Benign Prostatic Hyperplasia (BPH) is a benign adenomatous overgrowth of the periurethral part of the prostate gland. The symptoms correspond to infravesical obstruction, which includes sluggish urine flow, pressure fluctuations, pollakiuria, and imperative urges, among others. Diagnosis is mainly based on data from finger rectal examination and subjective symptoms, and data from cystoscopy, transrectal ultrasound, and urodynamic examination, among others.
Treatment options include the administration of 5 alpha-reductase inhibitors, alpha-blockers, tadalafil, and surgical procedure. In the periurethral region of the prostate, multiple fibroadenomatous nodules develop, apparently arising from the periurethral glands, and not from the true fibromuscular tissue of the prostate (surgical capsule). The capsule is displaced to the periphery due to the progressive growth of the nodules.
As the lumen of the prostatic part of the urethra narrows and lengthens, the outflow of urine is progressively hindered. Increased pressure associated with urination and distension of the bladder can lead to detrusor hypertrophy, trabecular formation, cellular formation, and false diverticula (CNO, 2021). The incomplete emptying of the bladder causes stagnation of urine and predisposes the formation of concretions and infection. Prolonged obstruction of the urinary tract, even incomplete, can cause hydronephrosis and impaired renal function.
Trans Urethral Prostate Resection (TURP) Surgery Procedure and Post-Operational Procedure
Drug therapy for the prostate adenoma is effective in a limited number of patients, in the early stages of the disease. In other cases, preference is given to surgical techniques. According to the CNO (2021), surgery operations are the most common and preferred method of surgical treatment of benign prostatic hyperplasia.
The essence of the method is that under the control of optics (endoscope) with the help of an electric rod (no more than 9 mm in size) through the lumen of the urethra, the adenoma tissues are “cut” in layers into the lumen of the bladder. Then the resulting “chips” are removed by a special pump (CNO, 2021). The duration of the operation, as a rule, does not exceed 1.5 hours. Anesthesia – regional or anesthesia.
With a smooth course of the postoperative period, patients are discharged from the clinic 3-4 days after the intervention, and after 7 days they can start working (CNO, 2021). In recent years, a new modification of the prostate TOUR has appeared – the so-called “bipolar TOUR” (CNO, 2021). The technique of the operation remained mostly the same, but thanks to the use of new equipment, it was possible to reduce the number of complications and narrow the range of contraindications to prostate cancer. The latest modification of the TUR is the bipolar plasma vaporization of the prostate gland-an exclusive development of OLYMPUS (CNO, 2021). This technique allows removing adenomatous prostate tissue almost bloodlessly and quickly enough.
Due to the restoration of normal urine outflow, the TURP prevents secondary kidney damage, the formation of concretions in the kidneys and bladder, frequent and recurrent urinary tract infections. Preparation for prostate surgery significantly reduces the operational risks and facilitates the postoperative period. A few weeks before the intervention, the patient will undergo a full physical examination and, if necessary, receive recommendations for the treatment for diabetes, normalizing blood pressure, improving the function of external respiration, etc.
The doctor will also recommend the patient to stop smoking. A few days before the operation, it is necessary to stop taking certain medications: Anticoagulants and antiplatelet agents (for example, clopidogrel and warfarin), non-steroidal anti-inflammatory drugs (for example, aspirin, ibuprofen, naproxen), vitamin E preparations, a broad-spectrum antibiotic is additionally prescribed to prevent urinary tract infections (CNO, 2021). It is also worth taking care of the actions after discharge from the clinic in advance. The patient will not be able to drive a vehicle and get home by car without an escort.
Acute Complications of TURP Surgery
Similar to any surgical intervention, transurethral resection of the prostate gland is associated with surgical complications. The patient’s doctor will discuss with them the possible risks and ways of preventing in advance.
- Temporary difficulties with urination. In the first few days after the operation, the patient will urinate through a catheter.
- Dry orgasm. After prostate surgery, the direction of movement of sperm during ejaculation changes as it retrogrades into the bladder. The process does not affect the achievement of orgasm, though it becomes an obstacle when planning a pregnancy.h
- Erectile dysfunction. The dysfunction develops when nerve endings are damaged.
- A decrease in the level of sodium in the blood or TURP-syndrome. During the TURP, the operating area is washed with a large amount of fluid, which is partially absorbed into the systemic circulation (CNO, 2021). The factor leads to impaired blood electrolyte levels and can potentially be a life-threatening condition. When using bipolar resectoscopes, the risk of developing this complication is reduced to zero.
Signs and Symptoms of an Enlarged Prostate
The prostate is a gland that surrounds the urethra and is located under the bladder in the pelvic region. The normal prostate gland of an adult is the size of a chestnut. The prostate is tightly entwined with many nerve fibers, which are responsible in particular for erectile function and urinary retention. In the course of life, the prostate gland increases. According to the CNO (2021), the etiology of prostate hyperplasia has not yet been clarified; it is assumed that one of the reasons is the change in male hormones with age. As a rule, there is a benign increase in the internal glandular part, i.e., where the urethra passes through the prostate. As a result of the enlargement of the prostate, the urethra is compressed, which makes it difficult to urinate.
The symptoms are not only related to the size of the prostate. Even minor hyperplasia can cause great discomfort.
Most common symptoms include the following:
- Weak urine flow;
- Prolonged emptying of the bladder;
- Leakage of urine after urination;
- Residual urine (feeling unable to empty the bladder completely);
- Pollakiuria (frequent urination);
- Imperative urge to urinate (feeling of pressure occurs quickly, which causes the need for immediate toilet visits);
- Urinary incontinence (uncontrolled loss of urine);
- Nycturia (urination at night).
CNO Module on Consent
According to the CNO (2021), the following are the guiding principles for consent:
- Nursing is one profession with two categories: Registered Nurse (RN) and Registered Practical Nurse (RPN).
- The foundational knowledge base for RNs and RPNs is different (differences in education) (CNO, 2021).
- Nurses enhance their knowledge through education, experience and reflection (CNO, 2021).
- Nurses are accountable for their actions.
- Clients are the central focus of nursing care.
- The overall goal is the best possible client outcome.
The following legislation governs the consent (CNO, 2021):
- Health Care Consent Act.
- Substitute Decisions Act.
Nurses are accountable for obtaining consent for:
- treatment;
- admission to a care facility;
- personal assistance services.
CNO Culturally Sensitive Care
Nurses should try to improve their skills in providing patient-centered care understanding how their patient culture and beliefs affect the nurse-patient relationship. The nurse must also understand how biopsychosocial needs and cultural background relate to health care needs. There are values considered most important in nursing care, such as patient well-being and patient choice. Nurses are responsible for listening to, understanding, and respecting the values, opinions, needs, and ethnocultural beliefs of their patients. By integrating these elements into the care plan, nurses support patients by achieving their specific health goals.
Nurses are also responsible for obtaining informed consent for any treatment offered. It is the nurse’s responsibility to determine the patient’s understanding of the treatment, to ensure that they have the necessary information to make an informed decision. When there are concerns that a decision to care for a patient negatively affects them, nurses work with the patient to explain the risks associated with the choice, allowing them to make an informed decision. The therapeutic nurse-patient relationship is based on meaningful communication between them. When some barriers exist, it is the nurse’s responsibility to use the necessary strategies and skills to ensure that the patient is an informed partner in providing care.
How Family is Involved in the Consent Process
Most patients give their consent, although there are also those who refuse to sign the appropriate document. Given the specific circumstances (the reasons for the patient’s refusal, their emotional state, and tendency to compromise, among others), a nurse can attract a family (CNO, 2021). The patient’s family can be involved in the consent process. The family can help the patient understand the severity of his condition and the importance of making an agreement (CNO, 2021). The family can also provide the patient with emotional support, which makes it easier and faster to give the necessary agreement.
Conclusion
In conclusion, Benign Prostatic Hyperplasia is a serious health problem for men. To overcome the disease, there are various ways and methods. The main way for the treatment is surgical intervention. It is the most reliable option for the patient to cure themselves. However, not all ill persons may give their consent to the operation. To persuade them, qualified specialists may be involved, as well as the members of the patients’ family.
References
CNO. (2021a). Consent. Web.
CNO. (2021b). Culturally sensitive care. Web.