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1. Post op mgt of BPH
By solomon

2. • Recovery area
• The outputs from the pelvic drain and urethral catheter (and
suprapubic tube, if present) are monitored
• it is routine to verify the hematocrit
• If significant hemorrhage is noted
– the urethral catheter may be placed on traction so that the balloon
containing 50 mL of saline can compress the bladder neck and
prostatic fossa

3. • Constant and reliable traction -securing the catheter to the
abdomen
• continuous bladder irrigation
• if excessive bleeding persists after these measures, the
urethral catheter can be removed in the operating suite and a
cystoscopic inspection of the prostatic fossa and bladder neck
can be performed to identify and fulgurate discrete bleeding
sites
• If marked hemorrhage should continue to persist, re-
exploration should be strongly considered

4. • On the evening of the day of surgery
– The patient is asked to
• perform the dorsiflexion and plantarflexion exercises
• perform pulmonary exercises
• Effective pain management
• intravenous opioids

5. First postoperative day
• start on a clear liquid diet and
• ambulate four times per day
• Pulmonary exercises
• If the hematuria is resolved, continuous bladder irrigation can
be discontinued with a urethral catheter (and suprapubic
tube, if present) placed for gravity drainage
• The balloon in the urethral catheter is partially deflated to 30
mL of saline and residual clots are removed by irrigation

6. second postoperative day
• If urine is clear ,the urethral catheter may be removed and the
suprapubic tube is clamped to allow a voiding trial
• Encouraged to ambulate and continue pulmonary exercises
• When the patient tolerates a regular diet, oral analgesics
• Appropriate discharge instructions for discharge on the
second day after surgery
• The pelvic drain is removed if the drainage is low

7. On discharge
• the patient is encouraged to gradually increase his activity
• If the patient has a clamped suprapubic tube and voids well
with a minimal post void residual urine volume, the
suprapubic tube is then removed in the clinic a week after
surgery
• If only the urethral catheter was used without a suprapubic
tube, it is removed in the clinic a week after surgery
• Resume full activity 4 to 6 weeks postoperatively with
outpatient visits at 6 weeks and 3 months

8. Reference…Campell-Walsh urology 10th ed.