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Patient Information


Instructions for Care following Male Sling Surgery
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:
Pain Control
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. 
Antibiotics
You will receive an antibiotic after surgery for 24 hours. You will also 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.
Instructions
  • 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.
Ambulation (Walking)
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.
Scrotal Support
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. 
Bathing
You may use the shower to bathe if you wish (even if you have a catheter in place). Gently wash the incision(s) with soap and water, rinse thoroughly, and pat dry. This will be sufficient to keep your incision(s) clean, dry, and free of bacteria.  Do not take any tub baths/soaks until your incision(s) are completely healed (which should be in 3-4 weeks). 


Urinary Catheter
You will have a Foley catheter placed in the operating room at the time of your male sling surgery. The catheter will be removed on the morning after surgery before you go home.  Once the Foley catheter is removed, you will be asked to urinate into a urinal so your doctor can measure your urine output.  After each time you urinate, your nurse will check a postvoid residual (PVR) by using an ultrasound on your low abdomen to measure how much urine is left over in your bladder.  If you are unable to empty your bladder after surgery, your doctor will determine the most appropriate management of your situation with you.
Activity
  • 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 6 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 6 weeks.
  • Do not drive for 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 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. 

Diet
You may return to your normal diet after surgery. Do not drink alcohol while taking narcotic pain medication. 
Bowel Habits
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.
Reasons to call your doctor:

  • The incision(s) become red, swollen, opens, or there is pus-like drainage.
  • The skin around your incision(s) feels warmer than elsewhere.
  • There is an abnormal odor or cloudiness to your urine.
  • You have nausea and vomiting.
  • You cannot move your 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 weeks after surgery.  At this time your doctor will check your incision(s) and may perform follow-up tests. Your doctor will discuss your postoperative progress, instructions and further follow-up with you at both visits.

We will keep your primary care physician informed of your progress so that, together, we can address all of your health issues.
ADDITIONAL INSTRUCTIONS
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.

Reviewed 11/04/10 Rou Wang