Impact of Preoperative Factors on the Artificial Urinary Sphincter Outcomes

Introduction

Over the recent past, male urinary incontinence has increasingly become prevalent, making its management a topic that merits great concerns for urologists but also for clinical nurse specialists. The artificial urinary sphincter (AUS), is deemed as the gold standard for the treatment of the post-prostatectomy incontinence. This, in essence, is considered the ultimate treatment option in cases where more conservative management has failed. With reference to existing literature, AUS implantation among different kinds of men have significant positive impacts on the patient's quality of life (QoL). In this regard, a majority of the patients undergoing this process are generally satisfied with their increased continence post-operatively hence allowing them to make use of the less absorbent pads on their daily activities. Kruzik (2009) contends that these pads are overly comfortable and patients can avoid the use of public restrooms.

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In my current clinical area of practice, I have made numerous discoveries and also learnt various things through my interaction with post-prostatectomy patients in both the surgery and the urology departments. In particular, a majority of the patients I got to interact with fail to have adequate information regarding their individual self-care regarding their artificial urinary sphincter surgery. Besides, others lack enough knowledge on how to use the device post their operation, and this is also mirrored through their families and also their immediate caregivers. Therefore, based on this context, a knowledge gap regarding the importance, suitability and use of external incontinence products as well as the surgical interventions, both the post and the pre-operative care exists.

There is a need to understand that there are various complications that follow the ASU placement after undergoing the radical prostatectomy. Based on this context, studies substantiate that the management of men with post-prostatectomy incontinence is overly complicated since it is associated with a history of salvage pelvic radiation. In a similar regard, Radiation Therapy (RT) is said to have the ability to impair tissue healing, induce fibrosis and also damage the microvascular circulation which, in turn, increase the complication rates following anti-incontinence surgery. Raj (2011) points out that prior AUS erosion, pelvic radiation or even the history of urethral stent placement are some of the factors that have been responsible for the increased risks of erosion and infection complications associated with AUS.

With reference to the already existing literature, there are reports that approximately 73-90% of the patients reported that they were satisfied with the levels of continence after the AUS implantation (Tse, 2014, p.212). This then leaves the pre-operative factors as the strongest determinants of the postoperative satisfaction, and therefore may assist an urologist, or a clinical nurse to be better placed in relation to counsel patients as they will refer to the postoperative expectations of the patients (Tse, 2014, p.212). The aim of this study is to assess the preoperative factors that are known to impact the AUS outcomes, and determine the associated factors that will improve the patient-reported quality of life measures.

The Role Played by the Clinical Nurse Specialist

The clinical nurse specialists play important roles when it comes to dealing with patients who have undergone the implantation of artificial urinary sphincter post-radical prostatectomy. In particular, their primary role, in this case, involves optimising patient care through working with the nursing staff and also to develop various specialized treatment plans after the patients have undergone examinations. The nurses are also tasked with the role of educating the patients and their families about their condition as well as the treatment procedure that they should expect (Raj, 2011)

Informed Consent

All patients undergoing radical prostatectomy (RP) using a surgical approach need to go through the informed consent process. Usually, this is the practical application of the shared decision making between the patient and the medical practitioner performing the surgery. The primary intent of the informed consent, especially before the surgical procedure, is to imply a duty of care by the surgeon as a means of conveying the general information about the operation procedure. Primarily, the patient usually has sufficient understanding of the procedure as well as the potential risks as they would relate to the individual. In this regard, clinical nurse practitioners serve as the enlightened patient advocates, and they, therefore, have an entrusted interest in understanding fully, every legal and ethical consideration of this informed consent process. Besides, the clinical nurse practitioners take the patients through the informed consent to give the patients a formal platform for pre-operative counselling. However, despite the fact that some of the ethical principles impacting informed consent are said to be the solid cornerstones of clinical and professional nursing practice, surgeons are ultimately responsible for the informed consent process right before the surgery.

Particularly, the radical prostatectomy (RP) procedure is often associated with significant morbidity and mortality to some extent. This being the case, the procedure, alternatives, potential oncological outcomes as well as possible complications such as incontinence and erectile dysfunction, ought to be understood by any patient who is about to undergo this kind of surgery. Finally, clinical nurse practitioners are responsible for offering the patients an opportunity to revisit both the benefits and the risks associated with the procedure, after the initial urological consultation.

Pre-Operative Education

Upon diagnosis, radical prostatectomy patients should have scheduled visits to the clinical nurse specialists, who provide them with the necessary information regarding their preoperative preparation. Clinical nurse specialists are tasked with the role of providing assistance, support, and information for RP patients right before surgery to help the surgery patients to be both physically and psychologically prepared for the process. Tse and So (2008) contends that it is important that patients are educated about the range of their conventional treatment options whose usage is dependent on the severity as well as the types of urinary incontinences that may be associated. Based on this context, Fong and Sweitzer (2014) argue that raising awareness on the existence of the risks of the surgery prior to the surgery helps in encouraging the patients to make the appropriate treatment decisions. This also gives their family and friends clues about what to expect from their patients after they have undergone surgery, and this essentially enables them to transition through the treatment journey with zero to minimum emotional distress.

According to a study done by Hird and Radomski (2015) substantiates that although significant stress incontinence is common after radical prostatectomy for prostate cancer patients, patients who received help from their clinical nurse specialists right before undergoing their surgery showed an increased likelihood of undergoing radical prostatectomy. According to this study, this increase in the likelihood of undergoing the process is highly attributed to the fact that the patient interaction with the clinical nurse specialist give the patients the opportunity to discuss and also reflect on their treatment options, the implications of the process, as well as the possible complications.

In a similar regard, in a study that primarily stresses the need for pre-operative education Maurice-Szamburski (2017) highlights that at the pre-operative stage, clinical nurse specialists ought to offer an intervention that is aimed at assisting patients in understanding the possible side effects, risks, implications such as incontinence, and the benefits of RP. This is an overly critical phase not only for the patients but also for their partners and the family as a whole, as they too need to receive support and attention before the surgery.

Post-Operative Intervention

The post-operative intervention includes both the care and the education that a patient receives after a surgical procedure. In this regard, clinical nurse specialists offer the intervention depending on the type of surgery received by the patient and also their medical history. (Heidenreich, Bastian, Bellmunt, Bolla, Joniau, Van der Kwast, Mottet, (2014) contend that the post-operative intervention process is also inclusive of wound care and pain management. At this point, the clinical nurse practitioner plays the role of reminding or informing the patient on the expected side-effects of the surgery. This, in essence, helps to psychologically prepare the patient on how to go about it. Besides, the information that is offered is essential for both the medical practitioner and the patient since the patient is well aware of what to expect and can, therefore, inform their doctor in case they receive any complications or in case they observe anything that is outside of what he was told to expect. Prakash and Rane (2013) highlights that it is during the post-operative period that the clinical nurse specialist educates the patient on the expected amount of time that the patient should spend in the hospital before being discharged. This is also inclusive of the amount of time that the patient should wait before they resume their normal functionalities. Like the pre-operative education, the post-operative education is important for both the patient and their families. Notably, the patient's family members are also educated on the changes and adjustments that they should expect from their patient. With reference to the recovery process, during the post-operative period, the patient is also advised on what to avoid, what to do and what not to do to aid in the recovery process.

Yao, Liu, Zhang, Dai, Zhang and Ye (2012) contend that knowledge of the effects of the particular approach, dose of educational interventions, and mode of delivery, among others, is crucial in the development and the implementation of effective postoperative education interventions. In this regard, the clinical nurse practitioner ought to understand the relationships of patient characteristics to the outcomes after the operation. Post-operative interventions are also said to continue even after the patient leaves the hospital. At this point, the post-operative intervention is coupled with the necessary information that the patient needs to learn about with regard to their recovery process. For instance, specific to radical prostatectomy patients, the post-operative information after leaving the hospital is inclusive of information on the hydration, nutrition, and most importantly, the urinary catheter care among other general care conducts. Concerning the nutrition and general health care, the clinical nurse practitioner plays the role of informing both the patient and their immediate caregivers regarding the nutritional health practices that they should adopt and those that will help with the functionality and the features of a bladder catheter. Besides, the patient is also entitled to information relating to his hygiene. This is includes cleaning, positioning and guiding of the external catheter elements such as the tube and bag for the comfort of the patient. Thus, in a nutshell, post-operative intervention, which is inclusive of education and general care is fundamental for the provision of...