Urinary retention (acute or chronic) related to bladder obstruction
OUTCOMES. Urinary continence; Urinary elimination; Infection status; Knowledge: Disease Process, Medication, Treatment Regimen; Symptom control behavior
INTERVENTIONS. Urinary retention care; Bladder irrigation; Fluid management; Fluid monitoring; Urinary catheterization; Urinary elimination management; Tube care: Urinary
SURGICAL. Those patients with the most severe cases, in which there is total urinary obstruction, chronic urinary retention, and recurrent urinary tract infection, usually require surgery. Transurethral resection of the prostate (TURP) is the most common surgical intervention. The procedure is performed by inserting a resectoscope through the urethra. Hypertrophic tissue is cut away, thereby relieving pressure on the urethra. Prostatectomy can be performed, in which the portion of the prostate gland causing the obstruction is removed.
The relatively newer surgical procedure called TUIP involves making an incision in the portion of the prostate attached to the bladder. The gland is split, reducing pressure on the
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urethra. TUIP is more helpful in men with smaller prostate glands that cause obstruction. Other minimally invasive treatments for BPH rely on heat to cause destruction of the prostate gland. The heat is delivered in a controlled fashion through a urinary catheter or a transrectal route, has the potential to reduce the complications associated with TURP, and has a lower anesthetic risk for the patient. Minimally invasive procedures include heat from laser energy, microwaves, radiofrequency energy, high-intensity ultrasound waves, and high-voltage electrical energy.
POSTSURGICAL. Postsurgical care involves supportive care and maintenance of the indwelling catheter to ensure patency and adequacy of irrigation. Belladonna and opium suppositories may relieve bladder spasms. Stool softeners are used to prevent straining during defecation after surgery. Ongoing monitoring of the drainage from the catheter determines the color, consistency, and amount of urine flow. The urine should be clear yellow or slightly pink in color. If the patient develops frank hematuria or an abrupt change in urinary output, the surgeon should be notified immediately. The most critical complications that can occur are septic or hemor-rhagic shock.
NONSURGICAL. In patients who are not candidates for surgery, a permanent indwelling catheter is inserted. If the catheter cannot be placed in the urethra because of obstruction, the patient may need a suprapubic cystostomy. Conservative therapy also includes prostatic massage, warm sitz baths, and a short-term fluid restriction to prevent bladder distension. Regular ejaculation may help decrease congestion of the prostate gland.
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