OBJECTIVES

*After 8 hours of duty in the OR of BAMC, I will be able to:

Knowledge
1. Discuss with group the goals or focus of doing Prostatectomy.
2. Identify the common causes of why Prostatectomy is performed/done.
3. Enumerate the complications of Prostatectomy.
Skill
1. Perform sterile handwashing correctly.
2. Assist or circulate in any procedure done in the OR.
3. Observe a minor procedure done in the OR.
Attitude
1. Display professionalism and competence while in the OR unit.
2. Respect decisions, values, and beliefs of clients in the OR.
3. Evaluate performance during the shift in the OR.

TIMEFRAME
6 : 45 7 : 00 Preconference / Assembly in the BAMC Chapel / Morning Devotional
7 : 00 13 : 00 On Call on DR (for CS and Cord Dressing cases) / Assist or Circulate any minor
procedures.
13 : 00 15 : 00 Scrub / Circulate in ORIF or Orthopedic Case
15 : 00 15 : 30 Post conference

Total Abdominal Hysterectomy - Bilateral Salpingo - Oophorectomy

(TAHBSO)
TAHBSO is the removal of the uterus, cervix, fallopian tube, and the ovaries. This surgery
is needed whenever there is a pelvic mass or growth. Often the cause of the pelvic masses is not
known until after the surgery.
Indications of TAHBSO
1. Hysterectomy is often performed on cancer patients or to relieve severe pelvic pain
from things like endometriosis or adenomyosis.
2. Hysterectomy is also used as a last resort for postpartum obstetrical hemorrhage or
uterine fibroids that causes heavy or unusual bleeding and discomfort in some women.
Risk and Side effects of TAHBSO
1. Hysterectomy has been found to be associated with increased bladder function
problems, such as incontinence
2. When the ovaries are also removed, estrogen levels will fall.
3. This removes the protective effects of estrogen on the cardiovascular and skeletal
system.
4. A menopausal woman has a three times greater risk of developing cardiovascular
disease such as atherosclerosis, peripheral artery disease or of having a heart attack
when compared to premenopausal women
5. Studies have also found that the risk of developing osteoporosis may increase.
Management of TAHBSO
Although hysterectomy is often the definitive treatment for many pelvic
pathologies, nonsurgical alternatives should always be attempted in elective cases.
Hormonal therapy, gonadotropin-releasing hormone antagonists, progesteronecontaining IUD, endometrial ablation, focused ultrasonographic surgery, cryotherapy, and
uterine artery embolization have been used with success.
Preoperative Care
No matter which type of hysterectomy procedure is performed, hysterectomy
requires hospitalization for one to five days.
Preparation for a hysterectomy typically involves several steps, including the following:

Physical examination to determine overall health

Pelvic exam
Blood and urine tests
Preoperative meeting with the surgeon to discuss the procedure and receive presurgery instructions
Preoperative meeting with the anesthesiologist to discuss the type of anesthesia
that will be used (general or local)

In many cases, patients are advised to quit smoking 2 to 6 weeks before surgery.
Smoking may cause breathing problems during surgery and has been shown to delay
healing. If a pain reliever is needed in the week prior to surgery, acetaminophen is
recommended over aspirin, ibuprofen, or naproxen, to reduce the risk for heavy bleeding
during surgery. In general, no food or drink is to be taken after midnight on the day of the
procedure. In some cases, a laxative or enema is indicated to empty the bowels before
surgery.

Postoperative Care
Immediately after surgery, the patient remains in the recovery room for a few hours.
She is monitored for discomfort, and is given medications to prevent pain and infection.
Hysterectomy requires at least one overnight stay in the hospital, and may require
hospitalization for as many as 5 days. After the first night, patients are up and walking.
Sanitary pads are used to manage bleeding and discharge, which can last for several days.
Full recovery can take from 4 to 8 weeks for open abdominal hysterectomy, and from 1 to
2 weeks for vaginal and laparoscopic hysterectomies. During this time, patients should get
plenty of rest. She should avoid heavy lifting and tub baths for a full 6 weeks. Depending
on the type of procedure used and on the patient's rate of recovery, light chores, some
driving, and even returning to work during this period of time may be possible. In general,
patients can resume sexual relations after six weeks.

Prostatectomy
Simple (open) prostatectomy differs from radical prostatectomy in that the former consists
of enucleation of a hyperplastic prostatic adenoma, and the latter involves removal en bloc of the
entire prostate, the seminal vesicles, and the vas deferens. This article reviews the indications
for open prostatectomy, discusses the various approaches for this procedure, weighs the
advantages and disadvantages of each approach, and provides a brief outline of standard
surgical technique.
When medical and minimally invasive options for benign prostatic hyperplasia (BPH) have been
unsuccessful, the more invasive treatment options for BPH should be considered, such as
transurethral resection of the prostate (TURP) or open prostatectomy. Patients who present for
open (simple) prostatectomy are typically age 60 years or older.
The advantages of open (simple) prostatectomy over TURP include the complete removal of the
prostatic adenoma under direct visualization in the suprapubic and retropubic approaches.
However, these procedures do not obviate the need for further prostate cancer surveillance
because the posterior zone of the prostate remains as a potential source of carcinoma formation.
Open (simple) prostatectomy has 3 different approaches: retropubic, suprapubic, and perineal.
Simple retropubic prostatectomy is the enucleation of a hyperplastic prostatic adenoma through
a direct incision of the anterior prostatic capsule. Simple suprapubic prostatectomy is the
enucleation of the hyperplastic prostatic adenoma through an extraperitoneal incision of the
lower anterior bladder wall.
Indications of Prostatectomy
The indications for either TURP or open (simple) prostatectomy include the following:

Acute urinary retention

Persistent or recurrent urinary tract infections
Significant hemorrhage or recurrent hematuria
Bladder calculi secondary to bladder outlet obstruction
Significant symptoms from bladder outlet obstruction that are not responsive to
medical or minimally invasive therapy
Renal insufficiency secondary to chronic bladder outlet obstruction

Risk and Side effects of Prostatectomy

Any surgery carries a risk for potential complications, including blood clots in the
legs, breathing problems, reactions to anesthesia, bleeding, infection, heart attack, and
stroke. Your doctor and care team will work hard to prevent these problems.
Problems specific to prostate surgery can potentially include:

urinary incontinence (problems with controlling the urge to urinate)

bowel incontinence (difficulty controlling bowel movements)
urethral stricture (scar tissue blocking part of the urethra)
infertility
problems maintaining an erection (impotence)
injury to internal organs

Postoperative Care
Postoperative care of patients who have had an open (simple) prostatectomy
parallels care following most major open surgical procedures. Because the need for
postoperative blood transfusions is minimized through improvements in understanding of
the relevant surgical anatomy and advancements in operative technique, most patients
are discharged comfortably on the second day following surgery. For the surgeon, the most
significant concern is to observe drain output and fluid status immediately after surgery,
as patients generally ambulate and tolerate a regular advancement of their diet by the
first day following surgery.
Monitor the patient in the clinic after surgery. If the Foley catheter was not removed
during the hospitalization, a voiding trial can be performed on an outpatient basis.
Review pathology and schedule follow-up examinations for the patient in order to
exclude carcinoma. With simple prostatectomy, the risk of prostate cancer development
remains and patients must be monitored with DRE and PSA studies.