Free paper - poster - nurses
N-01 Longterm follow-up and quality of life among children and adolescents treated at a voiding school modality
J Mohn1, A Bakke1, B Hanestad2
1Haukeland University Hospital, 2Section of Nursing Science, Department of Public Health and Primary Health Care, University of Bergen, Norway
Incontinence is a key symptom and a source of embarrassment among children with non-neurogenic voiding disorders. The child’s quality of life (QoL) can be threatened. Voiding school has come as a multidisciplinary treatment option.
Purpose: To evaluate children’s lower urinary tract symptoms (LUTS) and health-related quality of life (HR-QoL) after voiding school treatment at Haukeland University Hospital, Bergen, Norway.
Materials and methods: One to six years after treatment, 108 children were contacted.
1) Data were retrospectively collected from the children’s medical records to determine their symptoms at the first consultation.
2) Children’s current self-report was collected via two different questionnaires, a voiding-related symptom questionnaire and a HR-QoL questionnaire (KINDLN).
Results: 52 children agreed to take part: 17 girls and 35 boys, mean age 12.8 years (median 13.0). 47% of children reported resolution, 39% significant improvement, 12% no improvement, 2% don’t know. Highest value of HR-QoL: Emotional well-being (mean: 87/100). Poorest values: School- and Self-esteem (69/100). There were no statistically significant differences between genders and no statistically significant correlations between the children’s degree of current symptoms and their perceived HR-QoL.
Conclusions: Children reported fewer symptoms. Voiding school might be a successful treatment modality. The design of the present study does not allow any conclusion to be drawn regarding cause and effect.
N-02 Multidisciplinary development and planning of a new pain relief treatment for patients in connection with radical prostatectomy and continuous development of nursing for this group of patients
TH Lauridsen, B Lund-Nielsen
Department of Urology, Holstebro Hospital, Denmark
tilau@ringamt.dk, benie@ringamt.dk
The purpose of the project was to optimize the pain relief for patients in connection with radical prostatectomy.
A team of two urologist, one anaesthetist and two nurses participated in a national workshop concerning this groups of patients. Here we received new input, new ideas and inspiration to make a multidisciplinary project.
After the workshop the team divided the tasks between themselves, and set a date for initiation of the project.
In order to measure whether the new treatment had a better effect, we set up a new form for registration and documentation of the use of medicine, VAS-scores, vital scores and general conditions. Furthermore we revised all existing standards and checklists.
It was of great importance to us in the planning of the project, that it was implemented well with in all groups of professionals, in order to get a good start.
The conclusion after operating the first 50 patients was, that the new treatment was more effective, and the course of events for the patients were improved.
Patients were mobilized at an earlier stage, had fewer stomach problems and shorter admittances. We were surprised to see that we had made a more accelerated course of events for the patients, as this was not an aim we set out for. This however, was a positive gratifying side effect for the patients.
We learned that without significant extra costs or resources, we were able to perform an interesting project within our ward and furthermore strengthen the multidisciplinary cooperation.
N-03 Urinary continence after radical prostatectomy – Influence by the surgical method
A-D Seyer-Hansen, GM Hvistendahl, C Graugaard-Jensen, KV Pedersen, S Skou
Dept of Urology, Aarhus University Hospital- Skejby, Denmark
Aim of investigation: Urinary incontinence after radical prostatectomy is a well known complication. Questionnaire studies focus on incontinence based on the number of daily use of pads. Quality and quantity measurements are missing. The aim of the present study is to validate postoperative incontinence by quantification of the amount of urinary leakage.
Material and methods: Patients operated in 2007 were asked to perform a pad-weighing test for 72 hours 3, 6 and 12 months after retro pubic radical prostatectomy (RRP) or laparoscopic robot assisted prostatectomy (ROP), and to fill in a self administered questionnaire. Data on BMI and age as well as life style variables were registered. Bother score concerning urinary incontinence was graded on a 1-10 VAS scale.
Results and discussion: A total of 133 patients were included in the study. After 3, 6 and 12 months continence was obtained in patients operated with ROP in 50%, 78% and 88% respectively. The results in the RRP group were 34%, 53% and 72%. If patients with a leakage less than 10 grams/24 hours were included the 12 months data showed 95% continence after ROP vs. 79% after RRP. The ROP patients were both significantly younger (62.7 vs. 64.9 years) and had a lower BMI (25.0 vs. 26.4) than the RRP patients.
Conclusions: The long term postoperative continence after radical prostatectomy is significantly better after ROP compared to RRP. Selection criteria may explain at least some of the difference.
N-04 The influence of intrusive thoughts and social constraints in maintaining quality of life after prostate cancer diagnosis
Th K Thorsteinsdóttir1, J Stranne, S Ágústsdóttir3, H Valdimarsdóttir3,4, G Steineck1
1Division of Clinical Cancerepidemiology, The Sahlgrenska Academy, University of Gothenburg, 2Division of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden, 3Department of Psychology, Faculty of Health Sciences, University of Iceland, 4Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA
thordis.thorsteinsdottir@gmail.com, gunnar.steineck@gu.se
Aims: Our aim was to search evidence in published literature if intrusive thoughts and social constraints influence adaptation and quality of life of men with prostate cancer.
Method: Literature review of PubMed and CSA databases.
Results and discussion: Six studies were found, four addressed intrusive thoughts of patients with prostate cancer, one social constraints and one both topics. Patients that received abnormal results from cancer screening reported more intrusive thoughts than a non-screened control group. Intrusive thoughts correlated negatively to education and time from diagnosis positively to spousal constraints. Good marital relationships appeared to buffer psychological distress and moderate the effect of intrusion on mood disturbance. Furthermore, supportive social relations improved mental health by aiding the cognitive process of the cancer experience. Compared to women with gynaecological cancer, men with prostate cancer did not differ in perceptions of social constraints. On the other hand, men experienced greater distress by social constraints from spouse.
Conclusions: Available evidence says intrusive thoughts and social constraints decrease quality of life among men having contracted prostate cancer. As an implication for future research, intrusive thoughts and social constraints may constitute reasonable surrogate end-points for interventions aimed at increasing quality of life for prostate-cancer survivors. A study in a large population is in progress.
N-05 Carbohydrate drink vs. fasting after prostatectomy and nephrectomy
B-I Dahlin, B Ljungberg
Department of Urology, Umeå University Hospital, Umeå, Sweden
Aim: For elective surgery patients, decreased fasting time reduces preoperative discomfort and thirst. We aimed to assess the effects of a pre-operative carbohydrate drink on hospitalization time, drinking the first day postoperative, gut emptying, return to work and quality of life (QOL) parameters before and one month after surgery in elective urological patients.
Material and methods: 170 elective urological patients scheduled for prostatectomy or nephrectomy was randomized to either carbohydrate drink (CD) or routine overnight fasting (ROF). QLQ-C30 questionnaire responses was collected before and one month after surgery.
Results and discussion: After prostatectomy, the QOL variable “worry” improved (p=0.027) after CD, but there was no effect on weight loss. After nephrectomy, the CDs reported less weight loss (p=0.035), and improved QOL as: “short of breath” (p=0.038), “feel tense” (p=0.057), “worry” (p=0.035), and “social activities” (p=0.024). No differences in hospitalization time, drinking 1st day, gut emptying and return to normal activities were observed.
Conclusions: Patients treated with CD had improved QOL, particularly in the category ‘worry’. Nephrectomy patients reported less weight loss. CD can improve postoperative QOL.
N-06 How well can outflow obstruction and bladder overactivity be predicted by a clinical evaluation in men with LUTS
M Fehrling
Sahlgrenska University Hospital, Gothenburg Sweden
Aim: Evaluate if bladder outlet obstruction (BOO), overactive bladder (OAB) and uninhibited overactive bladder (UOB) can be predicted by clinical non-invasive variables in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).
Patients and methods: Men with LUTS, >40 years old, referred for an urodynamic investigation. Prostate surgery, neurological diseases were exclusion criteria. From prostate volume, S-PSA, IPSS, frequency-volume chart, residual urine and free flow the probable urodynamic diagnosis and the presence of obstruction was deduced and recorded. OAB and UOB was diagnosed according to ICS (2002) criteria and BOO determined according to Schäfer‘s grade of obstruction.
Results: 62 men, mean age 65 years (40- 89). Mean IPSS was 19±9, mean prostate volume 43±24 ml. The bladder was predicted to be normal in 20 patients; this was verified urodynamically in only 12 (60%). OAB or UOB was predicted in 42 patients and verified urodynamically in 31 (79%). In 15 (24%) patients it was impossible to perform a pressure-flow study due to a low bladder capacity. No obstruction was predicted in 11 patients but verified urodynamically in only 4 (36%). Obstruction was predicted in 36 patients but verified in 21 (53%).
Conclusion: OAB and UOB can be fairy well predicted. Obstruction was more difficult to predict. This suggest that pressure flow studies are motivated if it is essential to know if there is a BOO.
N-07 Follow up and new nursing initiatives towards patients with continence problems as a result of radical removal of the prostate
S Soenderby, H Bro
Regionshospital Holstebro, Denmark
In the spring 2004 the urologic ward at Regionshospitalet in Holstebro started to perform open radical prostatectomy.
On the 1st. of January 2009 there have been 320 operations.
The experiences were summed in January 2007 after the first 76 operations, and it showed 73% of the patients had total continence 6 months after the operation. The empirical study was repeated in January 2009 and here the success rate had dropped so that only 49% of the patient had total continence 6 month after the operation.
The aim of our project has been to investigate, if the nurses at the outpatient treatment could improve the continence degree, by increased efforts.
The form to clarify ”Continence after open radical prostatectomy” has been developed further, and used as a guide for interviewing the patients. Furthermore, the control of the patients pelvic muscle practice have been intensified, and nurses or physiotherapist have given individual guidance regarding pelvic muscle practice according to the patients needs.
The results of the interviewing patients about their needs for increased guidance regarding pelvic muscle practice will be summed up as per the 1st of May 2009. However, already now, after the pilot-project with 15 patients, we can see that the patients are very satisfied with this extra guidance.
The results of the increased efforts towards pelvic muscle practice in regards to the level of continence are made up every year as per the 1st of January.
N-08 Pelvic floor rehabilitation treatment for post-prostatectomy incontinence
B Pedersen1, HB Jørgensen1, BS Laursen2
1Department of Urology, Aalborg Hospital, 2Clinical Nursing Research Unit, Aalborg Hospital, Denmark
Background: The incidence of urinary incontinence after radical prostatectomy is found to be 6%-87%. Different therapeutic approaches have been used in this continence treatment and studies show a continence rate between 82%-93% a year after surgery. There is no evidence which therapeutic approach is getting the best result.
Purpose: The purpose of this quality assurance study is to evaluate individual pelvic muscles exercise (PME) using biofeedback in patient with incontinence after radical prostatectomy.
Methods: From January 2009 a total of 100 men whom underwent radical prostatectomy for clinically localized cancer will be included. Within the first week after catheter removal they will be instructed in PME using biofeedback and again in week 2 and 3. The first session will last one hour. The second and third session will last ½ hour each. Before the first PME and 3, 6 and 12 month postoperative, the patients will undergo a one day 24 hours pad test.
Results and conclusion: We expect the results can give us guidelines how to plan our pelvic floor rehabilitation treatment for post-prostatectomy incontinence that makes us able to offer the patients the best evidence based pelvic muscles exercise.
N-09 Nurse-supported telephone calls to men after Robot-assisted laparoscopic prostatectomy surgery
A Hägglund, J Svens
Department of Urology, Karolinska University Hospital, Solna, Stockholm, Sweden
anna.hagglund@karolinska.se, jessica.svens@karolinska.se
Background: At Karolinska University Hospital Solna, Sweden, there were approximately 400 Robot-assisted laparoscopic prostatectomy operations performed last year. These patients are usually discharged the day after surgery with an indwelling catheter that remains in place for seven to ten days. Due to the short hospital stay patients are in need of further support and advice after being discharged. Today these patients have no organized support to turn to, so they often phone their urology ward.
Method: In 2007 we started a follow-up through telephone calls, 3-5 days after the hospital discharge. Semi-structured questions were asked including questions about catheter care, bowel function and setbacks related to surgery.
Result: Decreased random telephone calls to the urology wards as well as a positive response from patients.
Conclusions: A majority of patients expressed that they felt more secured and better informed due to the semi structured phone calls. This system can prevent random phone-calls to the urology wards and unnecessary visits to the emergency clinics.
We are into the starting process of a study focusing on phone calls as a method of support to newly operated patients.
N-10 Nurses outpatient clinic for men with lower urinary tract symptoms. Patient acceptance and satisfaction
B Bonfils-Rasmussen, G Smidt, B Vendelbo, AL Persson, P Klarskov
Department of Urology, Herlev Hospital, Copenhagen, Denmark
Introduction and aim: Nurses in the urological outpatient clinic felt that many patients with LUTS had an unmet need for guidance and behavioural modification. The diagnostic program could involve a number of outpatient visits and last 2-4 months.
The aim of this study was to see if continence nurses were able to manage a structured diagnostic setup and provide guidance to male patients with LUTS in 2 visits to the satisfaction of the patients.
Material and methods: Included were 114 men referred with LUTS. The nurses recorded the medical history, arranged tests and counselled the patient on his LUTS.
The patient completed a 32-item questionnaire on his experience in the program. An audit of all patient records was done and a comparison with records of 40 consecutive patients, investigated in the previously used doctor-based set-up was made.
Results: After the nurse’s investigations, approximately 80% received advice on drinking habits, and 27% had guidance on incontinence aids. The nurse’s dialogue with the patients reduced LUTS in 58% of the patients.
Most patients appreciated the comprehensive nurse-instigated diagnostic program and 99% felt that the amount of information and tests per day was appropriate. The doctor was able to conclude on the investigation program at visit 2 and decide on any treatment.
Conclusions: Continence nurses were able to manage a structured diagnostic setup on male patients with LUTS, and to counsel on behavioural modification in 2 visits. Most patients had a high level of satisfaction with the nurse-led program.
N-11 Music during surgery in spinal anesthesia
A Gísladóttir, S Gunnarsdóttir
Landspitali, University Hospital, Reykjavík, Iceland
arnfrid@landspitali.is, sigrgunn@landspitali.is
The aims of the survey: To determine the proportion of patients interested in having music played during surgery and to evaluate their experience of listening to music. A second aim was to improve the nursing practice and the service available to patients in surgery.
Material and methods: The sample consisted of all patients undergoing Transurethral Resection of the Prostate (TURP) in the period from October 2006 till March 2007. Patients were offered the choice of various types of music as well as being offered to bring a CD of their choice. After the surgery, patients filled out a questionnaire to evaluate if they liked listening to the music, if they felt that it alleviated stress, what they thought of the list of music offered and if they could suggest some different music.
Results: Of the 117 patients, in the study period, 65% chose to participate. The majority of the patients (87%) enjoyed listening to the music. However, 13% could not describe the effect of music, possibly because the effect of sedative medication. Approximately half of the patients agreed that the inclusion of music helped to alleviate stress.
Conclusion: The results indicate that patients, who listen to music during TURP in spinal anesthesia, experience well-being and low anxiety. The positive reception ensures that music will continue to be offered to these patients. We conclude that applying Music Therapy enhances the quality of nursing and gives more pleased patients.
N-12 Avoiding complications in percutaneous nephrolithotomy. – A multidisciplinary team approach
I Bendixen, L Rytter, SS Osther, PJS Osther
Department of Urology, Fredericia Hospital, Fredericia, Denmark
palle.joern.osther@slb.regionsyddanmark.dk
Aim: Percutaneous nephrolithotomy (PCNL) effectively treats large volume renal calculi. To optimize treatment outcome and minimize the risk of complications a multidisciplinary team approach was established.
Material and methods: In 289 patients with branched kidney stones 300 procedures were performed. Preoperative selection, evaluation and treatment were performed using a multidisciplinary team approach involving urologist, uro-radiologist, radiological technicians and endourological trained nurses.
Results: Complications were seen in 11% of cases: In 12 cases (4%) significant haemorrhage occurred. Of these 10 cases were treated conservatively with transfusions; 2 cases needed embolisation due to development of A.V fistulae. 6 cases (2%) developed postoperative sepsis. Postoperative pneumothorax and haemothorax were seen in 2 and 1 case(s), respectively (1%). In 3% of cases (9 patients) primary access failed: in 7 cases due to abnormal kidney anatomy and in 2 cases due to abnormal patient anatomy. 3 patients (1%) developed postoperative cardiac complications. There were no deaths.
Conclusion: A multidisciplinary team approach including careful patient selection, use of imaging and safe techniques could effectively minimize complication rates in PCNL.