ECG if he has a history of cardiac disease, and is over 50 years of age. A chest x-ray is done if the patient has a history of respiratory disease. Part of the preparation includes assessment for risk factors that might impair healing, such as nutritional deficiencies, steroid use, radiation or chemotherapy, drug or alcohol abuse or metabolic diseases such as diabetes. The patient should also provide a list of all medications, vitamins and herbal or food supplements that she might be using. Supplements are often overlooked, but may cause adverse effects when used with general anesthetics. Some supplements can prolong bleeding time.
Latex allergy has become a public health concern. Latex is found in most sterile surgical gloves, and is common component in other medical supplies including general anesthesia masks, tubing and multi-dose medication vials. Every patient should be assessed for potential latex reaction.
Preoperative determination of urea and electrolyte levels will provide baseline measurements and permit correction before surgery. This may involve urethral catheterization to permit adequate bladder drainage, the use of I.V. fluid to achieve hydration and, if necessary, the provision of saline for irrigation.
Bowel clearance may be ordered. The patient should start the bowel preparation early the evening before surgery to prevent interrupted sleeping during the night.
The night before surgery, skin preparation is often ordered which can take the form of scrubbing with a special soap or possibly hair removal from the surgical area.
A preoperative checklist would also be done.
The checklist is designed to ensure that the patient is physiologically prepared for the surgery. Patients are often fearful or anxious about having surgery. It is often helpful for them to express their concerns to the nurses. This can be especially beneficial for patients who are critically ill or who are having a high risk procedure. The family needs to be included in psychological preoperative care. Pastoral care is usually offered in the hospital. If the patient has a fear of dying during surgery, this concern should be expressed, and the surgeon notified. In some cases, the procedure may be postponed until the patient feels more secure. Patients and family who are prepared psychological tend to cope better with the patient’s post operative course. Preparation leads to superior outcomes since the goals of recovery are known ahead of time, and the patient is able to manage postoperative pain more
effectively.
The patient’s or guardian’s written consent form for the surgery is a vital portion of preoperative care. By law, the physician who will perform the procedure must explain the risks and benefits of the surgery, along with other treatment options. It is important that the patient understands everything he is told. Since almost all men have retrograde ejaculation after prostatectomy it is essential that they are counseled adequately beforehand. Retrograde ejaculation does not cause impotence, but a patient who has not been given adequate reassurance on this point could suffer psychological upset resulting in impotence. Retrograde ejaculation will not render the patient sterile, but neither will it necessarily permit him to father children easily. It should not be presumed that all elderly men are not sexually active, and all patients are entitled to preoperative information.
Due to the fact that general anesthesia is going to be used, nothing is permitted to be given by mouth (NBM) after midnight the evening of the surgery. This is done to reduce the risk of vomiting and aspiration while under anesthesia. IV therapy is initiated to provide vascular access for administration of medication or anesthesia. Patients should be told which medications to take prior surgery and the medications that should have been brought with them (such as inhalers for patients with asthma).
Instruction about the surgery itself includes informing the patient about what will be done during the surgery, and how long the procedure is expected to take. The patient should be told also where the incision is going to be.
Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient’s outcome. Instruction about expected activities can also increase compliance and help prevent complications. This includes the opportunity for the patient to practice coughing and deep breathing exercises. Additionally, the patient should be informed about early ambulation (getting out of bed). Patients hospitalized postoperatively should be informed about the tubes and equipment they will have. These may include intravenous lines, drainage tubes, dressings etc…
Pain management is the primary concern for many patients. Patients should be encouraged to ask for pain medication before the pain becomes unbearable. If they will be using pain-controlled-analgesia pump (PCA), instruction should take place during the preoperative period. Finally, the patient should understand long-term goals such as when he’ll be able to eat solid food, go home, and drive a car and return to work.
Parameters will be checked and charted. When the operating theatre informs the surgical unit to hand over the patient, the nursing staff asks Mr.Fenech to change his clothing into a hospital dressing gown. The patient’s file will be checked and verified that the consent form is signed both by the consultant and the patient. It would also include full x-ray taken and the preoperative checklist. The patient then would be taken down to the operating theatre to be handed over to the nursing staff of the operating theatre. The nursing staff will ask again the same questions of the checklist, which have been asked before, check the patient name and I.D. number. Mr.Fenech would wait in the Holding Bay.
g. On receiving Mr.Fenech, a routine postoperative assessment is performed. The goals of postoperative management are to stabilize the patient’s vital signs; correct fluid and electrolyte imbalances prevent infection and promote healing. It also consists of pain or nausea assessment. Mr.Fenech would be received with an IV infusion. The type of fluid, flow
h. Major nursing considerations postoperatively includes;
- Risk of hemorrhage. Catheter should be checked frequently for drainage. Full bladder may cause bleeding. The nurse should be alert for any signs of hemorrhage and give close attention to the pulse, blood pressure and the amount of drainage. The drainage should be watery and blood tinged 24-28 hours postoperatively. The hemorrhage will always be a threat in the postoperative period, thus the patient is given light diet, no straining at stool, no enemas/rectal tubes or rectal thermometers to be inserted.
- Infection (urinary tract, epididymis or testis) prophylactic antibiotics are given to the patient.
- Clot retention.
- Deep vein thrombosis and pulmonary embolism; these could be prevented by advising the patient to wear compression stockings preoperatively.
- Urethral stricture.
- Incontinence
- Impotence
- Retrograde ejaculation
- Bladder neck stenosis.
i. Once the urine is clear, the catheter can normally be removed. This is usually done in the morning to allow the patient to establish a normal voiding pattern before retiring to bed. Provided the patient is able to pass urine without difficulty, he may be discharged from hospital the following day.
Many patients feel after the operation that they have gained no relief from their problems. It must be understood that it will take about 6 weeks for healing of the prostatic bed to occur such that full urinary control is possible. The patient should be advised to refrain from heavy activities and exercises. He should drink plenty of fluids and avoid becoming constipated. It should be noted that episode of bleeding may occur 2-4 weeks postoperatively. This is rarely serious and if the patient drinks plenty of fluids and rests, it should disappear. If not call the patient should see his doctor. Mr. Fenech should be advised that sexual intercourse can take place 5-6 weeks after the operation. During sexual climax, however, the patient will not emit any semen from the penis. The ejaculation may flow into the bladder instead of down the penis and the first time he passes urine after intercourse, it will be cloudy. That is not harmful. Mr. Fenech is told that he would unlikely produce any children following the operation but it shouldn't be relied on as safe contraception.
Care of a patient undergoing TURP.
Mr. Paul Fenech a 65 year old pensioner has been diagnosed with Prostatic Hypertrophy that requires surgery.
a. Describe the Anatomy and Physiology of the prostate gland including its functions.
b. Mention the disorders that could affect the prostate gland.
c. Describe the clinical manifestations of prostate hypertrophy.
d. Mention the investigations that are done to diagnose this condition.
e. Describe the possible surgical approaches for removal of the prostate gland.
f. Discuss the preoperative care required from admission until handover including the pre op assessment and physical and psychological care. (Holistic care).
g. Discuss the postoperative care required from handover in theatre until discharge.
h. What possible complications could occur post TURP and how are these prevented or dealt with?
i. Describe what advice should be given prior to discharge.
a. The prostate gland is a lobulated structure which lies in the pelvic cavity in …show more content…
front of the rectum and behind the syphilis pubis, surrounding the uppermost part of the urethra. It is palpable on rectal examination. The prostate gland secretes a thin, milky, alkaline fluid that makes up 60% of the seminal fluid; this fluid creates an environment more hospitable to sperm by giving protection from the normally acidic environment of the male urethra and female vagina. A neutral or slightly alkaline medium also increases sperm motility. The prostate is susceptible to hyperplasia, which, because of its proximity to the urethra can lead to urinary problems.
b. Three principal disease processes affect the prostate gland:
- Infection.
- Benign Prostatic Hypertrophy.
- Cancer.
Infection.
Bacteria that cause venereal, bladder and kidney infections may also infect the prostate. This may occur following an infection of the urinary tract, surgery or catheter insertion. Acute infection causes pain, tenderness, fever, chills, and burning urine. Chronic infection manifests as subtle or vague symptoms, such as pelvic pain and discomfort, low back pain or burning urine. So called ‘a bacterial prostatitis’ may be due either Chlamydia or Ureaplasm organisms. These are usually sexually transmitted. Infections of the prostate gland may be so mild that the male is unaware of it. Testing of Prostatic secretions and urine will lead to identification of the organism and appropriate antibiotic treatment.
Benign Prostatic Hypertrophy.
Benign enlargement of the prostate is extremely common in men over 50 years of age, with 70% of men by the age of 60 and 90% by the age of 70 having the condition. As a result, the prostate becomes a bumpy, rubbery mass that can be felt via a rectal examination. Such enlargement in the confined space of the pelvis, results in compression of the urethra and interference with passing urine. This produces the characteristic clinical symptoms of difficulty in starting micturition, difficulty in stopping micturition, frequency and urgency, poor flow and force in the urine passed, dribbling and incontinence and a feeling that the bladder is never completely emptied. This must be relieved by insertion of a catheter. As a result, bladder and kidney infections are much more common in men with this condition. Obstruction or infection, or both, may cause severe kidney damage in some people.
Cancer.
Cancer of the prostate gland is very common. Statistics indicate that it ranks among the most common cancer and cause of cancer death in men. The cause of prostate cancer is unknown; however it often occurs along with the benign (non-cancerous) enlargement of the prostate gland. Male sex hormones play a role in cancer growth. Drugs that reduce their levels or block their action are often used in the treatment of prostate cancer. In its early stage prostate cancer is usually an insidious, symptom less disease. Consequently it may not be discovered until it is quite advanced. Often the tumor is discovered incidentally after the removal of excessive benign tissue, which has been blocking urinary flow. Prostate cancer may spread to other pelvic areas, like the rectum, lymph glands and bones, where it can cause severe pain. If prostate cancer is diagnosed at an early stage, it is potentially curable.
c. The clinical manifestations of prostate hypertrophy are;
Nocturia, frequency, hesitancy in beginning of flow, stream of urine reduced in force and size and incomplete emptying of the bladder, reduction in bladder capacity, urgency, and cystitis.
The patient usually complains of; acute retention of urine and over distension of the bladder.
d. Investigations that are done to diagnose this condition are;
- IVU. This investigation involves the I.V. injection of an iodine-based contrast medium which is then excreted by the kidneys, allows a series of X-ray pictures of the kidneys, ureters and bladder to be taken. Prior to the IVU, a control X-ray of the kidneys, ureters and bladder (KUB) is taken. The patient is requested to abstain from fluid and foods several hours before the start of the X-rays. This helps the contrast medium to be excreted more quickly. The patient is also given an aperient to clear the bowel and thus ensure a clear image of the contrast medium on the X-ray.
Following the investigation, the patient is allowed to eat and drink again. The contrast medium will be passed when the patient voids urine, with no after-effects or change in colour of the urine.
The IVU X-rays may show:
Absence of kidney
Obstruction of kidney
Obstruction of the ureter
Irregularities of the bladder wall - this finding may indicate the presence of a bladder tumor, diverticulum, calculi or foreign body.
- Urinary flow rates.
- Renal function tests.
- Full Blood Count.
- Serum Acid Phosphate or Serum Prostate-Specific Antigen (PSA), to eliminate diagnosis of carcinoma.
- MSU
- Transurethral Ultrasound Scan and/or Biopsy.
e. Prostatectomy is indicated if there is significant outflow obstruction. Transurethral Resection of the Prostate Gland (TURP) is the operation of choice. Where the gland is too large to resect transurethral, an open procedure is used, most commonly taking the retro pubic or transvesical approach.
f. Pre-operative care.
Preoperative care is the preparation and management of a patient prior to surgery. It includes both physical and psychological preparation.
Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. The patient may feel psychologically excited or maybe fear regarding the surgery coming up. The preoperative teaching may help a lot of patients to alleviate their fear or excitement by being more informed about their surgery. Often patients who are more knowledgeable about what to expect after surgery and who have an opportunity to express their goals and opinions, may cope better with postoperative pain and deceased mobility.
Preoperative care is extremely important prior to any invasive procedure, regardless of whether the procedure is minimally invasive or a form of major surgery. Preoperative teaching must be individualized for each patient. Some people want as much information as possible, while others prefer only minimal information because too much knowledge may increase their anxiety. Patients have different abilities to comprehend medical procedures; some prefer printed information, while others learn more from oral presentations. It is important for the patient to ask questions during preoperative teaching. Preoperative care involves many components.
When Mr.Fenech is admitted to the ward for his preoperative care of prostatic hypertrophy, he is shown to his room, and is given a quick tour around the surgical ward. Mr.Fenech will be shown where to put his belongings and also introduced to the nursing staff. Physical assessment will be done. Physical assessment may consist of a complete medical history including the patient’s surgical and anesthesia background. The patient should inform the physician and nursing staff if he had any adverse reaction to anesthesia (such as anaphylactic shock), or if there is a family history of malignant hyperthermia. Routine preoperative laboratory assessments include CBC, electrolytes, prothrombin time and urinalysis. Since bleeding or hemorrhage, is a major risk after prostatectomy, preoperative care should involve determining baseline hematological values. Careful consideration must be given to those individuals receiving oral anticoagulants for other disease, since the risk of hemorrhage is so great. The patient will most likely have an ECG if he has a history of cardiac disease, and is over 50 years of age. A chest x-ray is done if the patient has a history of respiratory disease. Part of the preparation includes assessment for risk factors that might impair healing, such as nutritional deficiencies, steroid use, radiation or chemotherapy, drug or alcohol abuse or metabolic diseases such as diabetes. The patient should also provide a list of all medications, vitamins and herbal or food supplements that she might be using. Supplements are often overlooked, but may cause adverse effects when used with general anesthetics. Some supplements can prolong bleeding time.
Latex allergy has become a public health concern. Latex is found in most sterile surgical gloves, and is common component in other medical supplies including general anesthesia masks, tubing and multi-dose medication vials. Every patient should be assessed for potential latex reaction.
Preoperative determination of urea and electrolyte levels will provide baseline measurements and permit correction before surgery. This may involve urethral catheterization to permit adequate bladder drainage, the use of I.V. fluid to achieve hydration and, if necessary, the provision of saline for irrigation.
Bowel clearance may be ordered. The patient should start the bowel preparation early the evening before surgery to prevent interrupted sleeping during the night.
The night before surgery, skin preparation is often ordered which can take the form of scrubbing with a special soap or possibly hair removal from the surgical area.
A preoperative checklist would also be done.
The checklist is designed to ensure that the patient is physiologically prepared for the surgery. Patients are often fearful or anxious about having surgery. It is often helpful for them to express their concerns to the nurses. This can be especially beneficial for patients who are critically ill or who are having a high risk procedure. The family needs to be included in psychological preoperative care. Pastoral care is usually offered in the hospital. If the patient has a fear of dying during surgery, this concern should be expressed, and the surgeon notified. In some cases, the procedure may be postponed until the patient feels more secure. Patients and family who are prepared psychological tend to cope better with the patient’s post operative course. Preparation leads to superior outcomes since the goals of recovery are known ahead of time, and the patient is able to manage postoperative pain more
effectively.
The patient’s or guardian’s written consent form for the surgery is a vital portion of preoperative care. By law, the physician who will perform the procedure must explain the risks and benefits of the surgery, along with other treatment options. It is important that the patient understands everything he is told. Since almost all men have retrograde ejaculation after prostatectomy it is essential that they are counseled adequately beforehand. Retrograde ejaculation does not cause impotence, but a patient who has not been given adequate reassurance on this point could suffer psychological upset resulting in impotence. Retrograde ejaculation will not render the patient sterile, but neither will it necessarily permit him to father children easily. It should not be presumed that all elderly men are not sexually active, and all patients are entitled to preoperative information.
Due to the fact that general anesthesia is going to be used, nothing is permitted to be given by mouth (NBM) after midnight the evening of the surgery. This is done to reduce the risk of vomiting and aspiration while under anesthesia. IV therapy is initiated to provide vascular access for administration of medication or anesthesia. Patients should be told which medications to take prior surgery and the medications that should have been brought with them (such as inhalers for patients with asthma).
Instruction about the surgery itself includes informing the patient about what will be done during the surgery, and how long the procedure is expected to take. The patient should be told also where the incision is going to be.
Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient’s outcome. Instruction about expected activities can also increase compliance and help prevent complications. This includes the opportunity for the patient to practice coughing and deep breathing exercises. Additionally, the patient should be informed about early ambulation (getting out of bed). Patients hospitalized postoperatively should be informed about the tubes and equipment they will have. These may include intravenous lines, drainage tubes, dressings etc…
Pain management is the primary concern for many patients. Patients should be encouraged to ask for pain medication before the pain becomes unbearable. If they will be using pain-controlled-analgesia pump (PCA), instruction should take place during the preoperative period. Finally, the patient should understand long-term goals such as when he’ll be able to eat solid food, go home, and drive a car and return to work.
Parameters will be checked and charted. When the operating theatre informs the surgical unit to hand over the patient, the nursing staff asks Mr.Fenech to change his clothing into a hospital dressing gown. The patient’s file will be checked and verified that the consent form is signed both by the consultant and the patient. It would also include full x-ray taken and the preoperative checklist. The patient then would be taken down to the operating theatre to be handed over to the nursing staff of the operating theatre. The nursing staff will ask again the same questions of the checklist, which have been asked before, check the patient name and I.D. number. Mr.Fenech would wait in the Holding Bay.
g. On receiving Mr.Fenech, a routine postoperative assessment is performed. The goals of postoperative management are to stabilize the patient’s vital signs; correct fluid and electrolyte imbalances prevent infection and promote healing. It also consists of pain or nausea assessment. Mr.Fenech would be received with an IV infusion. The type of fluid, flow
h. Major nursing considerations postoperatively includes;
- Risk of hemorrhage. Catheter should be checked frequently for drainage. Full bladder may cause bleeding. The nurse should be alert for any signs of hemorrhage and give close attention to the pulse, blood pressure and the amount of drainage. The drainage should be watery and blood tinged 24-28 hours postoperatively. The hemorrhage will always be a threat in the postoperative period, thus the patient is given light diet, no straining at stool, no enemas/rectal tubes or rectal thermometers to be inserted.
- Infection (urinary tract, epididymis or testis) prophylactic antibiotics are given to the patient.
- Clot retention.
- Deep vein thrombosis and pulmonary embolism; these could be prevented by advising the patient to wear compression stockings preoperatively.
- Urethral stricture.
- Incontinence
- Impotence
- Retrograde ejaculation
- Bladder neck stenosis.
i. Once the urine is clear, the catheter can normally be removed. This is usually done in the morning to allow the patient to establish a normal voiding pattern before retiring to bed. Provided the patient is able to pass urine without difficulty, he may be discharged from hospital the following day.
Many patients feel after the operation that they have gained no relief from their problems. It must be understood that it will take about 6 weeks for healing of the prostatic bed to occur such that full urinary control is possible. The patient should be advised to refrain from heavy activities and exercises. He should drink plenty of fluids and avoid becoming constipated. It should be noted that episode of bleeding may occur 2-4 weeks postoperatively. This is rarely serious and if the patient drinks plenty of fluids and rests, it should disappear. If not call the patient should see his doctor. Mr. Fenech should be advised that sexual intercourse can take place 5-6 weeks after the operation. During sexual climax, however, the patient will not emit any semen from the penis. The ejaculation may flow into the bladder instead of down the penis and the first time he passes urine after intercourse, it will be cloudy. That is not harmful. Mr. Fenech is told that he would unlikely produce any children following the operation but it shouldn't be relied on as safe contraception.