Instructions For Care Following Conventional Prostatectomy/Robotic Prostatectomy
The healing process takes time and we would like for you to observe the following instructions during your initial recovery at home.
INITIAL POST-OP CARE IN THE HOSPITAL
The urethral catheter drains the bladder and allows the bladder to heal to the urethra. In general it will stay in place for 7 – 10 days, but can be longer if the connection between the bladder and urethra needs additional healing time. Your doctor will tell you exactly when to have the catheter removed.
IT IS CRITICAL THAT THE CATHETER STAY IN PLACE DURING THE HEALING PHASE.
During surgery, the physician will place a pelvic drain in or around the surgical area that will exit through the abdominal wall. This drain is used for drainage of excess fluid from the surgical area itself.
Most patients will have this drain removed the first day after surgery. Occasionally this pelvic drain may be left in for a week or more, in which case you would be instructed on how to care for it at home.
The night after your operation a Patient Controlled Analgesic device referred to as a PCA, is used to help control any post-surgical pain. This is a device that administers pain medication through your IV (intravenous). You will have access to a button that you can push, which will then automatically give you a prescribed dosage of the medication at preset intervals. This will be discontinued the day after your surgery in the morning and you will start on oral medication for pain control.
Preventing Blood Clots in the Legs
During the operation and through the night after surgery, you will wear self-inflating stockings which promote blood circulation in the legs. They help prevent blood clots (deep vein thrombosis or DVT) from forming in the legs. Once you start walking the next day, they will be removed.
YOUR RECOVERY AT HOME
Cleaning the urethral opening
To decrease risk of infection from the indwelling urethral catheter and later scarring, it is important to clean the urethral opening. Using soap and water wash around the urethra at the entry point of the Urethral twice a day. Rinse well. Place a small amount of Bacitracin ointment around the meatus. If a rash or skin irritation occurs with the Bacitracin, discontinue use and use K-Y lubricant.
Urethral Catheter Holder
- Position leg band around the thigh.
- Stretch the leg band in place and fasten Velcro tab.
- Place Urethral catheter over the green tab. Leave an ample loop in the catheter above the leg band to avoid traction.
- With the catheter in desired position, insert narrow green Velcro tab over the catheter and through the square opening so that the Velcro tabs overlap.
- Pull Velcro tabs in opposite directions and secure in place. To readjust, simply raise either side of the tab, adjust, and refasten tab.
- Reposition the band every 4 to 6 hours to prevent pressure on the leg from the elastic. This can be done by changing to the other leg or by lowering the leg band.
- The leg band can be washed if needed.
Urinary Drainage Bag
- The nurse will help with the initial set up (including adjusting the tubing length) of your large urinary bag and a more portable leg bag. You can wear either the large bag anytime during the day, according to your comfort and/or convenience. Although the leg bag is convenient, it can at times drain the bladder less effectively than the large bag, and needs to be emptied at least every 3 hours.
- Put the buttons of the leg bag strap through the slits at the top and bottom of the bag with buttons facing out to prevent a pressure point on your leg.
- Position bag with soft backing against the skin. Adjust the straps until comfortable. Excess strap may be trimmed with scissors.
- Attach urine bag to end of catheter by inserting the open end of the tubing from the bag snugly into the open end of the urethral catheter. Be very careful while connecting the leg bag tubing to the catheter to keep it clean.
- Ensure that the outlet valve at the bottom of the bag is firmly closed. Simply flip the valve of the bag drainage port upward toward the bag until it snaps firmly in place.
- To drain the bag, simply flip the clamp on the bag drainage port downward. The flexible outlet tube can be directed to control the flow of urine. You do not have to disconnect the leg bag from the urethral catheter to empty it. You can empty the bag directly into the commode.
- The connector should be washed with soap and water after each disconnection and covered with the gray cap that is provided. The gray cap can be soaked in soap and water while not being used. Rinse with warm water before placing on the connector.
- To keep the leg bag and large urinary drainage bag clean, rinse daily with equal parts water and vinegar to keep free of bacteria and reduce odor.
KEEP EITHER THE LEG BAG OR THE LARGE URINARY BAG BELOW THE LEVEL OF THE BLADDER TO PROMOTE DRAINAGE.
If your scrotum is swollen, wear supportive briefs or an athletic support. When resting, elevate your scrotum on a rolled towel. Scrotal swelling is common for up to a week but is harmless and painless.
It is common for your appetite and bowel movements to recover gradually in the first week after surgery. Usually bowel movements may not resume until 3 to 5 days after surgery. Avoid straining to have a bowel movement. You will be given Colace, a medication to soften your stool. If constipation becomes problematic you can increase your roughage you take in your diet, drink prune juice or apple cider or take an over the counter laxative such as milk of magnesium or magnesium citrate. It is recommended that you keep well hydrated by drinking 4 to 8 glasses of water a day to enhance the effectiveness of Colace.
You may also experience some cramping feelings, called bladder spasms, for several days to a week before the urethral catheter is removed. Bladder spasms are a natural response of the healing bladder. These can be felt as urgency to urinate or brief pelvic or rectal pressure. Bladder spasms also commonly cause urine or blood to squirt out of the penis at the time of a bowel movement. Should bladder spasms become a problem, call your doctor. You will be given Motrin or another medication (oxybutinin) to reduce these spasms and to prevent other pain, but there are other medications that can be given to relieve this discomfort. If you are taking oxbutynin, ditropan, or detrol for this particular problem, you must stop taking it 24 hours before your catheter is removed.
It is expected that you will resume regular activity around your home when you are discharged from the hospital. Gradually increase the amount of walking you do each day as tolerated. Do not walk to the point of exhaustion. You can resume your daily activities as you see fit. In general, patients are back to normal activities within 10 days and full activity in 21-28 days.
Do not drive any motorized vehicle until your catheter is removed and you are off narcotic pain medication. If traveling by car, be sure to stop every 1 to 2 hours. Get out of the car and walk around. Do not sign legal documents while taking narcotic pain medication. The narcotic medication may cause alteration in visual perception and impair judgment.
You may begin showering after surgery. You may not take a bath until your incisions are completely healed. If you have surgical staples, they will be removed at your first post operative visit. There will be white tape strips called Steri-strips on the incision that will fall off during a shower. Do not pull off.
Return to normal eating habits; although small meals are better tolerated at first. Allow your appetite to determine how much you eat; do not force food if you feel full or if your stomach is unsettled. In the first week after surgery, it may be best to avoid spicy or fatty foods.
Walking soon after surgery encourages early return of bowel function, promotes effective breathing, mobilizes secretions from the lungs, improves circulation, prevents stiff joints and relieves pressure. The morning after surgery, you will be instructed to be out of bed at least 6 times a day. This can be thought of as twice after breakfast, twice after lunch, and twice after dinner. Being out of bed more often is encouraged but must be at least 6 times a day. After you are discharged from the hospital it is very important to continue with the minimum of walking 6 times a day.
SPECIAL CONSIDERATIONS AFTER URETHRAL REMOVAL
The catheter will be removed in clinic. On the day of the catheter removal, arrive in the office well hydrated. Problems with urinary control are common once the catheter is removed. It is normal to experience leaking at first. Do not become discouraged. Urinary control may return in three phases:
- Phase 1-You are dry when you are lying down at night.
- Phase 2-You have periods of good urinary control in the early morning.
- Phase 3-Urinary control lasts for longer intervals and later into the afternoon and evening.
Until urine control returns completely, it may be helpful to wear an incontinence pad. “Depends” for men makes a pad designed to adhere to the inside of jockey-style briefs. These pads can be purchased at general retail stores such as Meijer, Wal-Mart, Target and any pharmacy. Please bring 2 to 3 pads with you when you return for the catheter removal.
After the urethral catheter is removed, you may have some initial bleeding from the penis. It is recommended that you also bring a pair of jockey shorts with you to clinic. The shorts will not only give you support but will also help to secure the incontinence pad.
You will be given a prescription for antibiotics to start the morning before the catheter is to be removed. You will continue the antibiotic for a total of 3 days. You will also be given a prescription for Flomax, a medication to improve your urinary stream, to start 3 days before the catheter removal and to continue for a total of 7 days. There is a small balloon filled with water that keeps the catheter in place. The water is removed with through the port at the end of the catheter and the catheter is then taken out. When the catheter is taken out, you may experience minimal discomfort for a few seconds.
Sexual Activity and Penile Rehabilitation
Sexual recovery is typically more gradual than urinary recovery. The return of sexual function varies depending on your age, previous function, and the extent of the tumor. For those men who have return of erections, it is a gradual process. Most men do not have erections sufficient for vaginal penetration immediately after catheter removal. Erection recovery can take months or years; during this period, medications can be used to help your erections be firmer and more durable. Many men, however, do experience improvement over the first year after the operation. The stimuli for erection during the first year will also be different. Visual stimuli will be less effective, and physical stimulation will be more effective. For this reason, do not be afraid to experiment with sexual activity-you can do no harm. If you obtain a partial erection, attempt vaginal penetration-this form of stimulation is a major factor to enhance further erection. Do not wait until you have the “perfect erection” before attempting intercourse. In addition, you should be able to have an orgasm even if you do not have an erection. With orgasm, there will not be an emission of semen because the prostate and seminal vesicles have been removed. There will be many aids available to assist in getting an erection. Your doctor will discuss this in detail with you.
You will receive a prescription for Viagra 100mg and a vacuum erectile device (VED). You should take ½ a Viagra pill (50mg) every other day or if your insurance plan limits the number of tabs to 6-8 then spread out the pills to every 3-5 days. Use the VED 4-5 times per week to achieve an erection that last for 10-15 minutes. You can have sexual relations with the erection but the goal is to get an erection and establish blood flow to the penis. This will not make you dependent on the VED for an erection, but will improve your chances of getting a natural erection.
After the first return clinic visit, your doctor will determine how often it will be necessary for you to return. You may follow up with your University of Michigan Urologist or with your local physician. For your follow-up, you should have a PSA done twice a year for the first 5 years after surgery. As long as your PSA remains undetectable, you can continue with an annual PSA thereafter. If you choose to have your local physician follow you and provide care, please have that physician forward PSA results to us.
REASONS TO CALL YOUR U-M UROLOGIST WITHOUT DELAY
- Any signs of pulmonary embolus (blood clot from pelvis which has gotten into the blood circulation of the lung):
- Chest pain
- Difficulty breathing
- Sensation of heart racing
THE ABOVE SYMPTOMS REQUIRE IMMEDIATE ATTENTION AND IF YOU ARE UNABLE TO REACH YOUR U-M UROLOGIST OR UROLOGIST ON CALL, YOU SHOULD GO TO A NEARBY EMERGENCY ROOM
- Signs of a blood clot in the legs or pelvis (Deep Vein Thrombosis)
- Pain in the back of the thigh, calf, or groin.
- Swelling of the leg.
- Red streaking color or warmth of the leg.
- Problems with the surgical incision
- Redness and/or warmth around incision.
- Pus draining from the incision.
- Separation of the skin at the incision line.
- Problems with the Urethral Catheter
- Urine not draining.
- Red blood which does not clear soon after resting and increasing fluid intake.
- Urethral catheter inadvertently pulled out from the bladder or penis.
- Fever with temperature by mouth greater than 101 F.
- Nausea, vomiting or severe abdominal bloating.
- Pain not relieved by prescribed medications.
- Inability to urinate after catheter removal.
- Decreased force of stream and sensation of incomplete emptying after catheter removal.
For urgent and emergent situations 24 hours a day, page the Urology Resident on call at 734 936 6267. They will contact the faculty physician for you.
Updated July 2007