Management of Urinary Incontinence Following Radical Prostatectomy

Brian McGlynn; Naels Al-Saffar; Helen Begg; Murat Gurun; Graham Hollins; Suzanne McPhee; Robert Meddings; Robert Meddings; Mary Tindall

Disclosures

Urol Nurs. 2004;24(6) 

In This Article

Abstract and Introduction

When working with patients with urology cancer, nurses will regularly care for men before and after radical prostatectomy. A critical review of the literature on the impact of urinary incontinence after radical prostatectomy is presented. Then by demonstrating how theoretical knowledge and understanding can be transferred to practice, a detailed description of an innovative multidisciplinary team approach is presented. This can positively affect symptom management and improve the quality of service for patients undergoing radical prostatectomy.

Introduction: The impact of a urology oncology nurse specialist in the practice environment to assist with both pre and postoperative education needs of men undergoing genitourinary surgery for cancer was evaluated.
Objective: This study aimed to improve the preoperative process and teaching for men planning surgery for genitourinary cancers, including the delivery of pathology results. A secondary aim was to decrease the incidence of postoperative incontinence.
Methods: Male patients undergoing a radical prostatectomy were recruited. Patients who underwent surgery were evaluated both before and after the urology oncology nurse specialist role was established. Followup was via phone call interview and International Prostate Symptom Score questionnaire.
Results: Men who received the personalized education from the urology oncology nurse specialist had a higher return of continence postoperatively, as well as higher satisfaction scores with the outcome of their surgery, including higher quality of life scores.
Conclusion: The urology oncology nurse specialist role had a significant impact on the postoperative incontinence rate and provided a missing patient education piece that improved the overall patient satisfaction rate with oncology-related care.

Prior to the appointment of a urology oncology nurse specialist within the study site, patients diagnosed with prostate cancer would receive their cancer diagnosis from a urologist. At that same visit, the urologist would inform them of their treatment options and the possible complications of each option. The decision to proceed with a radical prostatectomy was often made at this visit, or possibly the next visit. Patients were referred to the continence team postoperatively, after removal of their urethral catheter. The majority found that their bladder control was poor, and although this had been discussed pre-operatively with the urologist, many had very little memory of the discussion. This lack of recollection was understandable, as patients had to deal with their diagnosis while considering the treatment options. For those proceeding with surgery, uppermost in their minds was to remove the cancer, rather than the possible consequences of postoperative complications (Moore & Estey, 1999).

In this process, there was no nursing input providing support and information at the time of diagnosis or when planning treatment; similarly, there was no written patient information material made available. Ultimately, this resulted in patients and their families being poorly prepared postoperatively for the impact of urinary incontinence (UI) (Butler, Downe-Wamboldt, Marsh, Bell, & Jarvi, 2000).

Traditionally, it is medical staff who inform patients of their cancer diagnosis (Meredith et al., 1996). However, several authors question whether medical staff are in fact the best placed to deliver a cancer diagnosis to patients (Fallowfield, Jenkins, Farewell, Saul, Duffy, & Eves, 2002; Faulkner, 1998; Maguire, 1998). Limited consultation time and the unsuitable environment of a busy clinic have been highlighted as possible factors which may adversely influence the quality of consultation (Faulkner, Argent, Jones, & O'Keefe, 1995). Often patients are overwhelmed with details about treatment, side effects, prognosis, and followup; after hearing the word "cancer," they can become so shocked that the remainder of the conversation is usually lost (Faulkner, 1998). As a consequence of the nature and volume of the detail given to patients at this time, they can often suffer from information overload, resulting in an inability to recall and appreciate the implications of the diagnosis and treatment (Faulkner, 1998).

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