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

Findings and Results

Nurse-led histology clinic audit results of this new practice were extremely positive (see Figure 4). From 106 patients audited by questionnaire, following transrectal ultrasound and prostatic biopsies (77%; n=82), and transurethral resection of bladder tumor (23%; n=24), a total of 99% (n=105) expressed overall satisfaction at being told their diagnosis by a nurse. A data-collection tool was also devised to assess the time scale of appointments, ultimately resulting in 91% of patients diagnosed with prostate cancer being reviewed by the medical team within 5 weeks of their initial biopsy: these patients were fully staged, better prepared, and in the case of those requiring hormonal therapy, treatment had already started.

Nurse-Led Histology Clinic.

The audit results showed that prior to the service development, of the 25 men having radical prostatectomy, only 32% (n=8) were seen pre-operatively by the continence team. Under the new program, 85% (n=41) of the 47 men audited were reviewed at least 2 weeks before surgery and taught pelvic floor exercises. The remaining 15% (n=6) were seen on the day of admission with surgery the following day. This resulted in an improved level of urinary control following removal of the urethral catheter, with only 49% of the 47 men (n=23) experiencing poor control, compared with 72% (n=18) of the 25 patients treated prior to the service development. Similarly, patients were generally regaining total continence over a much shorter period of time, often being discharged continent from the clinic within 2 months. Previously, as shown from the audit results, this would occur around 8 months post prostatectomy.

Overall, results using the severity index study reflect a significant improvement, with 55% (n=26) of patients treated under the new development dry and 30% (n=14) acknowledging slight drip leakage on strenuous exercise. Of the remainder, 9% (n=4) admitted to pre-operative incontinence and being no worse after surgery, while 6% (n=3) had poor continence levels either due to sphincter involvement from the cancer or other co-morbidity.

Patients' quality of life was also much improved with the new approach. Most patients (97%; n=46) were delighted, happy, or pleased with their bladder control compared with only 68% (n=17) of the patients within the audit who were treated prior to the service development. The remaining 32% (n=8) had mixed feelings or were unhappy.

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