PROSTATECTOMY
GENERAL OBJECTIVE
• STUDENT SHOULD ACQUIRE
KNOWLEDGE, DEMONSTRATE AN
UNDERSTANDING OF PROSTATECTOMY
AND APPLY THE KNOWLEDGE ACQUIRED
IN THE PRE AND POST-OPERATIVE
NURSING MANAGEMENT OF CLIENTS
UNDERGOING PROSTATECTOMY
SPECIFIC OBJECTIVES
• DEFINITION
• INDICATIONS
• SURGICAL APPROACHES TO
PROSTATECOMY
• PRE-OPERATIVE PREPARATION OF
CLIENT
• POST-OPERATIVE NURSING
MANAGEMENT OF A CLIENT
• COMPLICATIONS
DEFINITION
• Prostatectomy refers to the surgical
removal of part or all of the prostate
gland .
INDICATIONS
• hydroureter and hydronephrosis
• Chronic prostatitis
• Severe and prolonged haematuria
secondary to BPH or Ca prostate
• BPH
• Ca prostate
SURGICAL APPROACHES TO
PROSTATECTOMY
1.Transurethral resection of the
Prostatectomy (TURP)
• This is an endoscopic approach in which
there is no abdominal incision.
• A cutting and ligating instrument
(resectoscope) is inserted through the
urethra to remove as much pieces of the
enlarged portion of the prostate as
possible as well as ligating bleeders.
1.Transurethral resection of the
Prostatectomy (TURP)
• The excised tissue is washed into the
bladder via the resectoscope and then
flushed out using the bladder drainage
• A catheter is left in the bladder for one to
five days to drain urine and blood
1.Transurethral resection of the
Prostatectomy (TURP)
Indications:
• Small prostate enlargement
• Bladder neck obstruction
• Very elderly clients
• Debilitated clients
Advantages:
• Suitable for clients who can not withstand the
stress of general anaesthesia
• Short period of hospitalization
1.Transurethral resection of the
Prostate (TURP)
Disadvantages:
• High risk for bladder perforation
• Prostate not completely removed
• Urethral trauma leading to stricture
formation
• High risk for haemorrhage
• Requires highly specialized manpower and
sophisticated equipment
2. Transvesical (Suprapubic )
Prostatectomy (TVP)
• A small abdominal incision is made just
above the symphysis pubis and directly
over the bladder
• The bladder is then distended with saline
and a small incision made in the bladder
wall
• The surgeon uses the fingers to remove
the enlarged prostate tissue
2. Transvesical (Suprapubic )
Prostatectomy (TVP)
• Indicated when the prostate is too large
to be removed transurethrally and when
some bladder surgery is to be done as
well
Advantages:
• Enough room to remove the gland
• Gland is accessed and inspected for any
lesions
2. Transvesical (Suprapubic )
Prostatectomy (TVP)
Disadvantages:
• High risk for peritonitis should urine leak
into peritoneal cavity
• Haemorrhage can be difficulty to control
• Not suitable for the elderly and clients
with debilitating illnesses
• Require longer period of hospitalization
3.Retropubic/Retrovesical
Prostatectomy
• An abdominal incision is made, bladder is
retracted posteriorly and incision is made
into anterior prostatic capsule through
which the gland is removed
• The urinary bladder is not opened
• Urethral catheter is inserted for urinary
catheter and drains are placed in the
abdominal wound.
3.Retropubic/Retrovesical
Prostatectomy
Indications:
• Too big a prostate to be removed transurethrally
without coexisting bladder problems
Advantages:
• Shorter period of hospitalization
• Haemorrhage easily controlled
• Gives direct access to the gland
• Disadvantage:
• High risk for pubic bone infection
4. Perineal Prostatectomy
• The incision is made between the scrotum and
the rectum from where the enlarged gland is
reached and removed.
• It is a rarely used approach due to fear of injury
to the spermatic cord, the urinary bladder and
fear of fecal wound contamination
• Urethral catheter is inserted to empty the
bladder and drain is placed in the perineal
wound.
4. Perineal Prostatectomy
Indications:
• Removal of gland with bladder calculi
• Treatment of prostatic abscess which fails
to responds to conservative approach
• Repair of prostatic
laceration/complications secondary to
previous surgery
4. Perineal Prostatectomy
Advantages:
• It is a direct approach to the prostate
• Minimal blood loss
Disadvantages:
• Danger of damaging rectal sphincters leading to
fecal incontinence
• High risk for infection due to fecal contamination
• Risk for impotence due to damage to spermatic
cord
SPECIFIC PRE-OPERATIVE
PREPARATION
AIM:
• To adequately prepare client psychologically
and emotionally and prevent post-operative
complications
Psychological care:
• Introduce yourself
• Explain condition – etiology and features
• Explain available treatment options to allow
client make informed choice
SPECIFIC PRE-OPERATIVE
PREPARATION
• Allow client to ask questions
• Involve client’s significant relations for
emotional and psychological support
• Bring in client who has had successful
prostatectomy for emotional and psychological
support
• Explain that surgery may not cause erectile
dysfunction but will affect fertility due to
retrograde ejaculation
SPECIFIC PRE-OPERATIVE
PREPARATION
• Explain that client will come back with
continuous bladder irrigation from theatre to
allay anxiety and promote client cooperation
• Explain the type of anaesthesia to be used to
allay anxiety
• Explain that client will be give analgesics in the
post-operative period to allay anxiety
• Obtain written surgical consent as legal
contract between client and the institution
SPECIFIC PRE-OPERATIVE
PREPARATION
Investigations:
• CXR to rule out pulmonary and cardiac
conditions
• Blood for Hb/Hct estimation to rule out
anaemia
SPECIFIC PRE-OPERATIVE
PREPARATION
Investigations:
• Blood for Type and cross-match (GXM) in
readiness for blood transfusion
• Blood for clotting time to ascertain
client’s haemostasis status
• Blood for platelet estimation to ascertain
client’s haemostasis status
SPECIFIC PRE-OPERATIVE
PREPARATION
Physical Preparation:
• Patients are advised not to take non-
steroid anti-inflammatory drug for one
week before surgery because of increased
risk of bleeding.
• Client is catheterized to relieve urinary
retention
• Pubic area is shaved (+/-), dependening
on surgeon’s preference
SPECIFIC PRE-OPERATIVE
PREPARATION
• Client is kept NPO to offset risk of vomiting
and subsequent aspiration
• Client is given a bath and clean gown on
the morning of surgery to prevent cross-
infection
• Remove dentures
• Remove jewellery
• Keep safe any client’s variables, if
necessary
SPECIFIC PRE-OPERATIVE
PREPARATION
• Do latest vital signs, including body
weight, as baseline information for
theatre team
• Label client for identity
• Get client’s typed and cross-matched
blood, treatment file and escort to theatre
• Make post-operative bed upon return
from escorting client
SPECIFIC POST OPERATIVE CARE
AIM: Maintain client’s patent airway, ensure
adequate continuous bladder irrigation and
prevent complications
• Care depends on the approach used
• After TURP, iv fluids are given in the first
few hours after surgery then discontinued
• Clear oral fluids are advised thereafter and
client progresses to regular as soon as
tolerated.
IMMEDIATE POST OPERATIVE
CARE
Collect client from theatre: as for any other
operations plus:
• Note if continuous bladder irrigation is
running or not to avoid blockage
Environment:
• As for any other major operations plus:
• Always have a 60cc sterile toomey syringe
and saline to flush the continuous bladder
irrigation, in case it gets blocked
IMMEDIATE POST OPERATIVE
CARE
Position/Maintenance of patent Airway: as for
any other major surgery
Maintenance of circulation:
• Keep client warm to promote circulation even to
extremities
• Administer IV fluids as prescribed by surgeon
• Ensure effective running of continous bladder
drainage to avoid blockage and subsequent
rupture of suture lines
IMMEDIATE POST OPERATIVE
CARE
• Monitor and record intake and output using
a fluid balance sheet to ensure adequate
hydration as well as ascertain any
haemorrhage ( if bloody urine even 24hrs
after surgery)
• Monitor and record vital signs
• Check for pallor and cyanosis
• Administer screened blood, if indicated to
replace lost blood
IMMEDIATE POST OPERATIVE
CARE
Care of continuous bladder irrigation/drainage
• Secure catheter to client’s thigh and bed to
prevent tugging
• Administer continuous saline bladder
irrigation as prescribed to avoid clot
formation and eventual blockage
• Note the colour of drainange output to
ensure it is either pink or colourless
IMMEDIATE POST OPERATIVE
CARE
• Milk the drainage line, if running slower than
expected, to avoid blockage
• Flush catheter using sterile toomey syringe
and saline, if blocked to prevent clot
formation
• Call the surgeon immediately, if flushing
yields no positive results
• Empty collecting bottle PRN to avoid overflow
IMMEDIATE POST OPERATIVE
CARE
Observations:
• Vital signs
• Continuous bladder irrigation
• Incision wound site
• Bladder drainage output: amount & colour
and consistence
• Pallor and cyanosis
• Facial expression for any severe pain
IMMEDIATE POST OPERATIVE
CARE
Pain Management:
• Secure catheter to client and bed to avoid
tugging
• Nurse client in recovery position to avoid
pressure on the incision
• Administer prescribed analgesics
• Ensure effective running of continuous
bladder drainage to avoid blockage
SUBSEQUENT POST-OP CARE
Continuous bladder irrigation:
• Usually clamped on and off 2-3 days post-
operatively in readiness for discontinuation 3-4
days later
• Foley catheter removed 5-7 days in readiness for
discharge
• Advise client not to try and pull the catheter to
avoid traumatizing the urethra
• Advise client not to regulate flow of irrigation to
avoid under-irrigation
SUBSEQUENT POST-OP CARE
Suprapubic wound care:
• Nurse client in most comfortble position to
avoid tension on suture lines
• Daily wound dressing using aseptic technique
• Advise client not to touch the wound
• Advise client to support wound when coughing
• Advise client to take enough fluids and
roughage in diet to prevent constipation
SUBSEQUENT POST-OP CARE
Medication:
• Antibiotics to prevent infection
• Analgesics to relief pain
Diet:
• High protein such as kapenta
• High vitamin such as fruits
• High iron such as green-leafy vegetables
• High fluid to flush urinary bladder
SUBSEQUENT POST-OP CARE
Observations:
• Check the incision site for bleeding.
• Ensure that the irrigation is running well if
in place
• Check conjunctiva and palms for pallor
and collect blood for Hb, as advised, to
rule out anaemia
SUBSEQUENT POST-OP CARE
Psychological care:
• Provide feed-back on surgery and
reinforce pre-operative advice such as
continuous bladder irrigation and
impotence
COMPLICATIONS OF
PROSTATECTOMY
• Haemorrhage
• Urinary tract infection (UTI) due to longer period of
catheterization
• Urinary bladder clot formation due to inadequate irrigation
• Infection
• Infertility, if damage to spermatic cord occurs
• Transient urinary incontinence due to temporal paralysis of
bladder sphincter
• Urethral scarring, in TURP
.
THANK YOU
