Going Out of the Hospital

Discharge: Approximately 24 hours after surgery, patients are usually eligible for discharge.

• We discharge every patient with a urinary catheter. “A Foley catheter, a type of catheter, uses a balloon to position itself in the bladder. It provides continuous drainage into a small external bladder collection bag that the individual can empty as needed. Please do not attempt to remove the catheter yourself. It must remain in place until you fully recover and no longer need it. Please read these instructions for more details.

• We discharge every patient with a urinary catheter. Someone needs to drive you home because you can’t drive yourself.

When you arrive at your house,

Activities

• Please do not drive for a week after surgery. You can resume driving and most other activities after a week. However, avoid strenuous activities (such as horseback riding, golfing, exercising, riding a motorcycle, or biking) for six weeks after surgery to allow your body to heal. As long as you use common sense, you can resume full activity after six weeks.
• Avoid using stairs as a form of exercise.
• Do not sit still for more than 45 minutes.
• Keep drains away from bathtubs, swimming pools, hot tubs, and other types of flood-prone areas as long as they are in place. After returning home, it’s OK to take a shower.
• Your career and speed of recovery will determine when you can return to work. You can return to most jobs within one to three weeks. Use common sense.

Medications

• We recommend that you first try ibuprofen or Tylenol (acetaminophen) for pain relief, as they usually work for most patients with only mild discomfort. Avoid strong prescription pain relievers, as they often cause severe constipation. If you still experience severe pain after taking Motrin or Tylenol, see your doctor for a prescription for a stronger pain reliever, such as hydrocodone or codeine.
• Your healthcare provider may also prescribe Cipro, an oral antibiotic when you are discharged from the hospital. You will not receive these treatments until the morning of the day the catheter is scheduled to be removed. Take one pill that morning. Thereafter, take one pill every twelve hours. Take two pills a day for three days, for a total of six pills. For example, if the catheter is scheduled to be removed on Thursday, take one antibiotic pill every 12 hours, starting Thursday morning and continuing until Saturday night.
• After you leave the hospital, feel free to resume taking any regular daily medications you were taking before surgery for other medical conditions.
• You will receive stool softeners when you leave the hospital to treat constipation. We recommend that you drink prune juice or magnesia milk in addition to stool softeners until you have your first bowel movement after surgery. You can continue to use stool softeners as needed to help relieve constipation.
• Your healthcare provider may also prescribe a small amount of ditropin (oxybutynin) if you experience bladder spasms while the catheter is still in place. A strong urge to urinate, sudden lower abdominal pain, or sudden leakage of urine from the catheter area are all common symptoms of bladder spasms.

Meals

• You may initially want to stick to a lighter diet to make it easier after leaving the hospital. Some patients prefer a fluid-rich diet. Stay away from carbonated drinks.
• Start eating soft foods after a bowel movement, including soup, scrambled eggs, toast, oatmeal, and other foods. Once you feel comfortable, gradually return to your normal diet.
• Avoid gas-producing foods such as broccoli, beans, and flour.
• If possible, try to space your meals so that you eat smaller meals throughout the day rather than several large meals immediately after surgery.

Clothing

After surgery, you may find it difficult to wear normal clothes because your abdomen will be slightly swollen. Wear comfortable, loose-fitting clothing, such as sweatpants or other pants, with an elastic waistband instead of buttons. You will most likely need to do this first to make room for the catheter and collection bag.

Wound Management

• On the day of discharge, you can now start bathing. You can remove the catheter collection bag while showering. Carefully remove the colored tubing from the bag’s clear plastic tube and the urine can flow into the shower. After showering, gently pad the suture area with a towel; do not rub or cause any other type of irritation.
• Applying an ointment (such as Neosporin) to the incision site is not recommended.
• Use sutures; they will dissolve on their own and do not need to be removed. A small amount of redness and swelling around the edges of the incision site and a small amount of bloody or clear wound leakage are acceptable. Notify your doctor if the incision site becomes redder than half an inch or if there is enough drainage to soak the dressing.

Care of Catheters

• As mentioned before, when you leave the hospital, your healthcare provider will insert a Foley catheter to continue draining urine from your bladder. While your anastomosis heals, it needs to stay in place. Never try to remove it yourself. If it falls off unexpectedly, you must contact your urologist immediately to have it replaced. Never ask a non-urologist to do it, even if they are a doctor or nurse. Your urologist carefully inserted the catheter during the prostatectomy and no one can replace it.
• Your healthcare provider will apply an antibacterial cream to your skin to lubricate the external catheter that enters the opening of your urethra (i.e., the tip of your penis). This ointment can relieve pain and reduce inflammation at the urethral opening. Use ointment as needed.
• To hold the catheter in place, your healthcare provider will give you a “stat-lock,” a plastic clip that attaches to your thigh. Your healthcare provider will remove the catheter one week after surgery.
• Your healthcare provider will provide you with two different sizes of urine collection bags: a larger bag for nighttime use and a smaller bag to wear under your pants during the day. Depending on how much liquid you drink, you can empty the smaller bag every three to four hours. You don’t need to wake up to empty the larger bag, as it will last you the entire night. You can remove, empty, and replace both bags as needed.
• If you experience any major problems with your catheter, such as poor drainage, notify your surgeon immediately. The purpose of the catheter is to aid your healing process. Typically, the urologist will remove it after a week. If your healing is not complete, you may need to leave it in place for two weeks instead of one. For this reason, a follow-up appointment should have been scheduled. Remember, this morning, on this particular day, you will start taking an oral antibiotic (probably Cipro).

Taking Back Control of Your Urine

• After the removal of a urinary catheter, most men face challenges in regaining urinary control. Keep adult pads (such as Depend Guards) with you on the day of catheter removal. Be prepared to wear these pads for a while, as it can take up to two months after surgery to regain normal bladder control. Remember, everyone is unique. Some people regain control within five days, while others take six days. Don’t be discouraged! Also keep in mind that urinary leakage usually occurs less when you sleep and lie down and more when you stand, move, and strain.
• Don’t forget to do Kegel exercises regularly. Your secondary urinary control mechanism is affected by the removal of the prostate during surgery. Complete control must now come from the external sphincter. Strengthening this mechanism requires time and effort.
• Some men may still experience mild incontinence from exertion for several years after surgery. In these cases, wearing a small pad can help you avoid problems. Urinary control rarely remains inadequate, even after one year. If this is the case, you still have options. Certain surgeries, such as the implantation of an artificial urinary sphincter, can help restore control, although they are rarely necessary.

Gaining Back Sexual Ability

1. There will be multiple ways in which the operation will impact sexual function, but once you heal, it shouldn’t keep you from enjoying a satisfying sexual life.  In men, erection, climax (orgasm), and sexual drive are the three parts of sexual function.  Even though they typically go hand in hand, these are distinct functions.  You don’t have to lose the others if you lose one.
2. A complex series of events stimulates the cavernous nerves and engorgement of the penis, resulting in an erection. The prostate and cavernosal nerves are millimeters apart and very close to where the cancer occurs. Additionally, prostate cancer often spreads along these nerves. For these reasons, nerve salvage may not occur, although it is technically feasible.
3. One or all of the nerves may be removed during surgery because the main goal is to remove the cancer. It is possible to regain an erection, although it may take some time. Nerves can heal, albeit slowly. The average recovery period for an erection sufficient for sexual activity is six to eighteen months, although some men may take longer. While you’re waiting for an erection, you can use a variety of methods to achieve an erection. Ask about these at our office. If these methods fail, implants may be implanted to restore sexual function.
4. Although ejaculation (the fluid released during orgasm) will no longer occur, Climatex will not be affected by the surgery. Although no fluid will be released and the ejaculate will be dry, you will still experience the same pleasurable sensations. This is caused by the removal and cutting of the seminal vesicles (which store ejaculate fluid) and the vas deferens (the tubes that carry sperm to the prostate) during surgery. Therefore, you will no longer be able to be a father and will not be able to have children.

Kindly get in touch with your physician if you have any inquiries regarding these instructions. Similar written instructions ought to have been given to you when you were released from the hospital.  You should carefully and closely follow these instructions, as they are provided for your benefit.

ITEMS POSSIBLE TO FACE AFTER SURGERY

Magnesia for Constipation

In addition to drinking prune juice or milk of magnesia for constipation, bloating, or bloating, make sure you take stool softeners as prescribed. If the gas cannot pass 24 hours after surgery, over-the-counter suppositories may be used.

Bladder spasms

These episodes are often accompanied by a strong urge to urinate, sudden lower abdominal pain, or sudden leakage of urine from the area around the catheter. If you have any of these side effects, take the ditopan (oxybutynin) you were prescribed when you were discharged from the hospital. If symptoms persist after taking this medication, contact your doctor.

Blood clots around the Foley catheter or in the urine

This is a common side effect after surgery, especially during stressful situations such as physical activity or bowel movements. If you stop doing everything and take a break, things will get better. If not, contact your doctor if you notice clots in your urine or if you don’t produce any urine within two hours.

There’s nothing to worry about

Bruising around the port is normal. They will disappear as soon as you recover.

Swelling of the lower legs or ankles

This is normal and should not raise any red flags or cause serious concern. After a week or two, the swelling should subside. It can be beneficial to raise your legs while sitting.

Pain between the rectum and scrotum (called perineal discomfort)

May persist for a few weeks after surgery and then go away on its own. If you continue to feel severe discomfort despite taking painkillers, talk to your doctor. Other options include applying hemorrhoid cream, increasing water and fiber intake in your diet, and placing your feet on a small stool after having a bowel movement.

Scrotal and penile bruising

These are normal and should not raise any red flags. You may experience swelling of your scrotum or penis from five days to shortly after surgery. It should go away on its own after a week or two. One possible way to reduce swelling is to try sitting or lying down with your scrotum resting on a small, rolled towel. Also, it’s best to wear supportive underwear—briefs, not boxer briefs.