Instructions for Care Following Transurethral Resection of the Prostate
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.
Post-op Treatments and Instructions
Pain Control Our goal is to keep you comfortable. Your 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 medication, as you need them. Sometimes you may experience bladder spasms, (the strong urge to urinate or strong lower abdominal cramping). You may be given antispasmodics (bladder relaxant) either by mouth or rectally. After your catheter is removed, rectal antispasmodics are
stopped to allow your bladder to return to normal tone. Your nurse will assess you frequently for pain or discomfort. However, please do not hesitate to ask for pain medication when you need it.
Foley Catheter There will be a catheter in your bladder. Your catheter will feel tight to you because it is to “traction”. This means that it has been taped tightly to your leg or up towards your abdomen. This is done to help control bleeding. The next morning after the doctor has seen you, depending on how clear or pink or red the urine is, the foley will be released. Your doctor will remove the foley when your urine is nearly clear. You will then be given a urinal to save all you urine and will be started on what we call “serial urines”. Your nurse will instruct you on saving the urine at that time. If your are unable to urinate on your own after the catheter is removed, a catheter will be inserted to initiate the flow of urine. This catheter will not remain in your bladder.
Intake and Output Your nurse will record fluids taken in and put out. Your may have a continuous bladder irrigation (CBI) thought the catheter to help keep the urine clear and free of clots or tissue. This will be discontinued when your urine is clear. It generally will run through the night. If you do not have a continuous irrigation and should your urine become bloody, it may be necessary for the nurse to occasionally irrigate the foley with a syringe to keep the urine clear. You may also be asked to drink about a glass of water every hour while awake to dilute the urine. All this intake and output will be recorded frequently.
Incentive Spirometry Purpose: To promote full lung expansion and prevent respiratory complications, which affect the body temperature. This will be used throughout your hospital stay. Though you have not been given a general anesthesia, you have been given sedation, and this can have an effect on your ability to take deep full breaths.
Instructions for use:
- Seal the lips tightly around the mouthpiece, inhale naturally and hold your breath for 3 to 5 seconds to achieve 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 and holding it as long as you can. Do this at least 10 times an hour while you are awake.
- Deep breathing exercises are also helpful. Simply take a regular breath through your mouth. Breathe out gently and completely. Then take a deep breath and hold it to the count of five. Exhale through your mouth and nose completely. Do this about 10 times each hour while you are awake.
Sequential compression devices (SCD) Purpose: SCDs aid circulation by providing intermittent periods of compression on the lower extremities. This is a plastic sleeve wrapped around each leg which are connected to a machine that has been preset to automatically give the prescribed or recommended compression pressures that is needed to prevent blood clots from forming. This provides the same effect to your legs as walking.
Instructions: The nurse will place the sleeve on both lower extremities when you return from surgery unless they have already been placed in the holding room. These must remain in place as long as you are in bed. Once ambulation begins, the SCDs are no longer necessary. There is also an exercise called “plantar extension/flexion” that is important even when you are using the SCD and more important when you are up again.
Plantar extension/flexion exercises Instructions: Begin with 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: Purpose: Walking soon after surgery helps with early return of normal bowel function, promotes more effective breathing, mobilizes secretions. Improves circulation, prevents stiffness of joints, and relieves pressure.
Instructions: You will be instructed to be up and about as soon as your foley has been released from traction. If you have traction to your foley, you will remain on bedrest until that is released by your doctor. Following removal of the foley, you will be encouraged 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. If you wish to be up more often, that is okay. You can also continue the plantar
extension/flexion exercises as well.
Scrotal roll for support Purpose: To alleviate swelling of the scrotum and to promote comfort. Instructions: Roll up a bath towel and place under the scrotum at all times when lying down or resting.
Diet: You will start out with liquids and progress to regular food as you tolerate it. You IV will be sufficient enough to keep hydrated for the short time you will be here.
Special Considerations: The area of surgery in your prostate generally takes four to six weeks to heal. In order to avoid adverse affects on the surgical area that could cause bleeding, we ask that you follow these simple instructions after you are discharged.
- You may experience some temporary loss of control of urination or a dribbling of the urine. These symptoms are temporary and will resolve. Should this occur, it might be helpful to wear an incontinent pad. Sometimes it helps to contract and relax the sphincter frequently to re-establish urinary control.
- Avoid heavy lifting and strenuous exercises. Heavy lifting increases abdominal pressure, which could result in bleeding from your urinary tract.
- Avoid bending. This can also increase abdominal pressure. If you must pick something up, bend at your knees, not your waist. Stoop to pick up the item.
- 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 if necessary. 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 your doctor.
- Do not take Aspirin, Motrin, Advil, Nuprin, or nonsteriodal analgesics for at least 6 weeks after your surgery as they may cause bleeding. If you have pain, simply take plain Tylenol.
- Avoid sitting upright in a firm chair for more than one hour at a time for the first 3 weeks after surgery. You may sit in a lounge chair, recliner, or on a chair with a footstool. This is to avoid pressure on your prostate.
- If your scrotum is swollen, wear supportive briefs or an athletic support. When resting, elevate your scrotum on a towel.
- Abstain from all sexual activity for 4 weeks after surgery.
- You may see blood in the urine during the first several weeks after you are home. If so, lie down, rest, and drink fluids. The bleeding should diminish within a few hours. If not, call your doctor.
- Ask your doctor about when you may return to work.
Reasons to call your doctor
- You have increased scrotal or penile swelling
- You have difficulty passing urine
- There is fresh blood in your urine that does not stop with rest or increase in fluid intake
- You have pain that is not relieved by Tylenol
- You have chills or a fever greater than 101 degrees