研究背景：50%中年男性有前列腺肥大問題，當年齡大於90歲時，高達90%以上有前列腺肥大，而經尿道前列腺刮除術是目前前列腺肥大手術治療之黃金標準。術後尿管留置為既定處置，然尿管留置會增加尿管相關泌尿道感染、與引起膀胱不適，更多其他因留置尿管導致的併發症。目前，術後移除尿管時間不定，且無早期移除尿管照護方案供醫療人員參考，故亟需發展早期移除尿管照護方案，以期減少尿管留置所帶來的併發症。
研究目的：發展經尿道前列腺切除術後早期移除尿管照護方案，再經前驅測試以調整方案。
研究方法：透過文獻回顧，初擬經尿道前列腺切除術後早期移除尿管照護方案，並運用修正型德菲爾法，邀請5位專家學者進行專家共識，發展此方案。再者，採前驅研究，以方便取樣選取符合前列腺肥大採經尿道前列腺切除術後之個案，進行照護方案介入及資料收集。收案期間為2019年12月至2020年7月，實驗組5位、對照組8位，共收13名受試者。資料收集於手術前的相關資料包括：住院個案基人口學資料、泌尿系統相關病史、國際攝護腺症狀評分表、察爾森共病症指標、修改版Katz日常生活功能評估量表、麻醉風險評估。於術後當天、第一天、第二天、第三天…直到出院日，每日評估混亂評估方法(CAM)、病人疼痛及病人不適的變化，並記錄個案詳細術式(單極、雙極或雷射)、手術時間、術中失血量、放置尿管大小、尿管水囊大小、前列腺刮除大小。出院當日收集資料，包括：尿管放置時間、是否發生術後併發症、是否重置導尿管、住院天數、修改版Katz日常生活功能評估量表。於2019年12月1日至2020年4月30日期間為對照組採常規照護模式，於2020年5月4日至2020年7月30日為實驗組以方案照護介入。實驗組收案期間，研究者執行照護方案，每日研究人員依經尿道前列腺切除術後早期移除尿管照護方案進行照護及追蹤。以IBM SPSS 22進行數據資料的分析，描述性統計包含：百分比、平均數、標準差與範圍，推論性統計分析費雪檢定與曼-惠尼檢定分析成效。
研究結果：前驅研究測試經尿道前列腺切除術後早期移除尿管照護方案，兩組於尿管留置時間、術後併發症、住院天數、日常生活功能、急性譫妄、疼痛及不適感受等皆未達顯著差異(P>0.05)。照護方案內容經兩回合專家共識程序，Cronbach’s α為0.88，共識收斂度達99%，並經臨床實際執行此照護方案，調整後方案內容為分別為「促進早期移除尿管評估與策略」，包含：方案對象(納入排除條件)、尿管留置照護相關策略(留置尿管照護、尿管移除尿液狀態)及「移除尿管後相關策略」，包含：建立排尿時間表及解尿日誌、教導骨盆底肌肉運動、執行誘尿方法、輔助藥物及個案自解尿後成功移除尿管判定與否。
結論：前驅測試經尿道前列腺切除術後病人早期移除尿管照護方案成效，於尿管留置時間、術後併發症、住院天數、日常生活功能、急性譫妄、疼痛及不適感受上皆無顯著差異。然因照護方案於臨床執行困難，故未能預期完整執行，或許為研究結果無顯著之主因。另外，照護方案經由專家共識與臨床執行後，已進行部分修訂，未來建議持續進行滾動式修正並增加收案量，促使臨床能夠普遍使用，使經尿道前列腺切除術後病人獲得最大照護效益。

The purpose of this study was to develp a protocol for early removal of the urinary catheter after Transurethral Resection of the Prostate (TURP) and to pilot test the effectiveness of the protocol. The content of protocol was developed through a modified Delphi method, the Cronbach's α is 0.88 and the consensus convergence rate is 99%. There were no significant differences in the length of urinary catheter day, postoperative complications, length of hospital stay, Katz ADLs, CAM, pain and discomfort between intervention and control groups (P>0.05). It is suggested to continue to revise the protocol, in order to promote clinical application and achieve maximum care benefits for patients after TURP.

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