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Patient Instructions - 4. After Surgery

Useful Items to Have in the Hospital and at Home

Bringing a few items with you may make your stay and experience with us more comfortable.

  • Loose-fitting clothing: such as sweatpants, elastic, or drawstring.

  • Brief-style underwear: this will help hold a pad in place and provide good support. Avoid boxer shorts.
  • Protective undergarment pads: a protective pad designed specifically for men that can be placed in your underwear to catch any urinary leakage after surgery. It is especially important to bring extra pads with you on your post-operative catheter removal visit. We recommend "Depends" guards for men rather than adult diapers.
  • Stool softener: Senokot-S or Pericolace have been good choices for patients in the past.
  • Milk of Magnesia (MOM): if you feel constipated.
  • Tylenol: over the counter medications are preferred after your operation, with prescription pain medication taken only when necessary.

Diet

  • DRINK PLENTY OF FLUIDS - ESPECIALLY WATER.
  • You may resume a regular diet. It is best to eat 5 smaller meals throughout the day because it is easier to tolerate until you feel less bloated. Bloating may continue for 2 to 3 weeks after surgery.
  • Avoid carbonated beverages and excessive dairy products during this time. Also avoid alcohol, caffeine, citrus juice, and spicy food as these can worsen bladder symptoms.

Activity

  • You should walk around throughout the day. You may walk outside, up and down stairs, as well as travel to neighbors, grocery store, etc.
  • Do not sit in one place for longer than 45 minutes at a time.
  • You may drive if you are NOT TAKING PRESCRIPTION PAIN MEDICATION and do not have a catheter in place.
  • Wait 6 weeks before resuming bicycle riding, weight lifting, and other resistance exercise such as abdominal crunches and leg squats.
  • DO NOT lift anything greater than 5 lbs for two weeks after surgery and then no greater than 20 lbs for 6 weeks after surgery.
  • You may shower 48 hours after your surgery. NO BATHS OR TUB SOAKS for 2-3 weeks after the catheter is removed.

Skin Care

  • You will have 5 or 6 port sites (small holes that we perform the operation through) that will have steri-strips (small pieces of tape) and band-aids/dry gauze covering them.
  • These will fall off themselves and do not require removal unless present 2 weeks after surgery. Then you may remove them.
  • Once the dressings come off, you may notice a small amount of discharge from the sites. This is normal and will go away after one to several days. You may apply an over-the-counter antibiotic ointment to the sites once the bandages are off.

Drain Site

  • You may go home with a drainage tube that comes out of one of the port sites on your abdomen. You will get instruction on care for it and when it will be removed.
  • YOU MAY NOTICE DISCHARGE FROM THIS SITE FOR A FEW DAYS.

Urinary Catheter

  • When you wake up from surgery you will have a urinary catheter in your bladder. This is a tube that carries urine from your bladder to the outside of your body into a collection bag. This catheter will stay in place until your anstomosis (the sutures that connect your bladder back to your urethra) heals. This process usually takes 6-10 days, but may require up to two weeks depending on the individual patient. At night the catheter should drain into a large bag, while during the day you can wear the smaller bag around your thigh under your loose fitting pant leg.
  • YOU MAY NOTICE LEAKING AROUND THE CATHETER - THIS IS NORMAL as long as urine is continuing to flow into the bag.

Medications

  • Resume all of your preoperative medications with the EXCEPTION of blood-thinning medications such as aspirin, Plavix, or Coumadin (warfarin). See you doctor as when to resume these medications.
  • Prostate medication will no longer be needed.
  • Take a stool softener (over-the-counter) for two weeks following catheter removal.
  • An antibiotic will be prescribed to start the day BEFORE the catheter comes out. Take this until finished, usually for 3-5 days.
  • For pain, you should take Ibuprofen (Motrin) every 8 hours regularly to reduce swelling and inflammation. A narcotic pain medication will be prescribed to use ONLY when you need it.

Recovery Times

  • The operation lasts two to four hours and the hospitalization usually lasts 24 hours. All patients will go home with a drainage catheter in place. Some may go home with an additional drainage tube from the abdomen (as discussed above).
  • You will be cleared for work generally 2-4 weeks after surgery depending on the type of work.
  • You may resume all normal activities of daily living 2 weeks after catheter removal EXCEPT weight lifting, abdominal crunches, leg lifts, bicycle riding, and other resistance type exercises.

Urinary Continence

  • A period of urinary incontinence occurs in most patients following catheter removal. During this interval you will have leakage that varies with activity. Therefore, we recommend avoiding strenuous activity during this period. Coughing, sneezing, laughing out loud may cause leakage. The incontinence improves slowly over time. Try not to assess your progress day to day but rather week to week. It is recommended that you perform Kegel exercises every waking hour by contracting your buttocks (as if you were holding in a bowel movement or gas) for a count of 10. Do this five times per waking hour. Also, remember to Kegel prior to position changes (standing up, coughing, sneezing) to prevent leakage.
  • Continue to wear brief style underwear as this will hold the pad in place and provide greater support to the perineum. Go to bathroom and urinate by the clock at least every 2 hours. Do not wait until you feel full as continuously emptying your bladder will help keep you dry.

Sexual Function

  • Return of sexual function (erections) is a slow and gradual process after surgery (nerves and blood vessels heal slowly). Do not attempt sexual activity for at least 2 weeks after your surgery. Because the prostate and seminal vesicles have been removed, you will no longer ejaculate when you have orgasm. The sensation, orgasm, and desire will all remain intact. Return of erections may take up to one year to occur.
  • Some pills or injections or vacuum erection devices may be offered to you after surgery to assist in the recovery of sexual function. These options should be discussed with your doctor after surgery.
  • Columbia Urology employs an aggressive penile rehabilitation program after surgery to maximize recovery of sexual function. This can discussed at length during your office visit either prior to surgery or afterwards.

Things You May Encounter After Surgery

  • Bruising and blisters around the port sites: this happens commonly and should not alarm you. This will resolve on it's own over time. You may apply antibacterial ointment to the area.
  • Abdominal distention, constipation, or bloating: this is the most common complaint after surgery and is normal. Make sure you take your stool softener as directed. If you do not have a bowel movement or pass gas or are feeling uncomfortable 2 days after surgery, you may try taking Milk of Magnesia (2-4 tbsp) as directed on the bottle.
  • Weight gain: do not be alarmed. After surgery there are many gas and fluid imbalances that even out over several weeks. This will return to normal.
  • Scrotal/penile swelling and bruising: this may appear immediately after surgery or develop in the ensuing week after surgery. Your scrotum may swell to as large as an orange or grapefruit, again, DO NOT BE ALARMED. This normally resolves in 2 weeks. Try elevated your scrotum on a small towel rolled up when you are sitting or lying down to decrease swelling. Again, wear brief (Jockey) type underwear for support, even with the catheter in place.
  • Bloody drainage around the catheter or in the urine: this is not uncommon, especially after increasing activity or following a bowel movement. Often resting for a short period of time resolves the problem. If you catheter does not drain urine for several hours after such an episode CONTACT YOUR DOCTOR.
  • Bladder spasms: this is common with or without the catheter in place. You may feel mild to severe bladder cramping, and the sudden urgent need to urinate. Call your doctor if this persists without relief.

Symptoms to report to Your Doctor

  • Fever greater than 101 F
  • Chills
  • Nausea and vomiting
  • Dark red urine that does not clear with rest and drinking fluids
  • Urine stops draining from your catheter into your bag
  • Severe abdominal cramps
  • Calf pain or swelling in one leg (some swelling after surgery is normal but usually occurs in both legs)
  • Difficulty or pain with breathing
  • Chest pain or shortness of breath

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