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

Purpose

Previously, patients were routinely given a 1-month review appointment with their urologist for their histology results after surgery or biopsy. All patients attended a very busy general urology clinic with only two doctors and approximately 45 patients per session. This allowed an average of only 8 minutes per consultation per patient. At this visit, the patient was informed of his diagnosis, possible treatment options and their side effects, further investigations or imaging studies, followup, and the potential prognosis. Due to the nature and volume of the information received, the individual had an inadequate opportunity to fully absorb and then discuss the implications of the diagnosis.

Staging investigations were usually ordered at this visit as well, resulting in a situation where medical staff were unable to provide a definite treatment plan as the study results were unavailable for review. The patient had to wait for the investigations to be completed, resulting in a further delay in order to receive results and initiate treatment. At times it could take up to 3 months from the initial diagnosis of prostate cancer to the time until a definitive treatment plan was initiated. This resulted in an inevitable increase in patient anxiety and uncertainty, with the possibility of disease progression. If radical prostatectomy was chosen as the treatment option, patients would have this carried out without any pre-operative support or information, and only had input from the continence team after the catheter was removed post operation.

Through audit and review of the current practice, it was established that a change of strategy was required, moving away from a fragmented approach with delayed intervention. The newly appointed urology oncology nurse, working with the continence nurses and physiotherapists, identified the need to improve the presurgical preparation for patients undergoing radical prostatectomy, in anticipation of improving outcomes.

The change needed was to create a structured multidisciplinary team involvement at all stages of the patient's cancer experience (National Institute for Clinical Excellence [NICE], 2002).

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