How is follow-up after transurethral prostatectomy best performed?

OBJECTIVE: To evaluate the role of the nurse practitioner (NP) in screening patients for potential discharge after routine transurethral prostatectomy (TURP) or bladder neck incision (BNI) where, although urologists continue to follow such patients, the trend is away from clinic attendance. PATIENTS AND METHODS: The NP telephoned 70 patients 4 weeks after surgery; information about expected postoperative problems, change in symptoms and the need to visit their general practitioner (GP) was recorded. A doctor then saw all the patients in a clinic 3 months after TURP or BNI. RESULTS: Complete records were available for 66 patients (TURP 56, BNI 10). Four weeks after their operation, 39 (59%) patients still had one or more significant symptoms but only nine (23%) had consulted their GP. After a telephone interview the NP considered that 38 of the 66 patients were fit to be discharged. At the 3-month outpatient appointment, 37 of these 38 patients were subsequently discharged. Of the remaining 29 patients, 15 (seven with carcinoma of the prostate and eight with significant symptoms) were given follow-up appointments. CONCLUSIONS: The persistence of significant symptoms in 12% of patients 3 months after TURP justifies the follow-up of all patients. A telephone interview by the NP at one month is recommended. This could result in safe discharge of more than half the patients and allow follow-up of those who need specialist input.