catheter removal, and the patient is informed that this is likely to subside over time.
Sexual Dysfunction
Depending on the type of surgery, the patient may experience sexual dysfunction
related to erectile dysfunction, decreased libido, and fatigue. These issues may
become a concern to the patient soon after surgery or in the weeks to months of
rehabilitation. Several options to restore erectile function are discussed with the
patient by the surgeon or urologist. These options may include medications, surgically
placed implants, or negative-pressure devices. A decrease in libido is usually related
to the impact of the surgery on the man's body. Reassurance that the usual level of
libido will return after recuperation from surgery is often helpful for the patient and
his partner. The patient should be aware that he may experience fatigue during
rehabilitation from surgery. This fatigue may also decrease his libido and alter his
enjoyment of usual activities.
Nursing interventions include assessing for the presence of sexual dysfunction after
surgery. Providing a private and confidential environment to discuss issues of
sexuality is important. The emotional challenges of prostate surgery and its
consequences need to be carefully explored with the patient and his partner. Providing
the opportunity to discuss these issues can be very beneficial to the patient. For
patients who demonstrate significant problems adjusting to their sexual dysfunction, a
referral to a sex therapist may be indicated.
Promoting Home and Community-Based Care
Teaching Patients Self-Care
The patient undergoing prostatectomy may be discharged within several days. The
length of the hospital stay depends on the type of prostatectomy performed. Patients
undergoing a perineal prostatectomy are hospitalized for 3 to 5 days. If a retropubic or
suprapubic prostatectomy is performed, the hospital stay may extend to 5 to 7 days.
The patient and family require instructions about how to manage the drainage system,
how to assess for complications, and how to promote recovery. The nurse provides
verbal and written instructions about the need to maintain the drainage system and to
monitor urinary output, about wound care, and about strategies to prevent
complications, such as infection, bleeding, and thrombosis. In addition, the patient
and family need to know about signs and symptoms that should be reported to the
physician (eg, blood in urine, decreased urine output, fever, change in wound
drainage, calf tenderness).
As the patient recovers and drainage tubes are removed, he may become discouraged
and depressed because he cannot regain bladder control immediately. Furthermore,
urinary frequency and burning may occur after the catheter is removed. Teaching the
patient the following exercises may help him regain urinary control:
Tense the perineal muscles by pressing the buttocks together; hold this
position; relax. This exercise can be performed 10 to 20 times each hour while
sitting or standing.
Try to interrupt the urinary stream after starting to void; wait a few seconds
and then continue to void.Perineal exercises should continue until the patient gains full urinary control. The
patient is instructed to urinate as soon as he feels the first urge to do so. It is important
that the patient know that regaining urinary control is a gradual process; he may
continue to ―dribble‖ after being discharged from the hospital, but this should
gradually diminish (within 1 year). Lining underwear with absorbent pads can help
minimize embarrassing stains on clothing. The urine may be cloudy for several weeks