9.5 Urological Surgical Nursing: Retention, BPH, Prostatectomy, Calculi & Catheter Care

9.5 Urological Surgical Nursing: Retention, BPH, Prostatectomy, Calculi & Catheter Care

Quick Answer: Urological questions test catheter safety and post-prostatectomy care. Relieve acute urinary retention by aseptic catheterisation (suprapubic drainage if the urethra cannot be passed), and prevent catheter-associated urinary tract infection by keeping a closed system with the bag below bladder level and off the floor. After prostatectomy, run continuous bladder irrigation to keep drainage light pink, calculate true urine output = total drainage − irrigation volume, and watch for clot retention, bleeding and—after transurethral resection—TUR syndrome (dilutional hyponatraemia causing confusion and bradycardia).

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Acute Urinary Retention

Causes: benign prostatic hyperplasia (BPH), urethral stricture, constipation, drugs with anticholinergic effects, pain and immobility after surgery, and spinal anaesthesia (section 9.4).

Presentation: inability to pass urine, suprapubic pain and a tender, dullness-to-percussion bladder above the pubis (a bladder scan confirms volume where available). Chronic retention may be painless with overflow dribbling.

Management and nursing care:

1. Non-invasive measures first when appropriate: privacy, running water, standing or sitting to void, analgesia;
2. Urethral catheterisation with strict asepsis, adequate lubrication (with local anaesthetic gel for men) and a sterile closed drainage system;
3. If the catheter cannot pass (e.g., stricture), stop and report—suprapubic catheterisation is performed by the doctor;
4. Record the volume drained; after relief of long-standing obstruction, monitor for post-obstructive diuresis (large urine volumes, dehydration, electrolyte loss) and report output greater than about 200 mL/hour sustained over several hours.

[!IMPORTANT] Exam Alert: Never force a catheter against resistance, and never inflate the balloon until urine is flowing—inflating it in the urethra causes serious injury. After trauma, blood at the urethral meatus means no urethral catheter until the urethra is assessed (section 10.1).

Preventing Catheter-Associated Urinary Tract Infection (CAUTI)

Benign Prostatic Hyperplasia (BPH)

Lower urinary tract symptoms: frequency, nocturia, urgency, hesitancy, poor stream, straining, terminal dribbling and a feeling of incomplete emptying.

Assessment: history, digital rectal examination, urinalysis, renal function, prostate-specific antigen (PSA) where indicated, and ultrasound for residual urine.

Treatment options:

• Alpha-blockers (e.g., tamsulosin): relax prostatic smooth muscle; teach about postural hypotension—rise slowly;
• 5-alpha-reductase inhibitors (e.g., finasteride): shrink the gland over months and roughly halve the PSA value;
• Surgery: transurethral resection of the prostate (TURP) or open prostatectomy (retropubic or transvesical/suprapubic), which remains common where endoscopic equipment is limited.

Nursing After Prostatectomy

Continuous bladder irrigation (CBI): a three-way catheter allows sterile irrigation fluid (usually normal saline) to flow in while urine, blood and fluid drain out.

• Adjust the irrigation rate to keep the drainage light pink (rosé) and free of clots;
• Never let the irrigation bag run dry;
• Record the input and output hourly.

Calculating true urine output:

True urine output = Total volume drained − Irrigation fluid infused Example: drainage bag emptied 3,800 mL; irrigation fluid used 3,000 mL → true urine output = 800 mL.

Complications to watch for:

After catheter removal: expect some frequency, urgency or dribbling; teach pelvic floor exercises, 2–3 L of fluid daily unless restricted, avoiding straining, heavy lifting and constipation for about 6 weeks, and reporting bleeding with clots or inability to pass urine. Retrograde ejaculation is common after TURP and should be explained beforehand.

Prostate Cancer

Prostate cancer is a common cancer among Ghanaian men and often presents late. Symptoms overlap with BPH, and advanced disease can cause bone pain. Nurses encourage men over about 40–50 years with urinary symptoms to seek assessment, explain PSA and digital rectal examination, and support men through treatment decisions and side effects such as incontinence and erectile dysfunction.

Urinary Calculi (Stones)

• Renal/ureteric colic: severe, colicky loin-to-groin pain, restlessness, nausea and haematuria;
• Nursing care: prompt analgesia (NSAIDs such as diclofenac are effective unless contraindicated, with opioids if needed), fluids, strain all urine to catch stones for analysis, watch for fever (an infected obstructed kidney is an emergency);
• Treatment: many small stones pass spontaneously; larger stones may need lithotripsy, ureteroscopy or surgery;
• Prevention: drink enough to pass pale urine (often 2.5–3 L a day), and follow dietary advice for the stone type.

Urethral Stricture

Narrowing of the urethra after infection (e.g., gonorrhoea), trauma or previous catheterisation causes a poor stream and retention. Management includes dilatation or urethroplasty; teach safe-sex practices and early treatment of urethritis.

Exam Traps at a Glance

• True urine output subtracts the irrigation fluid from the total drained.
• Confusion and bradycardia after TURP: think TUR syndrome and check sodium.
• The drainage bag stays below the bladder and off the floor.
• Strain urine in renal colic.