Case Studies

Case 9: A man with benign hypertrophy of the prostate gland (Part 11 The male reproductive system)

Mr Peter Jones is a recently retired university lecturer who lives with his wife, Jane, in a semi-detached house. Mr Jones and his wife are enjoying life more since their retirement. They enjoy activities such as hiking, swimming and visiting family in Canada.

Mr Jones goes to see his GP as he has noticed some changes to his urinary habit, some dysuria, some hesitancy and strangury. The GP performs serum creatinine levels and a PSA (prostatic specific antigen) blood test and asks Peter to go for an ultrasound scan. The results are suggestive of benign prostatic hypertrophy and as a result he is referred to the consultant urologist to undergo a transurethral resection of the prostate gland.

Whilst Peter is waiting to be admitted to the hospital for the procedure, he develops severe suprapubic pain and informs the triage nurse that he has only been able to pass a very small amount of urine in the past 12 hours (around 100 ml). His bladder is distended and an ultrasound scan shows urinary retention. He is admitted to the ward and has a urinary catheter in situ.

• 1. Mr Jones has an enlarged prostate gland surrounding the bladder neck. What are the possible effects on the urinary tract and his kidneys?

• 2. Explain the advantages and disadvantages of the PSA test. What are the key issues that a man needs to be aware of?

• 3. In the postoperative period how would you recognize haemorrhage and what are your immediate actions?

• 4. What are the possible side effects associated with prostatic surgery?

Consider the ways in which prostatic surgery can have an adverse impact on the man's sexual health. Think about ways in which the nurse can sensitively approach the important issue of sexuality and sexual health with the patient (and if appropriate) the patient's partner.