Question

A 65-year-old man is seen in the preoperative clinic 1 week before a scheduled radical prostatectomy. He has been diagnosed with femoral deep vein thrombosis (DVT) following a complaint of calf soreness.

1. What is a radical prostatectomy?

a. What would be a reason for this procedure (i.e. diagnostic, curative, restorative, etc.)

b. What is the level of urgency, degree of risk, and extent of urgency for this procedure? (i.e. emergency)

d What possible treatment would you anticipate being ordered for the treatment of DVT? (Discuss 2)

e. What are risk factors that contribute to the development of DVT? (Name 3)

Answer 1

1. Radical prostectomy is a surgical procedure usually performed for patients with prostate cancer. In this surgery, the prostate gland along with the near by lymph nodes are surgically removed.the surgery can be performed via a laproscopic approach or an open approach.

A. Radical prostatectomy is performed for the management of prostate cancer. Hence this surgery is a curative surgery. Here, the prostate gland, the near by lymph nodes and some time the seminal vesicles are surgically removed for preventing the spread of prostate cancer. This will prevent the metastasis of prostate cancer. This procedure is not done for any diagnostic process hence it is not a diagnostic surgery.the same way this surgery does not improve the prostate function,hence this is not a restorative procedure also.

B. Radical prostatectomy is relatively a risk associated procedure. Where the immediate risk is development of urinary incontinence.Due to surgical manipulations there are chances of blockage in the flow of urine. Hence the risk of UTI is very high.Seminal vesicles and near by lymph nodes are surgically removed here. Which can lead to altered sexual pattern and sometime dysfunction. the same time the level of urgency of this surgery is also high. Other wise the chances of metastasis of prostate cancer is very high.

D. There are various tretment options for DVT. They include use of anticoagulants, use of compression stockings, vena cava filters, blood thinners etc.

Use of anticoagulants: Anticoagulants like warfarin, low molecular weight heparin etc are effectively used for the tretment of DVT. these drugs will prevent the formation of new blood clots in the blood vein. Apart from this effect, these drugs will also allow the dissolving of early developed blood clots. Thus the travelling of these blood clots to the heart can be effectively prevented.

Use of compression stockings: Pneumatic compression devices or use of compression stockings will effectively helps to prevent the clot formation in lower extrimities. These compression stockings will helps to improve the blood flow in lower extrimities via its squeezing effect. Thus new clots are not developed. They apply gentle pressure over the major blood vessels and capillaries in leg and thus improve the blood flow.

E.The risk factors of DVT includes

Immobility: Prolonged immobility or bed rest leads to accumulation of blood in the dependent extrimities and leading to the development of DVT.

Smoking: Prolonged Smoking may leads to narrowing of the blood vessels in the lower extrimities called peripheral occlusive disorders. This can lead to impaired blood flow to the vessels, pooling of blood and developmet of DVT

Being over weight: Being over weight may lead to impaired flow of blood through the narrowed blood vessels. Due to compression effect and heavy body weight pooling of blood in the lower extrimities takes place. leading to DVT development