Post-Operative Instructions | Thomas E. Ahlering, M.D.
If you have had a robotic prostatectomy, it
is essential for your own safety and for the success of your surgery
that you carefully read and obey these instructions.
Post-Operative Instructions:
While robotic prostatectomy is performed routinely, it is still a relatively
major surgery that will take some time and effort to recover from.
Life will be harder for at least a few weeks, if not months after surgery,
however it is certainly preferable to the life-threatening hardships
of letting the cancer progress unchecked. So stay positive, you can
get through this.
LEAVING THE HOSPITAL
- Patients can generally be discharged from the hospital about 24
hours after surgery.
- All patients will be discharged from the hospital with a urinary
catheter in place. This catheter is known as a Foley catheter
and is held in place by a balloon inside the bladder. It allows
continuous drainage of the bladder into a small external collection
bag which is emptied as needed. Absolutely, do not try to
remove this catheter on your own. It must stay in place
until you heal enough that it is no longer needed. Read further
down in these instructions for more information.
- Since you will not be cleared to drive yourself, you will need someone
to drive you home.
WHEN YOU GET HOME
Activity
- Please refrain from driving for 1 week after your surgery.
After one week, you can resume driving and most activities.
Refrain from vigorous activity
(running, golf, exercising, horseback riding,
motorcycles, bicycling) however, for six weeks after surgery to give yourself time to heal. After six
weeks you may resume full activities using common sense.
- Avoid climbing stairs as a form of exercise.
- Avoid sitting still in one position for too long (more than 45
minutes)
- Avoid bathtubs, swimming pools, hot tubs or othewise submerging
yourself in water for as long as the catheter is in place. Showering is fine as soon as you go home.
- When you may return to work depends on your occupation and how
fast you recover. Most jobs you may return to in 1-3 weeks.
Use common sense.
Medication
- Most of our patients experience only minimal discomfort, and we
recommend that you try ibuprofen or Tylenol (acetaminophen) for pain
first, as they usuallysuffice. Stronger, prescription pain killers tend to be extremely
constipating and so it is better to avoid them if possible.
However, if you still have significant pain despite Motrin or Tylenol,
contact your physician for a prescription for stronger pain medication,
which will typically be hydrocodone or codeine.
- Upon discharge from the hospital, you will also be prescribed an
oral antibiotic, which will most likely be Cipro. You
will not take these until the morning you are scheduled to have your
catheter removed. On that morning, take one pill. Then
take one pill each 12 hours after that. This is twice a day for 3
days, for a total of six pills. For example, if you are going
to have your catheter removed on Thursday, take your first antibiotic
pill on Thursday morning, then every 12 hours after that, ending on
Saturday night.
- You may resume any of the usual daily medications you may have been
taking before surgery for other medical conditions, as soon as you
are discharged.
- At the time of discharge, you will be given a stool softener to
be used for constipation. We recommend that in addition to the
stool softener you also drink prune juice or milk of magnesia until
you have your first bowel movement after surgery. You many continue
taking the stool softener as needed to combat constipation.
- You may also be provided with a small amount of Ditropan (oxybutinin)
to be used in the event you develop bladder spasms while the catheter
is still inserted. Bladder spasms are typically associated with
a sudden onset of lower-abdominal discomfort, a strong urge to urinate,
or with sudden leakage of urine from around the catheter.
Food
- To make it easier on you immediately out of the hospital, you may
initially want to stick to a bland diet. Some patients prefer a mostly liquid diet. Avoid carbonated beverages.
- Once you have had a bowel movement, you should move to a soft food
diet of things like soups, scrambled eggs, toast, oatmeal etc... and
then work your way back to your normal diet as you feel comfortable.
- Avoid gas-producing foods such as flour, beans, brocolli.
- Try to spread out eating throughout the day with snacks and small
meals, to avoid eating large meals at once for a few days after surgery.
Clothing
- Immediately after surgery, your abdomen will be slightly bloated
so you may have trouble fitting into your regular clothes. For
comfort, wear lose fitting clothing such as sweatpants or other pants
with elastic (not button) waist bands. You will probably need
to do so initially anyway to accommodate the catheter and collection
bag.
Wound
Care
- You may now start showering the day of your discharge. The catheter collection bag
may be removed during showering. Gently pull the colored catheter
straight off of the clear plastic tubing from the bag and allow urine
to run into the shower. After showering, gently pad the suture
sites (do not rub
or otherwise irritate them) with a towel.
- Application of ointments (such as Neosporin)
to incision sites is not
recommended.
- Sutures were utilized which will dissolve on their own, there is
no need to have them removed. A small amount of redness at the
edges of the incision sites, as well as a small amount of clear or
bloody leakage from the wound, is acceptable. Drainage of sufficient
quantity to soak dressings, or redness greater than 1/2 inch from
the incision should be reported to the physician.
Catheter
Care
- As mentioned above, you will be discharged from the hospital with
a Foley catheter in place which continuosly drains urine from your
bladder. It must stay in place while your anastamosis heals.
Do not attempt to remove this on your own. If it should accidentally
fall out, you MUST IMMEDIATELY
notify your urologist to have
it replaced. Do NOT allow a non-urologist (even if they are a nurse or a doctor) to replace
it. The catheter was carefully placed by your urologist with
specific regard to your prostatectomy and cannot be replaced by just
anyone.
- You will be given antibiotic ointment to lubcricate the outside
catheter where it enters the tip of your penis (the uretheral meatus.)
This ointment will reduce inflammation to the uretheral meatus and
reduce discomfort. Apply the ointment as needed.
- You will provided with a "stat-lock," a plastic clip which will be glued to your thigh to hold the catheter. This will be removed when your catheter is removed 1 week after surgery.
- You will be provided with two urine collection bags of different
sizes, a smaller bag to be worn under your pants during the day, and
a larger bag to be used at night. The smaller bag usually lasts
about 3-4 hours before needing to be emptied, but of course this varies
with how much liquid you consume. The larger bag should last
you all night, so you do not need to wake up to empty it. Remove,
empty, and exhange these two bags as needed.
- Alert the surgeon if the catheter does not drain well, or if you
have any other serious problems with it.
- This catheter will stay in place for one week while you heal, and
can generally be removed by your urologist at the end of this time.
Sometimes it may have to stay in place longer if you are not sufficently
healed, perhaps two weeks instead of one. You should have already
scheduled a follow-up appointment for this purpose. Remember
from above, that you will start taking your oral antibiotic (probably
Cipro) on the morning of this day.
Regaining
Urinary Control
- Most men have difficulty with urinary control after catheter removal.
You should bring an adult urinary
pad (such as Depend Guards) with you the day your catheter is removed.
You should be prepared to wear these pads for a while because normal
urinary control may not be regained for 2 months from the time of
your surgery. Remember, everyone is different. Some men
regain control in a week, some take six months. Don't be discouraged!
Also, remember you will typically leak more standing, moving, and
straining, and less when lying down and sleeping.
- Remember to do your kegel
exercises regularly. The operation removed your prostate
and affected your secondary urinary control mechanisms. Your
external sphincter muscle must now take over all responsibility for
control. It will take time and effort to strengthen this mechanism.
- Some men may continue to have mild incontinence with straining even
several years after surgery. You can avoid a problem in these
situations by wearing a small pad. Rarely, urinary control will
be unsatisfactory even after a year. If so, something can still
be done. Though rarely needed, there are techniques for restoring
control such as placement of an artificial urinary sphincter.
Regaining
Sexual Function
- The operation will affect sexual function in several ways, but it
should not prevent you from having a fulfilling sex life when you recover. There are three
components to sexual function in men: sexual drive, sensation, erection
and climax (orgasm). Although these normally occur together,
they actually are seperate functions. Losing one does not necessarily
mean you will lose the others.
- Erections occur due to a complex sequence of events involving stimulation
of the cavernosal nerves and engorgement of the penis with blood.
The cavernosal nerves run alongside the prostate, only millimeters
away from where cancer often occurs. Prostate cancer also tends
to spread along these nerves. For these reasons, although it
may have been technically possible to spare the nerves, it may not
have been done.
- Since the primary goal of the surgery was to rid you of cancer,
one or both of these nerves may have been resected. There is
a chance of recovering erections, but recovery may be slow.
Nerves can heal, but very slowly. The average time to recovery
for erections adequate for sexual intercourse is 6-18 months, but
in some men can be even longer. While you are waiting for erections
to return, a number of approaches are available for achieving erections.
Ask about these in our office. If these methods are unsucessful,
a prothesis can be placed to restore sexual function.
- Climax will not be affected by the surgery, but ejaculation (the
release of fluid during orgasm) will no longer occur. You will
still have the same sensations of pleasure, but no fluid will be discharged
and you will have a dry ejaculation. This is because the seminal
vesicles, which store fluid for ejaculation, and the vas deferens,
the tubes that carry sperm to the prostate, are removed and cut during
the operation. This means that you will be infertile and no
longer able to father children.
- Read further about potency in our guide to regaining potency to learn about medical therapy for erectile dysfunction.
If you have any questions about
these instructions please contact your physician. You should
have recieved similar instructions on paper upon discharge from the hospital.
These instructions are given in your best interest and should be followed
as carefully and closely as possible.
THINGS YOU MIGHT ENCOUNTER AFTER SURGERY
- Abdominal Distention, Constipation or Bloating:
Make sure you are taking your stool softener as directed, and drinking
prune juice or milk of magnesia. If you still haven't had a
bowel movement 24 hours after surgery, you may take an over the counter
suppository.
- Bladder Spasms: Bladder spasms are typically associated
with a sudden onset of lower-abdominal discomfort, a strong urge to
urinate, or with sudden leakage of urine from around the catheter.
Take the Ditropan (oxybutinin) given to you at the time of discharge
if you encounter these problems. If they still persist despite
the medication, contact your physician.
- Bloody drainage around the Foley catheter or in the urine: Under stress, such as during physical activity or bowel movement,
this is not uncommon immediately after surgery. This should improve
if you cease activity and rest for a short while. If it does
not, or if you see clots in your urine, or have no urine output for
two hours, contact your physician.
- Bruising around the port sites: This is not uncommon,
and should not worry you. They will go away as you heal.
- Lower legs/ankle swelling: This is not abnormal
and is not cause for serious concern. The swelling should go away
in a week or two. Elevating your legs while sitting will help.
- Perineal Discomfort (pain between your rectum and
scrotum): This may last for several weeks after surgery, but it should
resolve on its own. If you are suffering significant pain despite
pain medication, contact your physician. You might also try
elevating your feet on a small stool when you have a bowel movement,
applying hemorrhoid ointment, and increasing the fiber and water intake
in your diet.
- Scrotal/Penile Swelling and Bruising: This is
not abnormal and is not cause for serious concern. You might notice
scrotal/penile swelling anywhere from immediately after surgery
to 5 days later. It should go away on its own in a week or two.
You might try elevating your scrotum on a small rolled up towel
when you are sitting or lying down to reduce swelling. Also, wearing
supportive underwear (briefs, not boxer shorts) is advisable.
Links
to other sites that might further help with your recovery:
(note: the above sites are not maintained
by nor affiliated with UC Irvine Urology. We are not responsible for the
accuracy of their content.)