Instructions for Care following Urethroplasty
You have just undergone a major operation. The healing process takes time and we would like for you to observe the following instructions during your initial recovery. We have written this information for you to use as a reference during this initial healing phase.
INITIAL POST-OP TREATMENTS AND INSTRUCTIONS:
Our goal is to keep you comfortable. You pain medication will be ordered as needed (PRN). This is not a medication that is given to you on a schedule. Ask your nurse for pain medications as you need them. Your nurse will assess you frequently for pain or discomfort. However, please do not hesitate to ask for pain medication when you need it.
You will generally receive an antibiotic after surgery for 24 hours. You may be discharged home with a prescription for an antibiotic pill depending on your doctor’s recommendation.
Incentive Spirometer (IS)
Purpose: To promote complete lung expansion and prevent respiratory complications. It is very important to use the incentive spirometer during the time before being up and about.
- Seal the lips tightly around the mouthpiece, inhale naturally, and hold your breath for 3 to 5 seconds to achieve full lung expansion. Exhale and rest a few seconds.
- Each time you inhale, breath deeper trying to get the disk in the column to a higher volume, holding it there as long as you can.
- This should be done at least 10 times an hour while you are awake.
- Deep breathing exercises are also helpful. Take a regular breath and hold to the count of five. Exhale completely. Do this about 10 times each hour while you are awake.
Sequential Compression Devices (SCD’s)
Purpose: SCD’s enhance circulation by pumping the calf muscles. Enhancing circulation helps prevent the formation of blood clots. Plastic sleeves are wrapped around each leg. The sleeves are connected to a machine that inflates and deflates different segments of the sleeves to a preset pressure. This action mimics the action of your calf muscles during walking. Instructions: The nurses will place the SCD sleeves on both your legs in the operating room before surgery.
These must remain in place as long as you are in bed after surgery. Once you are out of bed and walking, the SCD’s are no longer needed. There are exercises called plantar extension/flexion that are important even when you are using SCD’s, as well as when you are up walking again.
Plantar Extension/Flexion Exercises
Instructions: Begin by pointing your toes toward the bottom of the bed. Then point your toes up toward your face. Repeat this simple exercise at least 100 times an hour while awake.
You will be instructed to be up and about as much as you are able to tolerate. Sitting in the chair will be encouraged as well. The first few times that you get out of bed to walk around, someone will be with you to assist you. This is to make sure that you are steady on your feet. You should then spend as much time out of bed as possible. After you are discharged from the hospital, it is very important to continue to be up as much as possible. A rule of thumb is that you should be out of bed as much or more than you are in bed.
You may experience some swelling and redness/bruising of the scrotum. This is normal. A towel roll may be placed under your scrotum to help keep the swelling down. Wear supportive underwear/briefs or an athletic support.
You may use the shower to bathe if you wish (even if you have a catheter in place). Gently wash the incision with soap and water, rinse thoroughly, and pat dry. This will be sufficient to keep your incision clean, dry, and free of bacteria. Do not take any tub baths/soaks until your incision is completely healed (which should be in 3-4 weeks) or while you have a catheter.
You will have a Foley catheter in your urethra after surgery. You may have a second catheter (suprapubic tube or SP tube) that is placed in your bladder and comes out of the abdominal wall. The urethral Foley catheter will remain in place for two to three weeks after surgery. You will return to the Urology clinic to have it removed. If you also have a suprapubic catheter, the SP tube will generally be removed after the urethral catheter.
Whether you have one or two catheters, your catheter(s) should be anchored at all times with a catheter strap to your thigh or calf (or in some cases up to your abdomen). Instructions on how to do this are explained below and will be reviewed with you after surgery.
If your catheter falls out, contact the Urology Resident on call at the University of Michigan Hospital immediately. He/she will instruct you as to what to do about having it replaced.
Meatal / Catheter Care
Purpose: To decrease the risk of infection and scarring from the urethral Foley catheter.
Instructions: Using soap and water, wash the around the meatus at the entry point of the Foley
catheter. Place a small amount of bacitracin (triple antibiotic ointment) around the meatus at the entry point of the Foley catheter. While you are in the hospital and when you are home, you should do this at least three times a day until the Foley catheter is removed.
Catheter Leg Strap / Holder
Purpose: To secure the catheter and prevent irritation.
- Position the leg band high around the thigh or on the calf with the product label on the outside of the leg.
- Stretch the leg band in place and fasten Velcro tab.
- Place the catheter or tubing over the green tab. Leave an ample loop in the catheter above leg band to avoid traction on the catheter!
- With catheter or tubing in the desired position, insert the narrow green Velcro tab over the catheter or tubing and through the square opening so that the Velcro tabs overlap.
- Pull the Velcro tabs in opposite directions and secure in place. To readjust, raise either side of the tab, adjust, and refasten the tab.
- Reposition the leg band every 4 - 6 hours to prevent pressure on your leg. This can be done by changing to the other leg or by raising or lowering the leg band.
- The leg band can be washed and dried without damage.
Catheter Drainage Bags
Purpose: To collect and store urine draining from the urinary catheter.
- The nurse will help you with the initial set up. A connector is placed between the catheter and the tubing on the leg bag. Once the connector is attached, it should not be removed.
- Each leg bag comes with two straps. Attach one strap to the top of the bag and one strap to the bottom of the bag.
- Put the buttons of the leg bag strap through the slits on the bag. The buttons should face out to prevent a pressure point on your leg.
- Position the leg bag with soft backing against your skin. Adjust the straps until comfortable. Excess strap may be trimmed with scissors.
- Make sure that the outlet valve at the bottom of the bag is firmly closed before connecting it to your catheter.
- Attach the leg bag to the end of the catheter by inserting the tapered connector snugly into the catheter port.
- Dribbling of urine from the catheter can be avoided by bending the catheter just below the end while you disconnect the tubing from the catheter. Be careful to keep the ends of the catheter and the tubing clean while connecting them so bacteria are not introduced into the system.
- To drain the leg bag, open the clamp at the bottom of the bag and direct the urine into the toilet.
- The connector should be washed with soap and water after each disconnection and covered with the gray cap that is provided.
- Rinse the leg bag with equal parts water & vinegar daily to keep it bacteria free and reduce odor.
- You will also be given a large overnight bag like the one used in the hospital.
- NO MATTER WHAT DRAINAGE SYSTEM YOU USE, REMEMBER TO KEEP THE DRAINAGE BAG BELOW THE LEVEL OF THE BLADDER SO URINE WILL FLOW DOWNWARD INTO IT.
Purpose: If the catheter is not draining freely, you may need to irrigate (flush) it to remove the blockage. You do not need to irrigate your catheter unless it appears to be blocked.
Instructions: This applies to both urethral Foley catheters and suprapubic catheters (SP tubes). You will need sterile water or saline for irrigation at home. The water or saline MUST be sterile. DO NOT USE TAP WATER. Tap water often has bacteria in it that can cause infection if it is placed directly into your bladder. Your nurse will give you a bottle of sterile water or saline to take home with you.
- Wash your hands.
- Draw up 40 cc to 60 cc of sterile water or saline in the catheter tipped syringe provided.
- Disconnect the catheter from the drainage bag tubing.
- Hold the tip of the catheter upright between the thumb and first finger. Place the tip of the syringe into the catheter.
- Gently inject the sterile water or saline into the catheter.
- Gently withdraw the water or saline from the catheter with the syringe. Watch for mucus or a small clot (that is what you want to see).
- This process may be repeated as needed until the catheter drains freely.
- After you finish irrigating
- Rinse the inside of the syringe with a small amount of the sterile water or saline.
- Wash the tip of the syringe with soap and hot water.
- Cleanse the tip of the syringe with alcohol and recap it.
- Store your supplies in a clean place.
- If you notice a decrease in the amount of urine from your catheter, it may need to be irrigated.
- If irrigation does not result in adequate urine drainage or if you have questions, call the Urology Clinic and ask the nurse for further instruction.
- You should continue walking when you return home, gradually increasing the amount of walking you do each day. Short frequent walks of 10-15 minutes are a good starting point (at least 3-4 times a day). Walking will help you rebuild strength.
- Take planned rest periods during the day. The best gauge is your body and how you feel.
- You may walk up and down stairs as soon as you return home, but take them slowly.
- Avoid heavy lifting (greater than 5 pounds) or strenuous activity for 4 weeks after you are discharged. Heavy lifting can increase abdominal pressure, which can put a strain on your incision. If you need to brace yourself to pick something up, then it is too heavy. Five pounds is equivalent to a large telephone book or a gallon of milk.
- Avoid bending. This is tiring and also increases abdominal pressure. If you must pick something up, bend with your knees (not at your waist).
- Do not resume sexual activity until you discuss it with your doctor at your first post-operative visit. Your doctor will let you know when you can resume sexual activity, typically after 4 weeks.
- Do not drive for three to four weeks or as directed by your doctor. A good rule is to not drive until you are pain free. This is because when you are having pain, it will change the way you would react to something. You can be a passenger in the car but on long car trips, take frequent breaks, get out of the car and walk around for a few minutes.
- Do not drive any motorized vehicle or sign any documents while taking narcotic pain medication. The narcotic medication may cause changes in visual perception and impair your judgment.
*** A special note for men with a perineal incision about sitting down ***
As your doctor has explained, it is necessary for you to change the way that you sit down after urethral reconstruction surgery. This pertains to men who have a perineal incision (an incision in between the anus and the scrotum). Do not sit directly on the incision. Instead, sit with your weight shifted back onto your buttocks. You may use an air-filled donut, soft cushion or other type of pillow to sit on, especially for the first 3-4 weeks after surgery.
You should pay attention to this for 6 months after surgery. Do not put any direct pressure on the incision for 6 months. It is recommended that you do not do any activity that requires you to straddle anything, such as riding a bicycle/motorcycle/ATV, horseback riding, etc.
- You may return to your normal diet after surgery.
- Do not drink alcohol while taking narcotic pain medication.
- If there was a buccal mucosa graft harvested from your mouth:
- Swish and spit one to two ounces (30-60mL) of Magic Mouthwash or half strength hydrogen peroxide and saline solution four times a day until your mouth incision is completely healed.
- In addition, you may use other types of mouthwash/rinse, if you like.
- You resume your usual oral care, tooth brushing, etc. the day after surgery.
Avoid constipation. This will prevent unnecessary straining. To prevent constipation you can increase roughage in your diet, drink prune juice or orange juice, take milk of magnesia or some other over the counter laxative. You will be prescribed Colace when you are discharged. This is a stool softener, not a laxative. It is recommended that you drink 6-8 glasses of water a day to enhance the effectiveness of Colace. Should constipation become a problem that is not relieved, call the Urology Clinic and ask the nurse for further instruction.
Other common concerns
- You may experience leakage of urine or bloody fluid out of the end of the penis. The urine or blood may come out around and not through the urethral Foley catheter. This can happen when one has a catheter. You may or may not also experience pressure or pain in the bladder when the leakage occurs. This may happen more commonly when you are having a bowel movement.
- Check to see if the catheter(s) is draining adequately. If not, irrigate the catheter(s).
- The leakage may occur intermittently while you have the catheter in place. This is not dangerous, if the catheter is draining freely.
- If the leakage is continuous, if you have painful bladder spasms that are not going away, or if you have questions, call the Urology Clinic and ask the nurse for further instruction.
Reasons to call your doctor:
- The incision becomes red, swollen, opens, or there is pus-like drainage.
- The skin around your incision feels warmer than elsewhere.
- There is an abnormal odor or cloudiness to your urine.
- There is decreased or absent urine output for 2 hours.
- The urine becomes bloody and does not clear with rest and fluids.
- The catheter becomes dislodged.
- You have nausea and vomiting.
- You cannot move you bowels.
- You have chills or temperature greater than 101 degrees F.
- You experience severe pain that is not relieved by pain medication.
You will be given an appointment to return to the Urology Clinic two to three weeks after surgery. At this time your doctor will check your incision, catheter(s) and may perform follow-up tests. Your doctor will determine when the catheter(s) will be removed, and will discuss your postoperative progress, instructions and further follow-up with you.
We will keep your primary care physician informed of your progress so that, together, we can address all of your health issues.
Additional instructions are given on a case by case basis. Ask you health care provider if any other instructions are necessary in your particular case.
For Urgent or Emergent situations 24 hours a day, page the Urology Resident on call at 734.936.6267. They will contact the physician for you.