Prostatic Surgery

  1. General information
    1. Indicated for benign prostatic hypertrophy and prostatic cancer.
    2. Types
      1. Transurethral resection (TUR or TURP): insertion of a resectoscope into the urethra to excise prostatic tissue; good for poor surgical risks, does not require an incision; most common type of surgery for BPH
      2. Suprapubic prostatectomy: the prostate is approached by a low abdominal incision into the bladder to the anterior aspect of the prostate; for large tumors obstructing the urethra
      3. Retropubic prostatectomy: to remove a large mass high in the pelvic area; involves a low midline incision below the bladder and into the prostatic capsule
      4. Perineal prostatectomy: often used for prostatic cancer; the incision is made through the perineum, which facilitates radical surgery if a malignancy is found
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Institute and maintain urinary drainage.
    3. Force fluids; administer antibiotics, acid-ash diet to eradicate UTI.
    4. Reinforce what surgeon has told client/significant others regarding effects of surgery on sexual function.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Ensure patency of 3-way Foley.
    3. Monitor continuous bladder irrigations with sterile saline solution (removes clotted blood from bladder), and control rate to keep urine light pink changing to clear.
    4. Expect hematuria for 2-3 days.
    5. Irrigate catheter with normal saline as ordered.
    6. Control/treat bladder spasms; encourage short, frequent walks; decrease rate of continuous bladder irrigations (if urine is not red and is without clots); administer anticholinergics (propantheline bromide [Pro-Banthine]) or antispasmodics (B&O suppositories) as ordered.
    7. Prevent hemorrhage: administer stool softeners to discourage straining at stool; avoid rectal temperatures and enemas; monitor Hgb and hct.
    8. Report bright red, thick blood in the catheter; persistent clots, persistent drainage on dressings.
    9. Provide for bladder retraining after Foley removal.
      1. Instruct client to perform perineal exercises (stopping and starting stream during voiding; pressing buttocks together then relaxing muscles) to improve sphincter control.
      2. Limit liquid intake in evening.
      3. Restrict caffeine-containing beverages.
      4. Withhold anticholinergics and antispasmodics (these drugs relax bladder and increase chance of incontinence) if permitted.
    10. Provide client teaching and discharge planning concerning
      1. Continued increased fluid intake
      2. Signs of UTI and need to report them
      3. Continued perineal exercises
      4. Avoidance of heavy lifting, straining during defecation, and prolonged travel (at least 8-12 weeks)
      5. Measures that promote urinary continence
      6. Possible impotence (more common after perineal resection)
        1. discuss ways of expressing sexuality (massage, cuddling)
        2. suggest alternative methods of sexual gratification and use of assistive aids
        3. discuss possibility of penile prosthesis with physician
      7. Need for annual and self-exams