Prostate Care and Surgery

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 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.

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