SURGICAL MANAGEMENT

MINIMALLY INVASIVE THERAPIES Transurethral microwave heat treatment (TUMT) involves the application of heat to prostatic tissue. A transurethral probe is inserted into the urethra, and microwaves are directed to the prostate tissue. The targeted tissue becomes necrotic and sloughs.

Transurethral needle ablation (TUNA) is another minimally invasive treatment option that uses radiofrequency energy and the UroLume stent. TUNA uses low level radiofrequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues. The body then resorbs the dead tissue.

SURGICAL RESECTION Surgical resection of the prostate gland is another option for patients with moderate to severe lower urinary tract symptoms of BPH and for those with acute urinary retention or other complications. Transurethral resection of the prostate (TURP) remains the benchmark for surgical treatment of BPH. It involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra; no external skin incision is made. The treated tissue either vaporizes or becomes necrotic and sloughs.

Transurethral resection of the prostrate (TUR or TURP) Transurethral incision of the prostate (TUIP) is also an outpatient procedure used to treat smaller prostates. One or two cuts are made in the prostate and prostate capsule to reduce constriction of the urethra and decrease resistance to flow of urine out of the bladder, and no tissue is removed.

Open prostatectomy involves the surgical removal of the inner portion of the prostate via suprapubic, retropubic, or perineal (rare) approach for large prostate glands.

NURSING MANAGEMENT (PERIOPERATIVE NURSING) PREOPERATIVE PHASE The nurse must instruct the patient to visit the physician, as ordered before the surgery for:

Complete physical exam To make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems, are being treated well If the patient is a smoker, smoking should stop several weeks before the surgery. The nurse familiarizes the patient with preoperative and postoperative routines and initiates measures to reduce anxiety. The day before procedure, deep breathing and coughing exercises should be taught to the patient. If the patient experiences discomfort before surgery, bed rest is prescribed, analgesic agents are administered and measures are initiated to relieve anxiety. Preoperative medication administration and an NPO status should be carried out as ordered by the physician. Preoperative preparations such as bowel preparation like enema and use of laxatives and preparations like removal of nail polish, dentures, and cosmetics should be done. Antiembolism stockings are applied before surgery and particularly important to prevent deep vein thrombosis (DVT) if the patient is placed in lithotomy position during surgery. The consent should be checked if signed by the patient not more than 24 hours before the procedure and determine if the it was explained by the physician.

INTRAOPERATIVE PHASE The responsibilities of the nurse depend on the role during the procedure whether the nurse is a scrub nurse, assist, or circulating nurse. The most important responsibility of a nurse during the procedure is to maintain surgical asepsis which would help prevent harming the patient.

POSTOPERATIVE PHASE After surgery, the patient will have a Foley catheter in the bladder to remove urine. The urine will look bloody at first. It will clear with time. A bladder irrigation solution may be attached to the catheter to continuously flush the catheter. This helps keep it from getting clogged with blood. Clot obstruction is suspected if the patient complains of bladder spasm and anuria. The bleeding will gradually decrease, and the catheter will be removed within 1 to 3 days. Facilitate urinary elimination. The urine output and amount of fluid used for irrigation must be closely monitored to determine whether irrigation fluid is being retained and to ensure an adequate urine output. Assess for bowel sounds and flatulence to determine if bowel functioning returned to normal. Monitor intake and output. Daily weighs is also essential. Postoperative medication should be administered as ordered. The patient is assisted to sit and dangle his legs on the side of the bed on the day after surgery and next is assisted to ambulate. The patient may need to wear special compression stockings and use a breathing device to keep your lungs clear as ordered by the physician. When discharged from the hospital, patients are advised to: Avoid alcoholic beverages. Avoid sexual activities for a few weeks. Avoid driving a car for a week or more. Keep domestic activities to a minimum. Avoid weight lifting or strenuous exercise. Check their temperature and report any fever to the physician. Practice good hygiene, especially of the hands and penis. Drink plenty of liquids.

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By: DANE CARMELA M. MALACAD, RM Group 8