Urological Surgery Preoperative Care Quiz

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Questions and Answers

What is a primary goal in the preoperative phase for patients undergoing invasive procedures related to urinary issues?

Minimizing fluid intake

Restoration of urinary drainage (correct)

Maximizing sexual dysfunction

Complete bladder emptying

Which intervention is crucial for managing urinary retention preoperatively?

Administering oral antibiotics

Insertion of a coude catheter (correct)

Decreasing fluid intake to 1 L/day

Injection of saline solution

What should be encouraged to prevent urinary tract infections prior to invasive procedures?

High fluid intake (correct)

High protein intake

Avoiding all fluids

Low carbohydrate diet

What is a potential impact of surgery on sexual functioning that clients should be aware of?

Retrograde ejaculation may occur Signup and view all the answers

Which postoperative goal is essential for optimal recovery after urinary surgery?

Complete bladder emptying Signup and view all the answers

What is the typical duration for which a large indwelling catheter is left in place after a radical prostatectomy?

1 to 2 weeks Signup and view all the answers

What is the primary goal of a nerve-sparing procedure during radical prostatectomy?

To preserve neuro-vascular bundles Signup and view all the answers

What is the rationale for careful dressing changes and perineal care after a bowel movement following prostate surgery?

To aid in wound healing and prevent infection Signup and view all the answers

Which statement is true regarding the use of cryosurgery in prostate cancer treatment?

It involves freezing tissue to destroy cancer cells Signup and view all the answers

What is a possible risk associated with a nerve-sparing prostatectomy?

Increased risk of urinary incontinence Signup and view all the answers

Why is monitoring for an obstructed catheter important post-surgery?

To maintain proper fluid balance Signup and view all the answers

In what circumstance is surgery considered a viable option for advanced stage disease?

To relieve obstructive symptoms Signup and view all the answers

What is the primary purpose of bladder irrigation after prostate surgery?

To remove clotted blood and ensure urine drainage Signup and view all the answers

What indicates that there may be a complication during continuous bladder irrigation (CBI)?

Outflow is less than inflow Signup and view all the answers

How long are large amounts of blood clots considered normal after prostate surgery?

24 to 36 hours Signup and view all the answers

What condition can lead to bladder spasms after transurethral procedures?

Irritation of the bladder mucosa Signup and view all the answers

What should be done if a patient cannot void within 6 hours after catheter removal?

Reinsert the catheter for a day or two Signup and view all the answers

What could indicate a hemorrhage in a postoperative patient?

Bright-red blood in urine Signup and view all the answers

Which treatment is often used to relieve bladder spasms postoperatively?

Antispasmodics Signup and view all the answers

What is monitored to determine the effectiveness of bladder irrigation?

Color of urine output Signup and view all the answers

What might a patient experience immediately after catheter removal?

Poor sphincter tone Signup and view all the answers

What should be the appearance of urine drainage during CBI?

Light pink without clots Signup and view all the answers

What is the primary difference between hypertrophy and hyperplasia in the context of prostate enlargement?

Hypertrophy refers to an increase in cell size, while hyperplasia refers to an increase in the number of cells. Signup and view all the answers

Which of the following factors is the most significant risk for developing benign prostatic hyperplasia (BPH)?

Aging Signup and view all the answers

At what age does the risk of developing BPH typically begin to increase?

40 Signup and view all the answers

Which statement accurately reflects the potential progression of benign prostatic hyperplasia?

BPH can lead to partial or complete obstruction of the urethra. Signup and view all the answers

Which lifestyle factor has been shown to contribute to the increased risk of BPH?

Increasing abdominal obesity Signup and view all the answers

What is the primary indicator that bladder irrigation is effective postoperatively?

Urine drainage should be light pink without clots Signup and view all the answers

Which intervention should be taken if outflow from the catheter is less than inflow?

Assess the bladder and check catheter patency Signup and view all the answers

What complication may arise as a result of a catheter being obstructed?

Development of bladder spasms Signup and view all the answers

When should a nurse expect to see blood clots after prostate surgery?

For 24 to 36 hours post-surgery Signup and view all the answers

What is a likely outcome if a client cannot void within 6 hours after catheter removal?

A catheter may need to be reinserted for a day or two Signup and view all the answers

What is the mechanism by which finasteride alleviates symptoms of benign prostatic hyperplasia (BPH)?

Blocks 5α-reductase enzyme Signup and view all the answers

Which minimally invasive therapy uses microwave heat to treat BPH?

Transurethral Microwave Thermotherapy (TUMT) Signup and view all the answers

What is the primary characteristic of α-adrenergic receptor blockers in treating BPH?

They promote smooth muscle relaxation to facilitate urinary flow. Signup and view all the answers

Transurethral Needle Ablation (TUNA) uses which type of energy to treat enlarged prostate tissue?

Low-wave radiofrequency Signup and view all the answers

Which therapeutic approach is considered the standard for treating moderate to severe BPH?

Transurethral Resection of the Prostate (TURP) Signup and view all the answers

What does a negative balance of -200 ml between 1100 and 1500 hours indicate?

The patient is experiencing bladder spasms causing urine retention. Signup and view all the answers

During Continuous Bladder Irrigation (CBI), if 3400 ml is emptied from Bag #1 and the bag started with 3000 ml, what is the true urine output?

400 ml Signup and view all the answers

What should be assessed if a patient shows a negative urine output balance post-surgery?

Presence of clots that may block the catheter. Signup and view all the answers

What is indicated if a patient’s urine appears light pink 24 hours post-operatively?

It is a normal response following surgery. Signup and view all the answers

In the context of CBI, how is the total urine output computed for the day shift?

By summing the true urine output from each bag. Signup and view all the answers

Study Notes

Benign Prostate Hypertrophy (BPH) and Prostate and Testicular Cancer

Content focuses on individuals assigned male at birth (AMAB)
BPH is a benign enlargement of the prostate gland.
Non-inflammatory enlargement.
Resulting from hormonal changes & increase in cells.
Hypertrophy is an increase in cell size.
Hyperplasia is an increase in the number of cells.
BPH develops in the inner part of the prostate.
The most common urological problem in adult males/AMAB.
Occurs in 50% of males/AMAB over 50, and 80% of males/AMAB over 80.
Approximately 25% will require treatment by age 80.
Risk of developing prostate cancer is not clear, but having BPH may not lead to increased risk.
Important risk factors related to BPH include obesity, lack of physical activity, smoking and diabetes.
Symptoms worsen as obstruction increases.
Early symptoms are usually minimal.
Classified into 2 groups: obstructive (urinary retention) and irritative (inflammation/infection).
Obstructive symptoms: decrease in the caliber and force of urinary stream, difficulty initiating voiding, intermittency, and dribbling.
Irritative symptoms: Urinary frequency, urgency, dysuria, bladder pain, nocturia, and incontinence.
Complications related to urinary obstruction include acute urinary retention, urinary tract infection (UTI), incomplete bladder emptying, formation of calculi in the bladder, renal failure, pyelonephritis, and bladder damage.
Primary diagnostic methods include history and physical examination.
Digital rectal examination (DRE): Palpates prostate (firm and smooth, enlarged/symmetrically)
Prostate-Specific Antigen (PSA) levels were not recommended due to greater risks than benefits.
Normal reference PSA level: 0-4.0 ug/L
Serum creatinine to rule out renal insufficiency.
Additional diagnostic studies include transrectal ultrasound (TRUS), uroflowmetry, and cystourethroscopy.

Trans Women and Prostate Cancer

Individuals assigned male at birth (AMAB) who transitioned, but did not undergo bottom surgery, still have a prostate.
Links to stories of transwomen impacted by prostate cancer.

Risk Factors for Prostate Cancer

Aging: Risk increases with age, becoming noticeable around age 40, with higher incidence at age 50 and 80 (80%).
Obesity: Larger waist circumference, higher abdominal fat and leptin (hormone) levels, related to chronic high insulin levels and increased prostate volume.
Lack of physical activity: Exercise helps in fighting obesity, reducing inflammation, and managing Type 2 Diabetes and Insulin resistance.
Smoking: Causes inflammation.
Diabetes: High glucose levels and insulin resistance are linked to BPH development. Obesity worsens the progression.
Family history: First-degree relatives with prostate cancer increase risk.

Clinical Manifestations of BPH

Early symptoms are usually minimal.
Symptoms worsen with increased obstruction.
Classified into obstructive and irritative symptoms.

Complications of BPH

Acute urinary retention
Urinary tract infections (UTIs)
Incomplete bladder emptying.
Development of kidney stones.
Renal failure
Pyelonephritis.
Damage to the bladder

Diagnostic Studies for BPH

History and physical examination
Digital rectal examination (DRE)
Prostate-Specific Antigen (PSA) levels
Serum creatinine

Collaborative Therapies for Prostate Cancer

Active surveillance
Conservative therapy: Watchful waiting with annual physical exams, DRE, and considering aspects like life expectancy and co-morbid diseases. Low-grade, low-stage tumor and noticeable changes in DRE need reassessment.
Surgical options: Radical prostatectomy (nerve-sparing procedure), Cryosurgery, brachytherapy.
Radiation therapy (external beam) for primary, adjuvant and recurrent diseases
Hormone therapy of various kinds
Chemotherapy for metastatic disease

Nursing Interventions for pre-operative phase of BPH:

Restoration of urinary drainage.
Treatment of any UTI.
Understanding of procedure implications pertaining to sexual function and urinary control.

Nursing Interventions for post-operative BPH:

No complications (no further risks)
Restoration of urine control.
Complete bladder emptying.
Satisfying sexual expression.

Nursing Interventions for post-operative BPH and other cancer surgeries:

Maintaining urinary drainage (urinary catherization).
Administration of proper antibiotics for any infection.
Adequate fluid intake for flushing out the urinary tract to avoid infections and obstructions.
Pain management.
Monitoring for any infection or complications.

Diagnostic Studies for Prostate Cancer:

DRE (Digital Rectal Examination): Abnormalities are assessed (hard, nodular asymmetric).
PSA (Prostate-Specific Antigen) blood test: is no longer recommended as the risks outweigh the benefits. Used to monitor successful treatment. Low levels of PSA indicate successful treatment and undetectable levels means that treatment is successful.
Transurethral Resection of the Prostate (TURP): This is a procedure in which tissue is excised or removed cystoscopically.
Transurethral Incision of the Prostate (TUIP): Transurethral incisions are made for obstruction. This is effective for smaller sized prostate.
Prostatectomy: Surgical removal of the prostate- used as a last resort.
PCA3: A test more accurate than PSA. Benign prostate enlargement will NOT increase PCA, but will cause a rise in PSA. Useful for identifying early prostate cancer.
Biopsy of Prostate Tissue: Using transrectal ultrasound to visualize prostate gland.
Imaging: Bone scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI) to evaluate for metastatic disease in advanced stages.

Risk Factors for Testicular Cancer

Age: Most commonly diagnosed between age 15 and 40.
Cryptorchidism: Undescended testicles increase risk.
Klinefelter's syndrome: Extra X chromosome may lead to increased risk
Family history: A relative with testicular cancer increases the risk.
Ethnicity: White Canadian men have a higher risk, followed by black and Asian Canadian men.
Chemicals: Exposure to zinc, cadmium, and benzene (Group 1 carcinogens) in mining, oil and gas production.

Clinical manifestations of testicular cancer

Painless lump in scrotum.
Swelling in the scrotal area, feeling of heaviness.
Firm, nontender scrotal mass.
Dull ache in the scrotum, lower abdomen, or perineal area.
Acute pain in 10% of patients
Metastatic disease (metastatic manifestations) - lower back, chest, dyspnea.

Diagnostic Studies for Testicular Cancer

Palpation: First step to diagnosing testicular cancer - palpate scrotal contents for swelling, hardness, or lumps.
Testicular ultrasound: Diagnoses cancers that are not palpable or are suspected.
Lab tests: High levels of proteins and enzymes such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) help in finding tumors too small to be felt.
Testicular biopsy: Used for small, not palpable cancers - A small portion of the tissue sample is examined.
Imaging: Chest radiograph, CT, or MRI scan for metastatic cancers, and other tests such as anemia assessment, kidney function etc

Collaborative Management for Testicular Cancer

Radical Orchiectomy: Removal of the affected testis, spermatic cord and regional lymph nodes in pre-operative phase.
Post-surgery: Constant monitoring, radiation therapy, chemotherapy based on stage of the cancer
Stage 1: Removal of the single testis. If both testicles are removed, male fertility is compromised
Stages 2 and 3: Chemotherapy in combination with radiation therapy.

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Description

This quiz assesses your knowledge of crucial preoperative goals and interventions for patients undergoing invasive urinary procedures. Topics include urinary retention management, infection prevention, and understanding the impact of surgery on sexual functioning.