University Hospitals of North Midlands NHS Trust nursing care following day case laser
prostatectomy: a real world example
This nursing care template is an example cited in the NICE medical technologies guidance adoption
resource for GreenLight XPS 180 W for surgical treatment of benign prostatic hyperplasia. It was not
produced, commissioned or sanctioned by NICE.
NURSING CARE FOLLOWING DAY CASE LASER PROSTATECTOMY
Observations
Half hourly B/P, P, T and Resps for 2 hours post op. If temp exceeds 38
inform doctors.
Observe for signs of retention. If patient does not pass urine for 4 hours
contact the doctor.
Haematuria is normal after prostatectomy. However, if it is excessive or the
urine contains clots, notify the doctors.
Catheter
If the patient is catheterised observe for signs of excessive bleeding. Seek
medical advice re when the catheter is to be removed. The catheter may be
removed by the nursing staff prior to discharge if this is documented in the
medical notes.
If the patient is discharged home with a catheter, make arrangements for its
removal and subsequent TWOC.
TWOC
If patients go home with a catheter the district nurses will carry out the TWOC.
Please ask them to remove catheter the morning after discharge and to return
in the afternoon to ensure patient has PU’d. If possible they could carry out a
bladder scan but this is not essential. (See D/N info sheet)
Retention
Unless the surgeon states otherwise, district nurses may catheterise any
patients who go into retention at home
District Nurses are asked to inform the ward of any patients they TWOC or
catheterise and the ward staff must relay this information to the relevant
consultant for advice on follow up.
Spinal Anaesthesia
Some patients will have had a spinal anaesthetic. They may experience a
spinal headache which is worse on standing and is relieved by lying flat. They
should be given the normal post op analgesia, advised to lie flat and be
encouraged to drink plenty of fluids. They should still be fit for same day
discharge as long as the headache is not unduly severe. If it is contact the
anaesthetist for advice.
Length of Stay
Patients must remain on the unit until they have voided urine at least twice on
2 separate occasions,with reasonable bladder emptying. Please ensure they
use a urinal in order that we can measure the amount of urine they pass. It
should be at least 100mls. Recommended time of post op stay,4-6 hours.
Eating and drinking
As normal, once recovered from GA (although most patients will undergo
spinal anaesthesia) Unless patients are on restricted fluids for other medical
reasons, hourly fluids are to be encouraged.
Patients should be advised to avoid caffeine, fizzy drinks, citrus drinks and
alcohol for 4 weeks, as these may cause bladder spasm and increased
irritation.
TTO’s
All patients will have some form of analgesia to take home with them and
may, occasionally, also be given antibiotics, although this will not be routine.
Follow up
Please arrange any necessary follow up appointment ,usually 3 months in the
case of un catheterised straightforward patients. If the patient is catheterised
or has any other post op complications, then the follow up will vary and you
must check with the urology team.
District Nurse
All patients must have a district nurse visit on the evening of discharge and
the following day. Please arrange and be sure to send the district nurse info
sheet home with them.
District nurses are asked to inform the appropriate ward of any patients they
TWOC or catheterise and the ward must then inform the relevant consultant.
Ward 101/SAU
All patients have 48 hours of access to Ward 101 and/or SAU. Please ensure
you have passed on their details to these areas before the patient goes home.
Please inform SAU that if the patient presents with them in retention the
Urology Consultants are happy for them to catheterise unless Ward 105 staff
have informed them otherwise on verbal handover.