POST RADICAL PROSTATECTOMY SURGERY INSTRUCTION SHEET
CATHETER CARE:Your catheter is very important to allow healing of the bladder and the urethra. You may use either leg bags or external bags. Drain urine from the bag before it gets too full. The tip of the penis may get sore from the catheter rubbing. Use plain soap and water to wash this area daily or more often as needed.
DIET:
You may return to your normal diet immediately. Because of the raw surface in the bladder from the surgery, alcohol, spicy foods and drinks with caffeine may cause some irritation or sense of the need to void despite the fact that the catheter is emptying the bladder. However, if these foods don't bother you there is no reason to avoid them in moderation. More importantly is to keep your urine flowing freely, drink plenty of fluids during the day (8 - 10 glasses). The type of fluids (except alcohol) is not as important as the amount. Water is best but juices, coffee, tea, and soda are all acceptable. Food rich in protein will aid in wound healing. Fluid, fiber, and fruits in your diet will help prevent constipation. Follow dietitian recommendations if instructed.
ACTIVITY:
Your physical activity is to be restricted, especially during the first two weeks home. During this time use the following guidelines:
a. No lifting heavy objects (anything greater than 10 lbs).
b. No driving a car and limit long car rides (if you must, plan to stop, get out of the car every hour and walk a bit to reduce risk of blood clots in your legs.
c. No strenuous exercise, limit stair climbing to minimum.
BOWELS:
The rectum and the prostate are next to each other and any very large and hard stools that require straining can cause bleeding. You will be given stool softeners (usually) but these are not laxatives. A bowel movement every other day is reasonable. Use a mild laxative if needed and call if you are having problems. (Milk of Magnesia 2-3 Tablespoons, or 2 Dulcolax tablets as example)
MEDICATION:
You should resume your pre-surgery medication unless told not to. You may be discharged with iron tablets to build up your blood count and stool softeners to keep the stool soft. Pain pills (Tylox or Tylenol with Codeine) may also be given to help with wound and catheter discomfort. Tylenol (aceto-amenophen) or Advil (Ibuprofen) which have no narcotics are better if the pain is not too bad (and you can tolerate those medications!)
HYGIENE:
You may shower or bathe as soon as you get home.
PROBLEMS YOU SHOULD REPORT TO US
CALL IMMEDIATELY IF THE CATHETER FALLS OUT OR STOPS DRAINING.
Any increase in redness, or swelling in the incisional area.
If feeling chilled or feverish, take temperature and report if over 100.5 degrees.
Nausea, vomiting, or abdominal distention.
Persistent constipation, diarrhea, or blood in stool.
Pain not relieved by pain medication and rest.
Difficulty, frequency, or burning with urination.
Shortness of breath, cough, or chest congestion/pain
Drug reactions (Hives, rash, nausea, vomiting, diarrhea).
Bleeding from incision
FOLLOW-UP:
You will need a follow-up appointment to monitor your progress. Call for this appointment at the number above when you get home or from the phone in your hospital room before leaving. Usually the first appointment will be about 5-7 days after your surgery to remove the skin staples and 10-14 days to remove the catheter. Most people will not have good urinary control at first. Come to the office with a small supply of adult underwear liners (ATTENDS or DEPENDS) that can be purchased at any drug store.
You should make the following plans prior to being admitted to the hospital:
PREPARATION FOR HOME CARE
-Have someone available who will be able to assist you at home following your discharge from the hospital. This can be any person such as a spouse, adult child, friend, or neighbor who will be available to you at your home or can be reached by telephone.
Have help with:
-Heavy housework
- Grocery shopping
- Errands/ driving
-Make arrangements for someone to pick you up by 11:00 a.m. on the day of your discharge. You will probably be discharged 2 - 3 days after surgery.
FREQUENTLY ASKED QUESTIONS ABOUT SURGERY:
"Will I have pain?"
-Pain after surgery is normal and decreases over time.
" What Pain medication will I have?"
-Pain medication is available to you. It will not completely relieve your pain, but should allow you to increase your activity
-It is important that you tell your nurse when the pain medication is not working.
-Pain medication is given to you in different ways including PCA, Epidural and pills by mouth
What is Patient Controlled Analgesia (PCA)?
This is a machine that allows you to give pain medication to your self through your intravenous(IV) line by pushing a button.
Your nurse may give you IV pain medication as needed.
What is an Epidural Catheter?
Pain Medication is given through a small tube placed in your back during and after surgery by the anesthesiologist.
Oral medication (pills)
Once you begin eating you will receive pain pills. You will go home with this kind of medication.
"When will I be getting up?"
-You will sit up in bed the evening of surgery assisted by the nursing staff.
-You will get up to a chair and walk a short distance with help at least three times a day the day following your surgery.
"What tubes will I have?"
You may have all or some of the following:
Intravenous lines (I.V.), to provide fluids until you are able to eat and drink
Oxygen until your blood oxygen level is normal
Urinary catheter, placed into your bladder during surgery, to drain the urine from your bladder. This helps the physician/nurse monitor kidney function. The catheter remains in place for two to three weeks. at home).
Small drains such as Jackson Pratt tube (JP) or penrose drain may be placed during surgery to remove extra fluid from the area operated on. They are usually removed before you go home.
(Possible) Epidural catheter, for pain control
"Will I be able to eat right away?"
Your diet will start with ice chips and progress to clear liquids. After you tolerate this well, your diet will be progressed as your doctor prescribes.
You may return to your normal diet as soon as you can tolerate it, usually by the second or third day after surgery. Because of the raw surface from your surgery, alcohol, spicy foods and drinks with caffeine may cause some irritation or sense of the need to urinate despite the fact that the catheter is emptying the bladder. If these foods do not bother you, however, there is no reason to avoid them in moderation. More important is the need to keep your urine flowing freely, so drink plenty of fluids during the day (8 - 10 glasses). The type of fluids (except alcohol) is not as important as the amount. Water is best, but juices, coffee, tea, and soda are all acceptable. An American Diabetes Association (ADA) diet will be provided for patients with diabetes. If needed, our dietitian will give you information about your diet so that you can continue it at home.
"How can I speed my recovery?"
Caring for your Lungs
-It is important after your surgery and anesthesia to exercise your lungs
-Your nurse will listen to your lungs and instruct you in your deep breathing exercises. Use a pillow to splint your incision (the nursing staff will show you how to do this). Breathe as deeply as possible, 10 times every hour while you are awake. This will help to fully expand your lungs.
-You may get a breathing exerciser, called an "Incentive Spirometer" (IS). You will receive instructions on how to use it properly.
-Smoking is not allowed during your hospital stay. Information and support will be provided to smokers to help you manage without cigarettes during your hospital stay, and get started on a smoking-cessation program.
Promoting Circulation
-It is important to wiggle your toes and bend your ankles up and down frequently while in bed. This is called calf pumping. You should continue to do this at home until your activity level is normal .
-Avoid crossing your legs at the knees or ankles.
-Your doctor may order elastic anti-embolism stockings. Together with calf pumping, these will assist the return of blood flow from the legs and reduce chance of blood clots forming.
"What will my incision(s) be like?"
-Your incision(s) will probably be closed with metal staples. These will be removed at your doctor's office.
-The bandage on your incision is usually removed the morning following surgery. It is not unusual to have some oozing of clear or bloody fluid from your incision. Your nurse will keep your incision clean and dry. A light bandage may be applied to control oozing. Your nurse will show you how to apply it at home, if necessary.
-Showering over the incision can be done within 48 hours of the surgery. It does not usually need to be covered.
As an aside to your incision, the bruising may migrate down into your scrotum. Don't worry about the scrotal skin getting dark for the first week after surgery. It is normal and represents the blood in the tissues finding the lowest spot of gravity to come to a rest. Like a black eye and it all goes away.
"Will I have difficulty with bowel movements?"
The rectum and the prostate are next to each other. Any very large and hard stools that require straining to pass can cause bleeding. You will be given stool softeners but these are not laxatives. A bowel movement every other day is reasonable. Use a mild laxative if needed and call your doctor if you are having problems. Milk of magnesia, 2 - 3 tablespoons, or Dulcolax suppositories may be used.
Pain medication and decreased activity may lead to constipation. To prevent constipation:
-Keep active, take walks as instructed by your doctor.
-Drink plenty of fluids.
-Eat high fiber foods such as bran, raw fruits and vegetables.
"Will I be impotent?"
-For men who have had a radical prostatectomy for prostate cancer, the nerves that control the flow of blood into and out of the penis may be cut or removed. These nerves do not control the sensation to the penis, nor are they responsible for the orgasm that occurs with sexual intercourse. Only the firmness of the penis is affected.
-If nerve sparing was attempted during your procedure, the return of erections could take as long as six to 18 months. Partial erections may return earlier and may be a sign of subsequent complete return of function, although not a guarantee. Ask your doctor about other options for treatment.
"How do I check out of the hospital?"
-Discharge time is 11 a.m., or earlier if you are ready. Your discharge medications and instructions will be given and explained to you by your nurse.
-You will arrange a post-operative check-up with your surgeon after discharge.
"When can I drive?"
-Ask your surgeon when you can drive again. Average is about 3 weeks post surgery - if you are ready!
-Pain medications cause drowsiness and slow responses. (Driving too soon may also harm your incision).
"Can I shower or bathe?"
-Yes. You may shower within 48 hours of the surgery. Bathing should be witheld until the catheter is removed..
"When can I resume normal activity?"
-Your energy level will be low for the first few weeks after surgery and return to normal in one to two months.
-Gradually increasing your activity is essential to your recovery.
-Activity restrictions for up to six weeks after surgery are:
- lifting anything over ten pounds
- pushing / pulling heavy objects (e.g., vacuuming).
- strenuous exercise; limit stair climbing.
"How will I care for my catheter at home?"
-Your catheter is very important to allow healing of the bladder and the urethra.
-You may use either leg bags or overnight bags. Drain the bag before it gets too full.
-The tip of the penis may get sore from the catheter rubbing. Use plain soap and water to wash this area daily and more often as needed.
"When can I return to work?"
-It varies, depending on how physical your job is. If your job involves heavy lifting or long hours of physical exertion (e.g. nursing), a minimum of six weeks at home is required. If your job involves minimal exertion (e.g. physician), you may return sooner. Follow your doctor's instructions.
MALE URINARY CATHETER CARE SUGGESTIONS
You have been discharged with a urinary catheter. These tubes (usually called "Foley", named after the inventor) are used to drain the urinary bladder of urine normally stored in the bladder. Your physician can explain the reasons for the catheter's use and its expected length of stay.
Design: The catheter is a hollow tube with a hole on each end. A side arm can be seen on the catheter and this allows a small balloon to be filled in the bladder so that the catheter does not fall out.
Design: The catheter is a hollow tube with a hole on each end. A side arm can be seen on the catheter and this allows a small balloon to be filled in the bladder so that the catheter does not fall out.
Connection: The catheter needs to be connected to a drainage bag to allow continuous and unimpeded drainage. It is important not to obstruct the flow of urine, unless you are specifically asked to do so.
Drainage Bags: These are the plastic bags to which the catheter is connected. The bags vary in design but all have a connection adapter for the catheter and a drainage port or spigot at the bottom to empty the bag. Larger bags have long tubes so that they can be attached to the bed or carried. Larger bags are used around the house and overnight because of their larger capacity. Small bags or 'leg bags' have no tubing and must be attached to the leg with straps. They must be emptied every 2-4 hours depending on how much you drink. Leg bags are easy to conceal under you pants and allow you to go outside with complete privacy.
Note: both bags must be kept below the level of your bladder to drain properly.
To change Bags: Patients will switch between bags as mentioned above. To change bags properly, good hygeine must be observed. Wash your hands first. Before disconnecting the current bag, clean the connector of the drainage bag that you wish to use with alcohol (if the end looks clean) or soap and water, then alchohol, if the end is dirty or crusted. Pinching the catheter end to prevent leakage pull and twist the catheter from the connector. Then firmly attach the catheter to the new bag connector. Wash the old bag with soap and water, if available, and rinse well. Store in a clean place for later use.
Care: The major cause of irritation is at the tip of the penis. You should wash this area daily with a mild soap and water at least twice a day. In most cases, you will have less irritation of the tip of the penis if the catheter is secured to the leg with a gentle curve. Tape is the best and least expensive way of securing the catheter. Movement or tugging on the catheter will then pull on the tape, not on the penis.
Cleaning the drainage bags: Rinse bags with warm water and soap every day or two, depending on how dirty and how much odor is present. One teaspoon of vinegar may be used in the rinse water to reduce the odor.
Emptying bags: Hold any bag over the toilet or suitable container and open the spigot at the bottom of the bag. Let urine flow until empty and then close the spigot.
Problems: The more urine that flows, the less the chance for a blockage. You should be drinking 4-8 ounces of water every hour while awake.
Bleeding: Bleeding can be seen on occasion with any catheter. Small amounts of blood or clots are usually of little concern. Bleeding sufficient enough to make it impossible to see through the urine should be brought to your physician's attention.
Blockage: Urine should drain constantly into the bags. If you see no flow for more than an hour and feel the need to urinate, a blockage of the tube may be present. Debris or blood clots are the most common causes and will need to be dealt with in your physician's office, if open, or the emergency room. The catheter will either be irrigated until it is clear or the catheter changed.