prostate care

7/29/2019 prostate care

1/22

Prostate Care and Surgery


2/22

(c) GOTAFE 2008


Roughly the size of a walnut

Situated around the neck of the bladder, the prostategland is part of the male reproductive system and is vitalin the production of semen.

The tube through which the urine passes is called theurethra, which goes through the prostate gland.

If the prostate enlarges, then the urethra narrows andurination problems occur.

The prostate is also the centre for a bundle of sexualnerves, which is why prostate problems can causeimpotence


3/22

(c) GOTAFE 2008


The location of the prostate gland


4/22

(c) GOTAFE 2008


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)


5/22

(c) GOTAFE 2008

Prostate care and surgery

Cancer of the Prostate:

Prostate cancer is rare in men under 45.

Men with a family history of prostatecancer have a higher risk of developing

the disease.

There is also evidence to suggest thatAfro-Caribbean men have a higher risk of

developing the disease.


6/22

(c) GOTAFE 2008


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.


7/22

(c) GOTAFE 2008


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.


8/22

(c) GOTAFE 2008


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 thebladder to measure the pressure of the urine and how fast it flows

transrectal ultrasonography (TRUS) where an ultrasound probe ispassed into the rectum to give a view of the prostate


9/22

(c) GOTAFE 2008


Treatment:

The situation is monitored closely

Advice on simple lifestyle changes thatmay help to improve your symptoms.

not drinking alcoholic or caffeinated drinks

learning techniques to increase how

much urine your bladder can hold


10/22

(c) GOTAFE 2008


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 calleddihydrotestosterone (DHT). This can reduce thesize of the prostate by up to 30 percent.


11/22

(c) GOTAFE 2008


Surgical treatment for prostate disease:

Transurethral incision of the prostate (TUIP) may

be appropriate for men who have a lessenlarged 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.


12/22

(c) GOTAFE 2008

Prostate care and surgery:

Surgical treatment for prostate diseasecont..:

Open prostatectomy is only recommended

for men whose prostate is very large. It isa major operation carried out undergeneral anaesthesia and may require upto a week in hospital. An incision is madein the lower abdomen in order to removepart of the prostate.


13/22

(c) GOTAFE 2008

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.


14/22

(c) GOTAFE 2008


Surgery

Newer treatments

Laser therapy (using a laser probe to vaporise

prostate tissue) and transurethral microwavethermotherapy (using heat to remove some of

the prostate tissue via a probe) are becoming

more common treatments.


15/22

(c) GOTAFE 2008


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.


16/22

(c) GOTAFE 2008

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


17/22

(c) GOTAFE 2008


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.


18/22

(c) GOTAFE 2008


Post operative care

If the TURP is performed with a spinal anaesthetic, therewill be a sensation of numbness or "heaviness" in thelegs 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 onlylightly bloodstained, usually by the day following surgery.

It is important after the irrigation has ceased to drinkplenty of fluid to assist the process of flushing the bloodclear.


19/22

(c) GOTAFE 2008


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 toassist the process of flushing the blood clear.


20/22

(c) GOTAFE 2008


Post operative care cont.

I.V. therapy

Post operative observations hrly for 4hrs and then4hrly.

color, conscious stateB/P, pulse, respirations, oxygen saturations, observe forooze or leakage from catheter insertion site, pain, color,consistency and amount of urinary output.

Oxygen therapy

Continuous catheter irrigation (CCI)


21/22

(c) GOTAFE 2008


Post operative care cont

Fluid balance chart

Nil orally until awake and then light diet until eatingnormally

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 resumethe ability to pass urine in a normal manner

It can be 6 weeks before the urine clearscompletely


22/22

(c) GOTAFE 2008

References:

http://www.thepcrf.org/your_prostate/index.ph

http://www.patient.co.uk/showdoc/23068980/

Lewis, Heitkemper and Dirksen 2000.Medical Surgical Nursing(5th edition)

Mosby Inc.
http://www.thepcrf.org/your_prostate/index.phphttp://www.patient.co.uk/showdoc/23068980/http://www.patient.co.uk/showdoc/23068980/http://www.thepcrf.org/your_prostate/index.php

prostate care

Documents