Transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia with little damage, good effect. But after surgery patients because of the surgical trauma pain, urinary catheter and a balloon on bladder stimulation, bladder clot and the patient's emotional stress and other factors cause bladder spasm [1], not only to patients bring great pain, and easy secondary bleeding and urine leakage etc. complications and even cardiovascular and cerebrovascular accident. This paper analyzes the causes of bladder spasm after TURP operation and the corresponding nursing measures.
Materials and methods
1 general information. Select our hospital in July 2012 January -2014 line TURP surgery patients in 85 cases, aged 57-92 years old. Patients were due to micturition not free a series of urinary tract obstruction symptoms on admission, the abdominal ultrasonography and rectal refers to examination and prostate specific antigen (PSA) diagnosed as benign prostatic hyperplasia, the course of 10 years. Among them, with 83 cases of diabetes, hypertension, coronary heart disease, chronic bronchitis patients with other underlying diseases, preoperative positive control of the primary disease. After TURP, 57 patients had bladder spasm.
2 surgical methods for epidural anesthesia. By bladder lithotomy position, with the United States Shun Kang F26.5 electricity cut mirror practice for TURP. Postoperative indwelling F18-22 number three cavity balloon catheter, balloon into 40-60ml saline fixed to the inner thigh skin oppressive prostate fossa export reached hemostasis. After the operation, the continuous bladder irrigation was used.
Result
Transurethral resection syndrome in 3 cases. Postoperative bladder spasm of 57 cases (67.1%), displays for the postoperative 12-48h appears in the lower abdomen, urethra and bladder spasm pain, has the desire to defecate and urinate, urine is not independent from the urethra overflow washing liquid drops into the poor, even reflux. After the corresponding treatment and nursing measures were taken, the symptoms were relieved. Temporary urinary incontinence after operation in 11 cases. 85 cases were cured or improved.
discuss
At present, people of bladder spasm mechanism is not very clear, may and bladder mucosa, especially the trigone of the bladder mucosa of temperature, pressure and mechanical stimulation is very sensitive.
After transurethral resection of the prostate due to surgery and urethra and bladder neck mucosa injury and postoperative indwelling balloon catheter and bladder irrigation fluid temperature and pressure and other factors can cause involuntary detrusor contractions, bladder spasm pain. Therefore, after transurethral resection of the prostate bladder spasm occurs caused by subjective and objective factors, the occurrence of bladder spasm of patients should be a comprehensive analysis, in view of the reason to take corresponding treatment and nursing measures, so as to reduce the patient pain and improve the technological level of care.
1 causes of bladder spasm after operation.
(1) unstable bladder, prostate hyperplasia cause long-term bladder outlet obstruction, bladder detrusor compensatory hypertrophy, hyperplasia, bladder pressure increases, that bladder wall ischemia, innervation of the bladder detrusor nerve injury, urinary bladder detrusor muscle occurred to neural changes, resulting in bladder detrusor of acetylcholine showed hypersensitivity reaction, strong contraction, thus induce bladder spasm [2]. (2) psychological factors: after TURP patients with anxiety, stress and emotional instability will induce bladder spasm. (3) fluid velocity and temperature: the temperature of washing fluid is too low to stimulate the bladder smooth muscle, causing bladder spasm. Irrigation speed too much, too add to bladder stimulation, can cause bladder spasm. (4) adverse stimulation of the bladder neck, the bladder triangle and the posterior urethra:
These regional distribution rich sympathetic to more sensitive stimulation, the preoperative presence of urinary tract infection can cause bladder hypersensitivity. Surgical incision trauma and excessive traction catheter can stimulate the sensitive areas of the bladder, causing bladder spasm. (5) inadequate drainage: intraoperative residual prostate tissue debris or postoperative hemorrhage blood clots from forming can be clogged tube drainage, induced bladder spasm.
Nursing countermeasures of 2 postoperative patients with bladder spasm.
(1) psychological intervention:
In patients with benign prostatic hyperplasia for elderly, long-term urinary frequency, urgency and other series under the urinary tract obstruction symptom distress, easy to form a depression, anxiety, irritability and mental. Preoperative visit, are introduced to the patients during anaesthesia and surgery, so that patients a sense of security and satisfaction, increased surgical confidence. Postoperative 1-3 is the high incidence of bladder spasm, patients and patient encouraged to talk, reduce loneliness and anxiety. (2) to reduce the adverse stimulation of the bladder:
Reduce catheter stimulation. Postoperative indwelling of three cavity balloon guide catheter should be properly fixed, pull shoulds not be too tight, the outside dew catheter straightened a line is fixed on the thigh is appropriate. At the same time, the amount of normal saline was injected into the air bag according to the volume of the prostate gland. When the bladder spasm symptoms occur, the water injection quantity can be reduced appropriately.
Adjust the temperature of the washing liquid. The change of bladder irrigation fluid temperature has a direct effect on the occurrence of bladder spasm. Reports and bleeding after reduce bladder spasm and operation from the point of view, 30 DEG C in the bladder flushing liquid is the best choice [4], and studies suggest that using 30-35 DEG C bladder washing liquid induced bladder spasm at the same time, prostate fossa hemorrhage increased significantly, so that resection of the prostate postoperative bladder irrigation of the optimum temperature for 35-37 [5], and that prostate resection and postoperative bladder irrigation of the optimum temperature for the 25-29 degrees.
Therefore, the range of temperature of bladder irrigation fluid is divided. We according to the room temperature and seasonal effects, through an evidence-based, bladder irrigation fluid temperature setting for 21-35 degrees Celsius in the summer and winter 35-37. Which can maintain body temperature of the patients was within the normal range, ensure the thrombin activity in patients with agent normal coagulation function and the patients with surgical wound bleeding time was shortened, and significantly reduce the cold stimulation on bladder, reduce the occurrence of bladder spasm. Ensure smooth drainage. Bladder irrigation speed to 80-120 drops / divided into appropriate. Washing too fast increase of bladder detrusor stimulation could induce bladder spasm [7]; but cleaning speed is too slow, not up to flush the toilet, and easily lead to blood coagulation and blockage of the catheter, and even cause bladder pressure increases and bladder spasm. (3) drug therapy: the implementation of continuous postoperative analgesia, can prevent and reduce postoperative bladder spasm. On the part of paroxysmal spasm is still obvious, the doctor treated with indomethacin rectal suppository or lidocaine and saline irrigation of bladder and pinch 10-20min.
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