(prŏs‵tă-tĕk'tō-mē )

[Gr. prostates, prostate, + ektome, excision]

Excision of part or all of the prostate gland . The operation may be performed via a laparoscopic approach through an incision in the perineum (perineal prostatectomy), into the bladder (suprapubic prostatectomy), retropubically, or through the urethra (transurethral prostatectomy, TURP).

Patient Care: Preoperative: To prepare the patient for surgery and postoperative recovery, the type of procedure planned and expected results are explained and informed consent is obtained.

Postoperative: Vital signs are monitored closely for indications of hemorrhage or shock. Any dressings and drainage tubes are managed, skin is protected from excoriation, and incisions or tube insertion wounds are inspected for signs of infection. If a suprapubic tube is present, patency and drainage are monitored; drainage fluid should be amber to pink tinged. Urinary catheter patency is monitored, and intermittent or continuous bladder irrigation is maintained as prescribed, usually via a three-channel indwelling catheter. Irrigation rate should be fast enough to limit drainage color change to amber to pink tinged, rather than red; rate should be increased if color deepens or clots appear. Volume of irrigant and amount of drainage are carefully tracked, and the former is subtracted from the latter to determine urinary output. Medicines are administered as prescribed to reduce bladder spasms and pain. Sitz baths also may be used to relieve pain and discomfort.

When the catheter is removed, the patient should void every 2 hr, and serial urines are monitored for color, time, and amount of each voiding. Bladder ultrasound is used to assess for retained urine. Fluid intake of 2 to 3 L/day (unless restricted by cardiac or renal deficits), mainly as water, is encouraged; caffeine is avoided. The patient may experience urinary frequency temporarily and dribbling, but he can regain control of urinary function with Kegel exercises. Urine may be blood tinged for a few weeks, but any bright red bleeding and fever, chills, or other signs of infection should be reported. The patient should avoid straining at stool (stool softeners are often prescribed) and lifting objects of more than 10 lb, long automobile trips, and strenuous exercise for several weeks. Walking usually is considered acceptable exercise. Sexual intercourse should be delayed until the patient has been evaluated by the physician at the follow-up visit and has the physician's permission to begin such activity. The patient also should continue prescribed medications at least until the follow-up visit and should have an annual prostatic examination if prostate removal was partial.