Care of a patient undergoing TURP.
Mr. Paul Fenech a 65 year old pensioner has been diagnosed with Prostatic Hypertrophy that requires surgery.
a. Describe the Anatomy and Physiology of the prostate gland including its functions. b. Mention the disorders that could affect the prostate gland. c. Describe the clinical manifestations of prostate hypertrophy. d. Mention the investigations that are done to diagnose this condition. e. Describe the possible surgical approaches for removal of the prostate gland. f. Discuss the preoperative care required from admission until handover including the pre op assessment and physical and psychological care. (Holistic care). g. Discuss the postoperative care required from handover in theatre until discharge. h. What possible complications could occur post TURP and how are these prevented or dealt with? i. Describe what advice should be given prior to discharge.
The prostate gland is a lobulated structure which lies in the pelvic cavity in front of the rectum and behind the syphilis pubis, surrounding the uppermost part of the urethra. It is palpable on rectal examination. The prostate gland secretes a thin, milky, alkaline fluid that makes up 60% of the seminal fluid; this fluid creates an environment more hospitable to sperm by giving protection from the normally acidic environment of the male urethra and female vagina. A neutral or slightly alkaline medium also increases sperm motility. The prostate is susceptible to hyperplasia, which, because of its proximity to the urethra can lead to urinary problems.
Three principal disease processes affect the prostate gland:
- Benign Prostatic Hypertrophy.
Bacteria that cause venereal, bladder and kidney infections may also infect the prostate. This may occur following an infection of the urinary tract, surgery or catheter insertion. Acute infection causes pain, tenderness, fever, chills, and burning urine. Chronic infection manifests as subtle or vague symptoms, such as pelvic pain and discomfort, low back pain or burning urine. So called ‘a bacterial prostatitis’ may be due either Chlamydia or Ureaplasm organisms. These are usually sexually transmitted. Infections of the prostate gland may be so mild that the male is unaware of it. Testing of Prostatic secretions and urine will lead to identification of the organism and appropriate antibiotic treatment.
Benign Prostatic Hypertrophy.
Benign enlargement of the prostate is extremely common in men over 50 years of age, with 70% of men by the age of 60 and 90% by the age of 70 having the condition. As a result, the prostate becomes a bumpy, rubbery mass that can be felt via a rectal examination. Such enlargement in the confined space of the pelvis, results in compression of the urethra and interference with passing urine. This produces the characteristic clinical symptoms of difficulty in starting micturition, difficulty in stopping micturition, frequency and urgency, poor flow and force in the urine passed, dribbling and incontinence and a feeling that the bladder is never completely emptied. This must be relieved by insertion of a catheter. As a result, bladder and kidney infections are much more common in men with this condition. Obstruction or infection, or both, may cause severe kidney damage in some people.
Cancer of the prostate gland is very common. Statistics indicate that it ranks among the most common cancer and cause of cancer death in men. The cause of prostate cancer is unknown; however it often occurs along with the benign (non-cancerous) enlargement of the prostate gland. Male sex hormones play a role in cancer growth. Drugs that reduce their levels or block their action are often used in the treatment of prostate cancer. In its early stage prostate cancer is usually an insidious, symptom less disease. Consequently it may not be discovered until it is quite advanced. Often the tumor is...
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