Photoselective vaporization of the prostate in ambulatory surgery

AORN Journal,  Feb, 2006  by Margaret Wojcik,  Denise Dennison

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The article "Photoselective vaporization of the prostate in ambulatory surgery" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Feb 28, 2009.

Complete the examination answer sheet and learner evaluation found on pages 349-350 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on photoselective vaporization of the prostate in ambulatory surgery, nurses will be able to

1. describe laser safety credentialing requirements,

2. discuss the pathological effects of benign prostatic hypertrophy (BPH) on normal male anatomy,

3. explain treatment options for BPH, and

4. discuss perioperative care of the patient undergoing photoselective vaporization of the prostate.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

A minimum score of 70% on the multiple-choice examination is necessary to earn 3 contact hours for this independent study.

Purpose/Goal: To educate perioperative nurses about photoselective vaporization of the prostate in ambulatory surgery.

Photoselective vaporization of the prostate is a significant advancement in the treatment of benign prostatic hypertrophy (BPH), one of the most common ailments experienced by men older than age 50. (1) Although this procedure was pioneered in 1997 at the Mayo Clinic, (2) Rochester, Minn, it only recently was introduced at Christiana Care Health System, Newark, Del. Initially, the procedure was performed only in the main OR; however, it now is performed in two associated surgery centers.

When this treatment was first introduced at Christiana Care Health System, the laser could be used only in one specially outfitted room because of plumbing and electrical requirements. Initially, patients were admitted for 23-hour observation. After a number of these procedures were performed, perioperative team members decided that a majority of patients could be treated on an outpatient basis, and the team began the planning process to offer the procedure in the Christiana Surgicenter.

Staff members from the main OR and the Surgicenter were trained in laser safety and operation of a high-powered potassium-titanyl-phosphate (KTP) laser. The physician determines at which facility the patient receives treatment. The laser then is moved from one facility to the other to accommodate the patient's and physician's needs.

LASER SAFETY CREDENTIALING

A designated individual trained in laser safety and approved by Christiana Care Health System is responsible for operating the laser, monitoring all safety requirements, and observing the laser fiber for any breaks or malfunction. To be classified as competent in laser use, staff members must attend a basic laser course provided by the facility laser safety officer. After attending the five-hour course, each person must demonstrate proficiency on each specific laser by operating the laser during three supervised procedures. To become nationally certified, staff members must take a national laser examination and then demonstrate proficiency with documentation of procedures performed.

Only physicians credentialed by Christiana Care Health System to operate the laser may perform the procedure at these facilities. Credentialing requires physicians to provide documentation of having attended a course on the specific laser and to demonstrate proficient operation of the laser during at least three procedures proctored by a qualified physician.

ANATOMY AND PHYSIOLOGY

Benign prostatic hypertrophy is a condition in which the prostate increases in size, gradually pinching the urethra and resulting in a host of uncomfortable and painful symptoms. The prostate is a male reproductive gland that makes seminal fluid, which helps nourish and transport sperm. It is located in front of the rectum just below the bladder and wraps around the urethra. Other than adding a small amount of fluid to his ejaculate, it serves no known purpose after a man's reproductive years have passed. The prostate usually is the size of a small walnut, but as a man ages, the prostate increases in size and can become as large as a grapefruit. The cause of enlargement is not well understood; it usually begins in the early to mid forties and continues throughout life. (3)