Prostate Care and Surgery

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Prostate Care and Surgery
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Prostate Care and Surgery

• Roughly the size of a walnut
• Situated around the neck of the bladder, the
  prostate gland is part of the male reproductive
  system and is vital in the production of semen.
• The tube through which the urine passes is called
  the urethra, which goes through the prostate
  gland.
• If the prostate enlarges, then the urethra
  narrows and urination problems occur.
• The prostate is also the centre for a bundle of
  sexual nerves, which is why prostate problems can
  cause impotence

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Prostate Care and Surgery

• The location of the prostate gland

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Prostate Care and Surgery

• What can go wrong?
• There are a number of problems that can occur
  with the prostate.
• BPH (Benign Prostatic Hyperplasia)
• BPH is relatively common in men over 65
• Characterised by reduced urinary flow, and a
  weaker urine stream.
• Prostatitis
• There are two types of bacterial Prostatitis
• acute (sudden onset)
• chronic (persistent)

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Prostate care and surgery

• Cancer of the Prostate
• Prostate cancer is rare in men under 45.
• Men with a family history of prostate cancer have
  a higher risk of developing the disease.
• There is also evidence to suggest that
  Afro-Caribbean men have a higher risk of
  developing the disease.

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Prostate Care and Surgery

• Difficulties with urination.
• Thinking the bladder's empty, then needing to go
  again.
• Getting up to go during the night.
• The presence of blood in the urine (this is
  rare).
• An inability to gain or hold an erection.

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Prostate Care and Surgery

• Diagnostic tests for prostate disease
• Size and consistency of the prostate is examined
  by inserting a finger into the rectum - digital
  rectal examination (DRE).
• Feel the abdomen to find out if the bladder is
  over-filled with urine.
• A urine sample will be tested for infection or
  blood.

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Prostate care and surgery

• Diagnostic tests cont
• Blood tests, including a prostate-specific
  antigen (PSA) test may be carried out.
• Biopsies
• urine flow tests
• ultrasound to check for urine left in the bladder
  and bladder stones
• urodynamic measurements using a catheter inserted
  into the bladder to measure the pressure of the
  urine and how fast it flows
• transrectal ultrasonography (TRUS) where an
  ultrasound probe is passed into the rectum to
  give a view of the prostate

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Prostate care and surgery

• Treatment
• The situation is monitored closely
• Advice on simple lifestyle changes that may help
  to improve your symptoms.
• not drinking alcoholic or caffeinated drinks
• learning techniques to increase how much urine
  your bladder can hold

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Prostate Care and Surgery

• Medical treatment for prostate disease
• Alpha-blockers
• relax muscle fibres that control the tension in
  the prostate gland
• reduce the pressure on the urethra and increase
  the flow of urine
• 5-alpha-reductase inhibitors
• block production of a hormone called
  dihydrotestosterone (DHT). This can reduce the
  size of the prostate by up to 30 percent.

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Prostate Care and Surgery

• Surgical treatment for prostate disease
• Transurethral incision of the prostate (TUIP) may
  be appropriate for men who have a less enlarged
  prostate. It is a quicker operation than TURP and
  instead of "chipping away" a portion of the
  prostate, small cuts are made in the bladder neck
  and the prostate to improve the flow of urine.

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Prostate care and surgery

• Surgical treatment for prostate disease cont..
• Open prostatectomy is only recommended for men
  whose prostate is very large. It is a major
  operation carried out under general anaesthesia
  and may require up to a week in hospital. An
  incision is made in the lower abdomen in order to
  remove part of the prostate.

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• Surgery cont.
• Transurethral resection of the prostate (TURP)
• This operation involves reboring the inside of
  the prostate to open up the channel and relieve
  obstruction to the flow of urine out of the
  bladder.

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Prostate Care and Surgery

• Surgery
• Newer treatments
• Laser therapy (using a laser probe to vaporise
  prostate tissue) and transurethral microwave
  thermotherapy (using heat to remove some of the
  prostate tissue via a probe) are becoming more
  common treatments.
•  

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Prostate Care and Surgery

• Pre- operative care
• A TURP involves a short period of
  hospitalisation. Usually admission on the day of
  surgery and staying in hospital for two nights.
• The anaesthetist attends prior to the operation
  to discuss the anaesthetic.

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• The TURP may be performed under a general or a
  spinal anaesthetic
• All jewellery, nail polish, makeup is removed
  prior
• A shower with antiseptic solution is given
• Dentures are removed
• Theatre attire is given to the patient
• Informed consent is checked for signage
• Education regarding post op care is given

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Prostate care and surgery

• While the patient is in theatre the nurse
  organises the bed and room to include all
  equipment required on return to the ward.
• Divide into groups and list equipment needed.

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Prostate Care and Surgery

• Post operative care
• If the TURP is performed with a spinal
  anaesthetic, there will be a sensation of
  numbness or "heaviness" in the legs for several
  hours post-operatively.
• A catheter is initially left in position.
• Irrigation fluid is run through the catheter into
  the bladder to clear away blood and clots from
  the operative area. This irrigation will continue
  until the urine becomes only lightly
  bloodstained, usually by the day following
  surgery.
• It is important after the irrigation has ceased
  to drink plenty of fluid to assist the process of
  flushing the blood clear.

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Prostate Care and Surgery

• Because of the presence of blood, a catheter is
  initially left in position. Irrigation fluid is
  run through the catheter into the bladder to
  clear away blood and clots from the operative
  area. This irrigation will continue until the
  urine becomes only lightly bloodstained, usually
  by the day following surgery. It is important
  after the irrigation has ceased to drink plenty
  of fluid to assist the process of flushing the
  blood clear.

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Prostate Care and Surgery

• Post operative care cont.
• I.V. therapy
• Post operative observations ½ hrly for 4hrs and
  then 4hrly.
• color, conscious state
• B/P, pulse, respirations, oxygen saturations,
  observe for ooze or leakage from catheter
  insertion site, pain, color, consistency and
  amount of urinary output.
• Oxygen therapy
• Continuous catheter irrigation (CCI)

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Prostate care and surgery

• Post operative care cont
• Fluid balance chart
• Nil orally until awake and then light diet until
  eating normally
• Increase fluids orally as tolerated
• Turn down CCI as urine output becomes clearer
• Catheter is usually removed day 2 post operative.
• After removal of the catheter, most men resume
  the ability to pass urine in a normal manner
• It can be 6 weeks before the urine clears
  completely

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References

• http//www.thepcrf.org/your_prostate/index.php
• http//www.patient.co.uk/showdoc/23068980/
• Lewis, Heitkemper and Dirksen 2000. Medical
  Surgical Nursing (5th edition) Mosby Inc.