If you have had a conventional or a robotic prostatectomy, it is essential for your own safety and for the success of your surgery that you carefully read and follow these instructions.

Post-Operative Instructions.

While robotic prostatectomy is performed routinely, it is still a relatively major surgery, from which you will take some time and effort to recover 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. Be positive, you can get through this!

Leaving the Hospital

Patients will generally be discharged from the hospital about 24 to 48 hours after surgery. Each patient will leave 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. Do not try to remove this catheter on your own. It must remain in place until you have healed enough that it is no longer needed. Read further down in these instructions for more information.

Since you will not be allowed 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 other activities. Refrain from vigorous activities (running, golf, exercising, horseback riding, motorcycles, bicycling) for six weeks after surgery to give yourself time to heal. After six weeks you may resume full activities You should attempt to walk and climb stairs as much as you can tolerate to help rehabilitate yourself.

• Avoid sitting still in one position for too long (more than 45 minutes).

• Avoid bathtubs, swimming pools, hot tubs or otherwise submerging yourself in water for four weeks. Showering is fine 48 hours after surgery.

• When you may return to work depends on your occupation and how fast you recover. Most jobs you may return to in 2-3 weeks. Use common sense.

Most of our patients experience only minimal discomfort, and we recommend that they first try ibuprofen or Tylenol (acetaminophen) for pain, as they usually suffice. Stronger, prescription painkillers 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 typically will be hydrocodone or codeine.

Upon discharge from the hospital, you will also be prescribed an oral antibiotic, which most likely will 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, that 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, which you may have been taking before surgery for other medical conditions as soon as you are discharged, with the exception of Coumadin, which you may Resume once the foley catheter has been removed, but only with your doctor?s approval.

At the time of discharge, you will be prescribed a stool softener to prevent 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 avoid constipation.

You may also be provided with a small amount of Ditropan (oxybutinin) to be used in the event that you should develop bladder spasms while the catheter is still place. 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. Do not take Ditropan, within 24 hours of catheter removal, as it may prevent you from voiding properly.

Food

On leaving the hospital, you should stick to a mostly liquid diet of broth, juices, Jello etc. until you get your first bowel movement. Avoid carbonated beverages. After 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, and broccoli.

• 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.

Immediately after surgery, your abdomen will be slightly bloated so that you may have trouble fitting into your regular clothes. For comfort, wear loose fitting clothing such as sweatpants or other pants with elastic (not button) waistbands. You will need to do so initially anyway, to accommodate the catheter and collection bag.

Wound Care

Two days after surgery, remove the clear dressing and gauze covering your wound sites. You may now start showering. We encourage you to shower 1-2 times a day at home. For example, if your surgery was on Tuesday, you may remove the dressing and resume showering on Thursday.

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 antibiotic or other 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 continuously drains urine from your bladder. It must stay in place while your wounds heal. Do not attempt to remove the catheter 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 lubricate 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 be provided with a strap around your thigh to hold the catheter tubing in place. Adjust this strap as necessary to prevent tension from being applied to the catheter.
• 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 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. Disconnect, empty, and exchange 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 will be removed by your urologist at the end of this time.
• Sometimes it may have to stay in place longer if you are not sufficiently healed, perhaps two weeks instead of one. You should have already scheduled a follow-up appointment for this purpose. Remember that you will start taking your oral antibiotic (probably Cipro) on the morning of this day.
• Do not do any Kegel exercises while this catheter is in place. However, once the catheter has been removed, resume doing male kegel exercises.

Hopefully you were doing kegel exercises regularly before surgery, and should already be familiar with them. If not, now is the time to learn.

You should not attempt kegel exercises while the Foley catheter is in place, but as soon as it is removed you should either resume or start for the first time (usually about one-week after surgery.) By strengthening your pelvic floor muscles you can speed your recovery to continence and potency. Be pro-active.

Long-Term Recovery

Regaining Urinary Control
Most men have difficulty with urinary control after removal of the catheter. You should bring an adult urinary pad (such as Depend Guards) with you on 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 may regain control in a week, some may 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.

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: (1) sexual drive, (2) sensation,(3) erection and climax (orgasm). Although these normally occur together, they actually are separate 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 damaged. 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 erectile function to return, a number of approaches are available for achieving erections. Ask about these in our office If these methods are unsuccessful, a prosthesis 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 be able to father children.

Read further about potency in our guide to regaining potency and to learn about medical therapy for erectile dysfunction.

If you have any questions about these instructions please contact your physician. You should have received 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: This is not uncommon immediately after surgery, when under stress, such as during physical activity or bowel movement. This should decrease or stop 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 wound 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,
• after you have a bowel movement, apply hemorrhoid ointment, and
• increase the fiber and water intake in your diet.

ADDITIONAL INFORMATION Here is a list of internet sites that might provide more information and further help with your recovery:

Seek Wellness.com-Prostate (note: the above sites are not maintained by nor affiliated with our practice of Urology. We are not responsible for the accuracy of their content.)

Midland Urology Home Page

Permian Basin Urology Center, L.P.
Daniel Khouri, M.D.

1200 West Wall Street
Midland, TX 79701
Tel: 432.682.0574
Fax: 432.682.8939
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