Introduction
Over the last decade, there have been several advances in anesthetic and surgical techniques which have greatly impacted the work of postoperative care. These improved areas have seen many patients recover very quickly with minimal effects from an anesthetic state (Monda & Oesterling: 717). New and improved suturing materials have become available and thus have enabled more operative surgery to be performed (718). Because these techniques facilitate quicker recovery, the patient’s stay in hospital has remained quite short and the number of patients going through surgical wards has increased spontaneously hence drastically expanding the role of postoperative nursing care.
However, challenges still exist among patients who have undergone radical prostatectomy and ones who have had a transurethral resection. This is because there are variables that enter treatment decision making such as age, accompanying comorbidities, and patient preference, and significant other demands and opinions (Merrill & Potosky: 1603). Furthermore, prostatectomy may result in serious side effects on the patient, hence treatment and care that seem equal based on disease response and survival may not be significant since most patients have been found to mostly suffer from localized prostate cancer.
On the other hand, transurethral resection of the prostate (benign prostate hyperplasia) has become a common urological condition among aging males (1604). Studies have revealed that at least half of men above 50 years of age have some degree of prostatic enlargement even though the cause is unknown (Parker & Tong: 7). When the enlargement of the prostate occurs to the point where urine outflow is obstructed, transurethral resection of the prostate is one of the most commonly preferred treatments (12).
Radical prostatectomy
In most cases, radical prostatectomy is performed when there is a complete lack of evidence of metastases (Walsh & Worthington: 54). If such a scenario occurs, two types of radical prostatectomies are performed namely: retropubic approach or perineal approach. In the retropubic approach, an incision is made in the lower abdomen and there is a possibility that the surgeon may avoid removal of the nerves controlling erections and bladder muscles (54).
If this happens, there is a likelihood of lowering the impotence risk as well as incontinence that is a common feature of many of such similar surgeries (55). However, it should be noted that this does not eliminate the possibility of such complications occurring. On the other hand, a radical perineal prostatectomy involves doing an incision in the skin between the scrotum and anus (Religio & Larson: 259). It is noted that in this type of surgery, it is not possible to do nerve-sparing surgery through the approach and again it does not support the removal of lymph nodes (260). In some cases, however, a surgeon may remove some lymph nodes by doing a small incision in the abdomen through the use of a laparoscope (261).
The period for the surgeries may take in between two to six hours, but the perineal approach normally takes a shorter time as compared to the retropubic approach (Religo & Larson: 262). However, both types of surgeries may lead to an approximate hospital stay of three days and about 4 weeks of absence from work (Wilson: 343). During the operation, the management of fluid is normally maintained through administering crystalloid and colloid solutions (Wilson: 344).
After the operation, the patient is moved to the recovery ward where the nurse assesses the patient’s respiratory status and ensures that the patient is going through normal respiratory functions (Wilson: 345). Some of the identified causes of airwaves are 1. obstruction as a result of collection of mucus in the throat, vomit aspiration; laryngospasm attributed to intubation and anesthetic irritation; bronchospasm attributed to any other respiratory disease experienced by the patient earlier, and if the patient inhale gastric juices during surgery (347)
Postoperative care following a radical prostatectomy usually involves the management and care of the ureteral injury, bladder injury, and urine leak from an anastomotic site (Walsh & Worthington: 71). Rectal injury has been detected in some cases as well; it has been proved that successful laparoscopic two-layer rectal wall repair can be achieved when the injury is detected earlier during the intraoperative session (73). However, if this fails, some extra operative interventions will be needed.
After the surgery, the nurses continue to observe and assess the patient’s condition closely. It is crucial to maintain the patient’s airways together with ensuring the patient is well oxygenated and thus if necessary, the working suction to be made available at all times; and administration of oxygen for the early period of post-operation to be needed until the patient appears to have good skin color (Walsh & Worthington: 74). Sometimes specific suctions may have been provided by the surgeon in the patient’s notes and thus should be followed to the latter and the wound sites and drainage are observed for excessive blood loss (Wilson: 349)
The extraperitoneal approach to radical prostatectomy is necessary since it reduces the intra-abdominal complications such as ileus, avoidance of peritoneal space in patients with a history of previous abdominal surgery, and limitation of postoperative urine leak to the extraperitoneal space (Walsh & Worthington: 74). This approach calls for the first step which entails helping the patient manage their urinary incontinence i.e. it involves an assessment to identify characteristics and contributing factors of the urinary incontinence (74).
In this case, a patient profile will be identified through the number and amount of incontinent and incontinent episodes, precipitating events, urgency and leakage, and a number of pads used (74-75). In most cases, an indwelling catheter is being inserted into a patient’s bladder immediately after the surgery, especially when the patient is still asleep to ensure he or she urinates easily (Wilson: 350). This will ensure the pressure on the operative area is reduced and at the same time allow the nurse to measure the output of the urine (Wilson: 350).
Transurethral resection
Transurethral resection requires the intervention of nurses that primarily involve the management and prevention of the resultant complications. When the most dangerous complication, commonly known as transurethral resection (TURP) syndrome occurs, it normally causes severe dilutional hyponatremia as hypervolemia (Parker & Tong: 7).
Transurethral resection of the prostate involves the insertion of a resectoscope along the urethra by the use of a loop that has been electrically energized to excise hyperplastic lobes of the prostate (Beetstra & Gabrielson: 163). After the surgery, the patient is expected to be retained as an inpatient, where the nurse begins his or her duty by first completing an initial assessment and monitor for the signs of urinary compromise (Monda & Oesterling: 720; Beetstra & Gabrielson: 165).
The nursing interventions entail monitoring the urinary catheter for any signs of patency as well as blood loss, often conducted after every 1 to 2 hours as recommended by the American Urological Association (Monda & Oesterling: 723). Such signs of excessive blood loss being monitored are rapid pulse and decreasing blood pressure and input Vs output after every one or two hours (724). After the check is done, the output can be calculated by subtracting the total amount of irrigation solution infused from the total amount of urine output that is emptied from the bag (730). In case blood clots supersede the catheter drainage, irrigation may be performed and if the anomaly persists, continuous bladder irrigation, commonly known as CBI infusion, may be performed (Schover: 11; Monda & Oesterling: 726).
The removal of the urinary catheter is normally done after 3 days and the nurse continues to monitor the urinary output in a span of two to four hours, and subsequently encouraging the patient to take between two to 3 L of fluids per day. This is meant to relieve the patient of dysuria and eliminate hematuria (Monda & Oesterling: 732; Beetstra J & Gabrielson; 166).
Occasionally, discomfort may occur as a result of irrigation, bladder distention, or bladder spasm, thus prompting the physician to recommend the use of smooth muscle relaxants e.g. opium suppositories (Beetstra J & Gabrielson: 166). Combining this with the minimization of the catheter manipulation and an additional rest normally provide a good start for the patient’s comfort (167). Since the discomfort is largely attributed to the irrigation of the meatal resulting from the movement of the catheter, it is important to reduce the pressure through frequent rotation of the bladder with such equipment as Velcro holder (Monda, J. & Oesterling: 734)
Conclusion
Radical prostatectomy is a very important treatment for non-metastatic prostate cancer. However, the operation can be lengthy and may come with additional side effects due to the incisions on the surrounding tissues and glands (Monda & Oesterling: 136).
Nurses, therefore, play an integral part in the postoperative care of such patients as they recover from the effect. At the same time, caring for the TRUP patients need skilled medical and nursing care after the surgery to ensure the patients experience the least amount of pain as they recover. In both cases, patient education will form an integral part of the care process since this will not only facilitate quicker recovery but will form a crucial step in the transition to home care (Monda & Oesterling: 137). Primarily, this calls for a clear knowledge of the appropriate treatment techniques to ensure a positive outcome of the whole nursing process.
Work Cited
Beetstra J & Gabrielson A. “Transurethral resection of the prostate in an ambulatory setting.” Journal of Urological Nursing, 2002; 11(3):163-168.
Merrill M. & Potosky L. Changing trends in U.S. prostate cancer Incidence Rates. J National Cancer Institute, 2006; 88:1603-5.
Monda, J. & Oesterling, E. “Medical management of prostatic obstruction”. Journal of Urological Nursing. 1994; 13(2):717-738.
Parker S. & Tong T. Cancer statistics. Cancer J Clin 2007, 47:5-27.
Religo, W & M, Larson T R. “Microwave therapy: new wave of treatment for benign prostatic hyperplasia.” Journal of the American Academy of Physician Assistants, 2004; 7(4):259-267.
Schover, L. Sexuality and Fertility after Cancer. Wiley & Sons Inc:1997.
Walsh, P. & Worthington J. The Prostate: A Guide for Men and the Women Who Love Them. Johns Hopkins Press, 2005.
Wilson M. “Care of the patient undergoing transurethral resection of the prostate”, Journal of Perianesthesia Nursing, 2007; 12(5):341-351.