Electrovaporization of the prostate: initial experiences and nursing management

STUDY DESCRIPTION: Electrocautery power is increasingly used to destroy prostatic tissue as well as to control bleeding during transurethral surgery for benign prostatic hyperplasia. This study summarizes our initial experiences with the electrovaporization procedure and combines these with the published findings of others in order to provide recommendations for the nursing management of this increasingly common urologic surgical procedure.

A retrospective review of 36 consecutive patients managed by electrovaporization of the prostate was completed. A standardized data collection form was used to evaluate the preoperative preparation, intraoperative experiences, and short-term postoperative responses to the electrovaporization procedure. These data were combined with the published experiences of others in order to provide initial insights into the nursing management of patients undergoing this procedure.

Patient preparation was similar to that used for transurethral resection of the prostate. No patients experienced significant intraoperative bleeding. Two subjects (7%) experienced significant but transient hematuria in the postoperative period. Five men (17%) experienced urinary retention requiring catheterization, of these three were caused by blood clots and two were attributable to pre-existing detrusor muscle weakness. Urinary tract infection occurred in eight patients (27%), three of which were accompanied by a fever. All patients reported urethral and suprapubic pain following the procedure. One subject experienced flank pain caused by an acute obstruction of a solitary ureter, and one reported bladder spasms. Significant pain requiring analgesia resolved within 5 days of the procedure in all cases.

The preoperative nursing management of the patient undergoing electrovaporization of prostate tissue is similar to that for transurethral resection of the prostate with the exception of patient teaching. Patient education should emphasize self-assessment for urinary retention, hematuria, and urinary tract infection. The postprocedural care initially focuses on monitoring the patient for catheter patency, hematuria, and infection. Patients and significant others should be warned that delayed hematuria and urinary retention may occur days or weeks after electrovaporization of the prostate. During the past decade, the number of alternative procedures for prostate tissue destruction has grown significantly. Each of these procedures offers potential advantages when compared to the classic transurethral resection of the prostate (TURP). While their usefulness in treating obstruction due to benign prostate enlargement has been reasonably well described (McCullough, 1998), the nursing management of patients undergoing many of these procedures has not been adequately studied or described. The purpose of this study was to summarize our initial experiences with the VaporTrode procedure and to better define the nursing management of patients undergoing this increasingly common urologic surgery.