What preparations are necessary for prostate surgery?

Preoperative Preparations for Prostate Surgery

Prior to prostate surgery, patients should be free of urinary tract infections, systemic infections, and cutaneous lesions in the operative area, and should receive broad-spectrum antibiotics providing both Gram-negative and Gram-positive coverage before the procedure begins. 1

Medical Optimization

Infection Prevention

• Ensure patient is free of urinary tract infections 1
• No systemic infections that could lead to bacterial seeding during healing 1
• No dermatitis, wounds, or cutaneous lesions in the operative area 1
• For patients undergoing endoscopic urologic procedures with mucosal trauma, screening for and treating asymptomatic bacteriuria is strongly recommended 1
• For artificial urinary sphincter or penile prosthesis implantation, standard perioperative antimicrobial prophylaxis is sufficient without screening for asymptomatic bacteriuria 1

Antibiotic Prophylaxis

• Administer broad-spectrum antibiotics 30-60 minutes before incision 1
• Commonly used agents: aminoglycosides, vancomycin, cephalosporins, and fluoroquinolones 1
• Short course (1-2 doses) is sufficient for most urologic procedures 1

Thrombosis Prophylaxis

• All patients should wear well-fitting compression stockings 1
• Administer pharmacological prophylaxis with low molecular weight heparin (LMWH) 1
• For high-risk patients (age >60 years, cancer, prior venous thromboembolism), extended prophylaxis for 4 weeks is recommended 1

Preoperative Preparation

Bowel Preparation

• Mechanical bowel preparation can be safely omitted for most urologic procedures 1
• Shave the operative area immediately prior to surgery, not earlier 1
• Thorough skin preparation should be performed after shaving 1

Fasting and Nutrition

• Clear fluids allowed up to 2 hours before anesthesia 1
• Solid foods allowed up to 6 hours before anesthesia 1
• Preoperative oral carbohydrate loading recommended for non-diabetic patients 1
• Consider nutritional support for malnourished patients 1

Medication Management

• Avoid long-acting sedatives before surgery 1
• Review all current medications and adjust as needed 2
• Consider stopping medications that increase bleeding risk after consultation with prescribing physician

Day of Surgery Preparations

Anesthesia Considerations

• Prostate surgery is typically performed under general, spinal, or epidural anesthesia 1
• Thoracic epidural analgesia is superior to systemic opioids for pain relief 1
• Maintain adequate hemodynamic control, oxygenation, and muscle relaxation during the procedure 1

Operating Room Setup

• For TURP procedures, prepare for potential blood loss monitoring 3
• Ensure appropriate positioning to minimize risk of nerve damage 4
• Optimize fluid management using goal-directed therapy to avoid overhydration 1
• Maintain normal body temperature throughout the procedure 1

Special Considerations

For Transurethral Resection of Prostate (TURP)

• Early ambulation is recommended for DVT prophylaxis 1
• For patients at increased risk of DVT, consider graduated compression stockings (GCS), intermittent pneumatic compression (IPC), or pharmacologic prophylaxis 1
• Be aware of potential complications including bleeding, retrograde ejaculation (65-70%), and TURP syndrome 3

For Radical Prostatectomy

• Inform patient about potential urinary incontinence after prostate treatment (IPT) 1
• Counsel patients about risk of sexual arousal incontinence and climacturia following radical prostatectomy 1
• Discuss potential for erectile dysfunction and ejaculatory dysfunction 1

Postoperative Planning

• Plan for urinary catheter placement for 1-3 days after TURP 3
• Expect hospital stay of 1-2 days for most prostate procedures 3
• Advise patient to avoid heavy lifting, straining, or strenuous activity for 4-6 weeks 3
• Prepare patient for potential blood in urine that gradually clears over 2-3 weeks 3

By following these comprehensive preoperative preparations, the risk of complications from prostate surgery can be significantly reduced, improving patient outcomes in terms of morbidity, mortality, and quality of life.