Korean J Urol.  2008 Apr;49(4):330-336.

Application of the Clinical Pathway for Transurethral Resection of Prostate

• Shin JS
• Park YI

Abstract

PURPOSE: The purpose of a clinical pathway(CP) is to standardize the clinical practice of specialists to optimize the medical care. The objective of this study is to develop CP for transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia(BPH) and to evaluate the results of the CP.
MATERIALS AND METHODS
18 patients with BPH and who were managed according to the CP between November 2006 and April 2007 were compared with 38 patients, for whom this pathway had not been used between the period of November 2005 to October 2006. The patients had no other disease except benign prostatic hyperplasia. The results such as the operative time, the resection volume, the length of the hospital stay, the complication rates, the catheter indwelling time and the maximal flow rate were compared between the CP group and the non-CP group.
RESULTS
There were no statistically significant differences between both groups for the postoperative complication rates(p=0.683). With the application of the clinical pathway, the mean duration of the hospital stay and the catheter indwelling time were significantly lower for the CP group than that for the non-CP group(p<0.001). Statistically, there were no significant differences of the maximal flow rate and International Prostate Symptom Score(IPSS) between the two groups. All members of the CP group were satisfied with the application of the CP.
CONCLUSIONS
The application of the clinical pathway for patients undergoing transurethral resection of prostate has reduced the catheter indwelling time and the length of the hospital stay. This improves the bed use and hospital efficiency while it also results in a higher level of patient satisfaction. Furthermore, reducing the variability of medical care has improved its quality.

Keyword

Clinical pathways; Prostatic hyperplasia; Transurethral resection of prostate

MeSH Terms

Catheters
Critical Pathways
Humans
Length of Stay
Operative Time
Patient Satisfaction
Postoperative Complications
Prostate
Prostatic Hyperplasia
Specialization
Transurethral Resection of Prostate

Reference

1. Graversen PH, Gasser TC, Wasson JH, Hinmann F Jr, Bruskewitz RC. Controversies about indications for transurethral resection of the prostate. J Urol. 1989. 141:475–481.

2. Kim JY, Moon KH, Yoon CJ, Park TC. Bipolar transurethral resection of the prostate: a comparative study with monopolar transurethral resection. Korean J Urol. 2006. 47:493–497.

3. Kim HG, Lee BK, Paick SH, Lho YS. Efficacy of bipolar transurethral resection of the prostate: comparison with standard monopolar transurethral resection of the prostate. Korean J Urol. 2006. 47:377–380.

4. Hwang EC, Joo JS, Min KD, Oh BR, Kang TW, Kwon DD, et al. A short-term comparative study on efficacy and safety of standard transurethral resection and high power (80W) potassium-titanyl-phosphate laser vaporization of the prostate. Korean J Urol. 2005. 46:1251–1255.

5. Turley K, Tyndall M, Roge C, Cooper M, Turley K, Applebaum M, et al. Critical pathway methodology: effectiveness in congenital heart surgery. Ann Thorac Surg. 1994. 58:57–63.

6. Melbert RB, Kimmins MH, Isler JT, Billingham RP, Lawton D, Salvadalena G, et al. Use of a critical pathway for colon resections. J Gastrointest Surg. 2002. 6:745–752.

7. Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. Surg Clin North Am. 2000. 80:1127–1149.

8. Lee S, Jeong BC, Lee E. The usefulness of the critical pathway for radical retropubic prostatectomy. Korean J Urol. 2006. 47:1029–1034.

9. Zander K. Nursing case management: strategic management of cost and quality outcomes. J Nurs Adm. 1988. 18:23–30.

10. Chang PL, Huang ST, Hsieh ML, Wang TM, Chen JI, Kuo HH, et al. Use of the transurethral prostatectomy clinical path to monitor health outcomes. J Urol. 1997. 157:177–183.

11. Song KY, Kim SN, Park CH. Critical pathway for operable gastric cancer. J Korean Gastric Cancer Assoc. 2005. 5:95–100.

12. Wyman A. What time of day should a urethral catheter be removed? J R Soc Med. 1987. 80:755–756.

13. Lim WT, Song JM. Clinical experience of early catheter removal following transurethral resection of the prostate. Korean J Urol. 1993. 34:448–451.

14. Kim HG, Choi DY, Yoo TK. Catheter removal on the first day after transurethral prostatectomy: probability of successful voiding and its safety. Korean J Urol. 2000. 41:218–222.

15. Agrawal SK, Kumar AS. Early removal of catheter following transurethral resection of the prostate. Br J Urol. 1993. 72:928–929.

16. Dodds L, Lawson PS, Crossthwaite AH, Wells GR. Early catheter removal: a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate. Br J Urol. 1995. 75:755–757.

17. Kaya C, Ilktac A, Gokmen E, Ozturk M, Karaman IM. The long-term results of transurethral vaporization of the prostate using plasmakinetic energy. BJU Int. 2007. 99:845–848.