Article 120: Surgical Methods, Nursing Care, and Sexual Life Issues Related to Benign Prostatic Hyperplasia

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

Surgical treatment of benign prostatic hyperplasia

1. Prostatectomy: Prostatectomy is a radical treatment for benign prostatic hyperplasia (BPH). It is suitable for patients with significant urinary tract obstruction, good general condition, and no serious impairment of cardiopulmonary, hepatic, or renal function. Since this disease primarily occurs in elderly patients, preoperative preparation is extremely important, including examination and treatment of cardiopulmonary, hepatic, and renal function, drainage of residual urine, and control of urinary tract infections. There are four surgical approaches for prostatectomy: transurethral, ​​suprapubic, retropubic, and perineal. The first two are more commonly used. Suprapubic transvesical prostatectomy is easily mastered by general surgeons, provides good exposure, allows for complete removal of hyperplastic tissue, and can simultaneously address other bladder lesions such as stones and tumors. However, this method is highly invasive, prostatic bleeding is difficult to control completely, and the recovery period is longer. In recent years, with advancements in instruments and techniques, transurethral prostatectomy has become increasingly widespread. This method has the advantages of less pain, less damage and faster recovery, but it is technically difficult and not easy to master. The prostate removal is not always complete and there are complications such as transurethral resection of the prostate syndrome, urethral and bladder neck stenosis and urinary incontinence.

2. Bilateral orchiectomy or enucleation: This procedure is suitable for elderly and frail patients with severe impairment of cardiopulmonary, hepatic, and renal function, who cannot tolerate prostatectomy, and for whom non-surgical treatment has been ineffective. This method is simple, requires no special equipment, and has low risk.

Nursing care after benign prostatic hyperplasia resection

1. Preoperative care:

(1) Preoperative examination and preparation: Due to their advanced age, patients often have damage to the function of organs such as heart, lungs and kidneys. Before the operation, the patient's tolerance to anesthesia and surgery should be fully assessed. The patient's cardiovascular, respiratory, endocrine and nervous system conditions should be fully and carefully examined. Complications should be treated and the operation should be performed after the condition is stable.

For those with poor blood clotting mechanisms, appropriate supplements such as whole blood and platelets can be given, and sufficient blood should be prepared for transfusion.

Patients with indwelling catheters should have their bladders flushed regularly to control urinary tract infections.

Keep warm, prevent colds, quit smoking and drinking, train bedpan use, and give those with constipation high-fiber foods or laxatives.

An enema was administered the night before surgery, and the patient was kept from eating or drinking on the morning of surgery.

2. Postoperative care:

(1) After the patient returns to the room, closely monitor vital signs and overall condition, quickly connect all drainage tubes, select the appropriate position according to the anesthesia method, keep the room well-ventilated, minimize movement of people, and ensure the patient gets sufficient rest. After the anesthesia period, place the patient in a sloping position to facilitate bladder drainage and prevent hypostatic pneumonia. Record 24-hour fluid intake and output.

(2) Closely monitor for hematuria. Early bleeding usually occurs within 24 hours postoperatively. The causes are often related to incomplete hemostasis during surgery, insufficient pressure from the balloon catheter, or wound oozing. A characteristic symptom is that the continuous bladder irrigation fluid is dark red, accompanied by small blood clots; large amounts can easily cause post-catheterization obstruction. If this is observed, report it to the doctor immediately. The treatment involves increasing the bladder irrigation rate to prevent blood clot formation in the bladder.

The balloon catheter is used to apply pressure and traction, compressing the opening of the prostatic fossa to prevent blood from flowing back into the bladder.

Apply hemostatic drugs intravenously locally.

Use a syringe or negative pressure suction device to aspirate until the blood clot is removed.

To prevent bleeding, continuous external bladder irrigation with isotonic saline must be performed for 48 hours post-surgery. Because the irrigation fluid circulates through the urethra and bladder rapidly, the patient may experience a drop in body temperature or chills; therefore, it is important to keep the patient warm and monitor blood circulation in the extremities. If the drainage fluid becomes clear after 2-3 days, the irrigation frequency can be adjusted to once every 2-4 hours, and then twice daily after one week.

(3) Care of various tubes: Securely fix all drainage tubes, keep the balloon catheter and cystostomy tube unobstructed, and when turning the patient, pay attention to whether the drainage tubes have shifted or fallen off, ensure that the tubes are not twisted or kinked, and squeeze the drainage tubes regularly. To prevent blood clots from blocking the urethra, clean the urethral opening once a day with a cotton ball soaked in benzalkonium chloride solution, and change the drainage bag twice every 3 days to prevent retrograde infection.

(4) Basic Nursing Care: Pay attention to any urinary incontinence, bleeding, or dressing soaking or falling off at the wound site, and address these issues promptly. Keep the bed clean and dry, and maintain cleanliness and dryness of the abdominal, buttock, and perineal skin to prevent eczema and bedsores. Try to meet the patient's needs, assist them in changing positions to reduce their sensitivity to pain, and administer sedatives if necessary. Provide proper oral care in the morning and evening. Strengthen dietary care; once bowel movements have resumed, provide easily digestible, high-fiber foods to maintain regular bowel movements. Take precautions to prevent pulmonary complications; administer nebulized inhalation for patients with excessive sputum, and use the bottom-up percussion method to assist with expectoration. Encourage lower limb movement to prevent venous thrombosis.

(5) Do not perform rectal tube gas expulsion or enema for one week after surgery to avoid damage to the prostate fossa and bleeding.

(6) Post-catheter removal care: The urinary catheter can be removed about 10 days after surgery, once the urine has cleared, and the cystostomy tube can be removed about 15 days after surgery. The patient's condition should still be monitored after the catheter is removed, and the patient should avoid getting out of bed on the day of the removal.

(7) Before discharge, the residual urine volume in the bladder should be measured and the renal function should be checked. If there is still difficulty in urination or urinary incontinence 3-4 weeks after surgery, the cause should be identified and necessary treatment should be given.

Can I still have sex after prostate removal?

Due to the effects of the surgery, some people may experience changes in sexual function, the most common being retrograde ejaculation and erectile dysfunction.

Retrograde ejaculation refers to a condition in which semen fails to exit the body through the urethra during ejaculation and instead flows backward into the bladder. This is caused by damage to the bladder neck during prostate surgery, preventing the normally closed internal bladder orifice from closing completely. Retrograde ejaculation does not affect sexual life. Once the patient understands the mechanism of retrograde ejaculation, they can fully adapt to this condition after surgery. Generally speaking, it does not affect sexual pleasure and is harmless to the body.

While surgical trauma that damages the nerves controlling penile erection can lead to erectile dysfunction, this is relatively rare. Most cases of erectile dysfunction in older men, or their reluctance to resume sexual activity, are due to psychological factors. Other older men, even after full recovery and noticing spontaneous penile erections, suppress their libido due to a lack of medical knowledge and fear that resuming sexual activity will affect the surgical outcome or cause a recurrence of urethral obstruction.

In summary, although prostatectomy may have some impact on sexual life, most patients can recover their sexual ability after a period of recovery. In particular, those who had normal sexual function before the surgery and did not undergo perineal or radical surgery need not worry. Even if retrograde ejaculation occurs, there is no need to worry too much, as their sexual function can generally be restored to the pre-operative level.