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TURP Nursing Care: Pre & Post-Op

Updated: May 23, 2022

TURP stands for Transurethral Resection of the Prostate, which is the surgical removal of the Prostate

Working in a Urology ward means that you will get a lot of patients with problems in their prostate. The two most common issues are Benign Prostatic Hyperplasia and Prostatic Cancer, and they are both typically treated with TURP.

There are several ways to remove the prostate, but the TURP surgery provides a lot of advantages:

  1. It can be done through endoscopy, so the patient avoids an abdominal incision, making it safer for patients with surgical risks.

  2. Shorter hospital stay

  3. Lower morbidity rate

  4. Decreased post-operative pain

  5. Minimal risk of erectile dysfunction

Pre-Operative Nursing Care for TURP

Pre-Operative Nursing Assessment for TURP

Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the conversation, make sure to ask specific questions that will explain your patient’s situation. So, ask him:

  1. What he understands about the diagnosis and the surgery

  2. If his activity level has changed since the problem started

  3. His presenting symptoms (Nocturia/ urgency/ retention etc.)

  4. Erectile dysfunction or sex-related issues

  5. Related pain or discomfort

  6. How he feels about the diagnosis

  7. Whether he needs any psychological or emotional support

  8. If he has a relative or friend who can support him

During the nursing assessment, you should also obtain a full medical and family history of your patient.

Pre- Operative Nursing Diagnosis for TURP

Having finished the conversation, you can now build your nursing diagnosis, and you’ll most likely find the following:

  1. Lack of knowledge about the surgery

  2. Fear and anxiety about the operation and outcomes

  3. Acute pain related to bladder distention

Pre-operative Nursing Interventions for TURP

1. Education about TURP

As a nurse, you play a significant role in effectively educating your patient and addressing any questions. With the help of diagrams, you should highlight which structures are being affected, and what their job is in the urinary and reproductive system.

After that, you can give your patient an overview of how the surgery works, and what he can expect after it is done. Mainly that he will have a urinary catheter inserted, and possibly also an irrigation system.  Lastly, reassure your patient that the post-operative pain will be addressed through analgesia and supportive measures.

2. Managing Anxiety & Fear

Pre-operative anxiety and fear can arise from many factors. Particularly in a TURP, patients often feel scared about how the surgery will affect their body in terms of reproduction, sexual function. They might also have a false idea that their current issue is related to their sexual practice.

Research has indicated that men tend to suppress their feelings and hide their fears, so encourage your patient to verbalise any concerns that he might have and answer accordingly. Moreover, you should give your patient a contact number so that he can get in touch if he has any other questions. Lastly, reassure your patient that once he is fully recovered, he will be able to function normally and go on with his daily life.

3. Managing Discomfort

If your patient is in pain during the pre-op stage, he will most likely get analgesia and bedrest prescribed. In some cases, the patient may be hospitalised before the surgery, so you should take note of:

  1. His voiding patterns

  2. Bladder distention

  3. Urinary retention

An indwelling catheter may be indicated if your patient has reoccurring urinary retention, or Azotemia (build-up of nitrogenous waste in the blood). In that case, you should pay close attention to your patient’s blood pressure and kidney function as they might fluctuate after inserting the catheter.

4. Preparation on the Day of Surgery

The final step is to make sure that your patient is ready for surgery from the medical perspective. Your patient should be starved for at least 6 hours before the surgery, and make sure that he is kept hydrated through adequate IVI infusions.

Make sure that your patient has the following:

  1. Identification Bracelet

  2. Allergy Bracelet (if applicable)

  3. Changed into a hospital gown and removed his underwear

  4. Removed all jewellery/ foreign teeth/ hearing aid/ contact-lenses/ glasses/ make-up

Before going down to the Operating Theatre, your patient’s file should have:

  1. All medical notes and treatment charts

  2. A signed consent form

  3. Pre-operative medical assessment

  4. An ECG done in the last 2weeks

  5. Blood results, and Blood type from the past 3 days (often found online)

Post-Operative Nursing Care for TURP

Post TURP Nursing Assessment

Start by having a quick chat with your patient to determine his consciousness level. While having the conversation, ask her if she is in pain or feeling nauseous as these are expected after surgery. And you will also be assessing her airway and breathing patterns.

The next thing to do is to check:

  1. Vital signs

  2. Circulation in his hands and feet

  3. Check if the penis is bleeding around the catheter

  4. Take note of the urine volume and colour

Before leaving his side, ensure that the environment is safe; Place the bed rails up and give the nurse call bell to the patient. Check that all IV lines are secure, and that catheter is not kinked. Lastly, ask the patient if he wants a relative or a friend to be by his side.

Post TURP Nursing Diagnosis

The nursing assessment is likely to highlight the following nursing diagnoses:

  1. Acute pain from bladder spasms

  2. Discomfort from the catheter

  3. Fluid imbalance

Post TURP Nursing Interventions

1. Relieving Pain and Discomfort

When your patient complains of pain, ask him to identify which part of his body is painful. Pain in the flank area can be from kidney problems or radiating from bladder spasms, while pain in the penis is likely from the catheter.

Bladder spasms post TURP are a common occurrence and can be very painful; typically, these can be resolved with smooth muscle relaxant medication and a warm compress on the pubis.

Moreover, because the bladder will be irritated, it may form blood clots that can block the catheter and cause urine retention. So, pay close attention to the drainage tubing and irrigate the system as prescribed to relieve any obstruction.

Lastly, advise your patient not to sit for long periods as this increases the intra-abdominal pressure, and can worsen the pain.

2. Maintaining a Good Fluid Balance

Since the patient will most likely have continuous irrigation into the bladder, he will be at risk of fluid imbalance. The irrigating solution might be absorbed through incisions in the bladder instead of appropriately excreted, and this can lead to fluid retention, electrolyte imbalance and water intoxication.

So, with this in mind, make sure to chart your patient’s intake and output frequently, and record any discrepancies. You should also look out for high blood pressure, confusion, respiratory distress, or electrolyte imbalance as they are all symptoms of fluid imbalance.

Post TURP Complications

Having a Hysterectomy might put patients at risk of:

  1. Haemorrhagic Shock

  2. Deep Vein Thrombosis

  3. Infection

  4. Catheter issues

  5. Urinary Incontinence

  6. Sexual Dysfunction

Post TURP Discharge Planning

Before sending your patient home, make sure that she has:

  1. Anxiety under control

  2. Minimal pain and discomfort

  3. Fluid and Electrolytes within range

  4. Normal urine output

  5. Is continent of urine, or knows what exercises to do to regain continence

  6. No complications

Did you find this helpful? If so then you should have a look at the rest of the Study Guides Here. 

If reading is not for you, Don’t Worry! Take a look at my YouTube Channel were I explain the Pre-Operative Phase in Detail

And if you have any questions just send me a message on my Instagram Profile Nurse.Miriana

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