Instructions for Care Following Cryoablation of the Prostate
The healing process takes time and we would like for you to observe the following instructions during your initial recovery at home. We are providing important information to keep you knowledgeable of your self-care after cryoablation.
Normal Findings after Cryoablation Some patients experience a number of findings after cryoablation that should not be cause for alarm. Signs and symptoms include:
- Blood in the urine. When you are discharged from the hospital, your urine may have some blood in it and appear red but without any blood clots. This occurs to some degree in all patients after cryoablation and is not cause for alarm. Your urine should clear in approximately 24 hours after the procedure.
- Scrotal and penile swelling. This occurs 2-3 days after cryoablation and is caused by tissue swelling that temporarily blocks lymphatic drainage. Scrotal swelling can last up to a week but is harmless and painless. Lying down for short periods during the day will help improve swelling. Wearing briefs or athletic support will help as well.
- . Small amounts of bloody discharge from the end of your penis. This may occur for up to 6 weeks after the procedure and is due to discharge from the urethra in the area of the prostate.
- . Some numbness in the head of the penis. Occasionally, when a large amount of freezing is required, the nerve supply to one or both sides of the head of the penis may be affected. Sensation returns after a number of months.
Findings of Concern after Cryoablation
There are certain symptoms that you may experience which might indicate a problem. If you have any of the symptoms described below, please contact your U-M Urologist’s office or Urologist on call at 734-936-6267. They will contact the faculty physician for you.
Symptoms of concern include:
- Fever, chills, worsening pelvic pain, or pain during urination. These symptoms may indicate an infection and needs to be dealt with quickly.
- Decreasing urinary stream. This may indicate sloughing of dead tissue from the urethra in the area of the prostate. This may clear on its own or may require removal of dead tissue through a scope if severe.
- Diarrhea after urination of foul smelling urine. These symptoms may indicate an urethrorectal fistula and further investigation is needed.
- Urine is not draining from your catheter or suprapubic tube. There may be an obstruction and further investigation is needed.
You will be discharged with either a foley catheter, suprapubic catheter or both catheters. If you have both catheters, the foley catheter is attached to a leg bag or an overnight drainage bag; the suprapubic catheter will be “off” and not attached to a drainage bag.
Suprapubic Catheter (S-P tube)
If you have a suprapubic catheter, do not attempt to urinate normally until 4-6 weeks. At 4-6 weeks, you can try turning off the suprapubic tube valve and try voiding on your own. After urinating, or if you are unable to urinate, open the suprapubic tube, drain urine, measure the output, and record the amount.
Change the suprapubic tube dressing once a day. Use two 4x4 gauze dressings. Place one gauze below the tube and one above and secure gauze with tape.
You may have a urethral catheter draining your bladder when you leave the hospital. You will be taking an antibiotic to prevent urinary tract infection while the foley catheter is in your urethra. The urethral catheter will drain your bladder for 3 weeks. At three weeks, the catheter will be removed and you will be able to urinate normally. Occasionally, there is still swelling in the prostate at 3 weeks which makes urination difficult. If this is the case, a urethral catheter will need to be reinserted for an additional week.
You will be given 2 different urine collection bags. One is a large urinary drainage bag for overnight use and the other is a leg bag for use under your clothes during the day. If It is possible that your urethral catheter will become blocked with a small amount of tissue that has sloughed from the urethra at some point during the 3 weeks. If this occurs, you will notice that the drainage bag has stopped filling, you will be uncomfortable as your bladder fills with urine. You will receive instructions on urethral catheter irrigations if this should happen. Please call the Urology clinic if your catheter is not functioning properly.
Cleaning the Urethral Opening
To decrease risk of infection from the indwelling urethral (foley) 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 catheter twice a day and rinse well. Place a small amount of Bacitracin ointment around the meatus. If a rash or skin irritation occurs with Bacitracin, discontinue use and use K-Y lubricant.
Urethral Catheter Holder (Leg Strap)
- Position leg band around the thigh. Stretch 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, raise either side of the tab, adjust, and refasten tab.
- Reposition the band every 4-6 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 may be washed if needed.
Urinary Drainage Bag
- The nurse will help with 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 or leg 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 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 straps may be trimmed with scissors.
- Attach urine bag to the 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 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 urethra 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 of water and vinegar to keep free of bacteria and reduce odor.
- You will be given prescriptions to take certain medications after your procedure.
- An antibiotic to prevent infection while you have a catheter. This is usually Bactrim, one pill 2 times each day for 3 days starting the day before the catheter is removed.
- An anti-spasmodic to prevent bladder contractions. This is usually Ditropan, one pill 3 times each day. If you are taking Ditropan, you must stop taking it 24 hours before your catheter is removed.
- A medication to improve urinary flow from the bladder. Flomax 0.4mg, one pill each day for 4 weeks.
- An anti-inflammatory medication to prevent pain. Celebrex 200mg, one pill once each day.
In general, there are no restrictions in activity following cryoablation and you can return to your normal activities as soon as you feel comfortable. Gradually increase the amount of walking you do each day as tolerated. Do not walk to the point of exhaustion. Many patients resume normal activity in about a week.
- You will have 6 puncture wounds with the sutures behind your scrotum. This makes sitting down painful and uncomfortable. Stitches are usually uncomfortable for 1-2 weeks. Use a donut to sit on for hemorrhoids.
- You will have swelling and bruising of the penis and scrotum. On rare occasions, swelling may be up to the size of a grapefruit. Wearing a jock strap or athletic support helps most patients.
- Ice packs to the scrotum will help keep the swelling down. Place ice packs to the scrotum and behind the scrotum, 2 hours at a time, with a 30 minute break from ice packs. Do not try to freeze your scrotum and perineal areas. Use ice packs for 5-7 days. Some people may require a longer period of time using ice packs.
- Lying flat on your back will also help decrease swelling. You may find that swelling increases during the day when you are sitting up or walking around.
You may shower the 2nd day after surgery. You may not take a bath until your incisions are completely healed.
Diet and Bowel Function
Resume your normal diet. If you are having nausea and vomiting, or feel that you are bloated, notify your physician. You will be given Colace, a medication to soften your stool. Keep yourself well hydrated by drinking 4 to 8 glasses of water a day to enhance the effectiveness of Colace. If you have constipation, increase roughage in your diet, drink prune juice, apple cider, or try an over the counter laxative like Dulcolax or Milk of Magnesium. Do not give yourself any enemas or rectal medications. The rectal wall is thin after cryoablation. Please do not hesitate to contact us if you have any questions or problems.
UMHS Department of Urology, September 2008