NCP Prostatectomy

Many men older than age 75 have small, slow-growing prostate tumors that cause little harm. However, surgical resection of the portion of the prostate gland encroaching on the urethra may be required to improve urinary flow and relieve acute urinary retention regardless of the patient’s age. Note: Laser prostatectomy is being done in routine practice; however, published data relative to the efficacy of the procedure are currently insufficient for long-term outcomes.

Transurethral resection of the prostate (TURP): Obstructive prostatic tissue of the medial lobe surrounding the urethra is removed by means of a cystoscope/resectoscope introduced through the urethra.

Suprapubic/open prostatectomy: Indicated for masses exceeding 60 g (2 oz). Obstructing prostatic tissue is removed through a low midline incision made through the bladder. This approach is preferred if bladder stones are present.

Retropubic prostatectomy: Hypertrophied prostatic tissue mass (located high in the pelvic region) is removed through a low abdominal incision without opening the bladder. This approach may be used if the tumor is limited.

Perineal prostatectomy: Large prostatic masses low in the pelvic area are removed through an incision between the scrotum and the rectum. This more radical procedure is done for larger tumors/presence of nerve invasion and may result in impotence.

CARE SETTING

Inpatient acute surgical unit.

RELATED CONCERNS

Cancer

Psychosocial aspects of care

Surgical intervention

Patient Assessment Datebase

Refer to CP: Benign Prostatic Hyperplasia (BPH), p. 000, for assessment information.

Discharge plan

DRG projected mean length of inpatient stay: 3.3–7.1 days

Refer to section at end of plan for postdischarge considerations.

NURSING PRIORITIES

1. Maintain homeostasis/hemodynamic stability.
2. Promote comfort.
3. Prevent complications.
4. Provide information about surgical procedure/prognosis, treatment, and rehabilitation needs.

DISCHARGE GOALS

1. Urinary flow restored/enhanced.
2. Pain relieved/controlled.
3. Complications prevented/minimized.
4. Procedure/prognosis, therapeutic regimen, and rehabilitation needs understood.
5. Plan in place to meet needs after discharge.