Instructions for care following

PATIENT INSTRUCTIONS AFTER
LAPAROSCOPIC RADICAL RETROPUBIC PROSTATECTOMY
McGill University – Montreal General Hospital
1650 Cedar Avenue
Montreal, Quebec
For urgent and emergent situations 24 hours a day, page the Urology Resident on call at 514-934-1934 (then dial 0 for the operator) They will contact the faculty physician for you. Office telephone numbers for contacting your McGill Urologist:
514-843-1628
Aprikian
514-934-8295
514-934-8535
You have just undergone a major operation. The healing process takes time and we would like for you to observe the following instructions during your initial recovery at home. We have written this pamphlet for you to use as a reference during this recovery. Pelvic Drains
During surgery, the physician will place a pelvic drain around the surgical area that will exit
through the abdominal wall. These are used for drainage of excess fluid from the surgical area
itself.
Most patients will have these removed along with there urinary catheter on post-operative day 3
or 4, depending on your surgeon. Occasionally this pelvic drain may be left in for a week or two,
in which case you would be instructed how to care for it at home.
Pain Control
The night after your operation (and occasionally through the following day or two) a Patient
Controlled Analgesic device referred to, as a PCA be used to help control any post-surgical pain.
This is a device that administers pain medication through your IV. You will have access to a
button that you can push, which will then automatically give you a prescribed dosage of the
medication at preset intervals. This will be discontinued the day after your surgery and you will
start on oral medication for pain control.
Preventing Blood Clots in the Legs
During the operation and through the night after surgery, you will wear compressive leg (TED)
stockings which promote blood circulation in the veins. They help prevent blood clots (deep
venous thrombosis or DVT) from forming. We advise wearing them, above the level of the knee
until your discharge from hospital.
Preventing
Respiratory
Complications
While awake and in bed for the first few days after surgery, you are required to use the incentive spirometer 10 times per hour. These respiratory exercises help in the prevention of pneumonia. Urinary Catheter Care
The nurse will help with the initial set up (including adjusting the tubing length) of your large Foley bag. If you are not circumcised, you should ensure that the foreskin be retracted over the tip of the penis at all times. Scrotal Swelling
If your scrotum is swollen, wear supportive briefs or an athletic support. When resting, elevate
your scrotum on a towel. Scrotal swelling is common for up to a week but is harmless and
painless.
Bowel Function
It is common for your appetite and bowel movements to recover gradually in the first week after
surgery. Usually bowel movements may not resume until 3 to 5 days after surgery. Avoid
straining to have a bowel movement. You will be given Colace, a medication to soften your stool.
If constipation becomes problematic you can increase your roughage intake in your diet, drink
prune juice or take an over the counter laxative. It is recommended that you keep well hydrated
by drinking 4-8 glasses of water a day to enhance the effectiveness of Colace.
Bladder Spasms
You may also experience some cramping feelings, called bladder spasms, which are harmless
and resolve after the removal of the Foley. These can be felt as urgency to urinate or brief pelvic
or rectal pressure. Urine or blood may drain from around the catheter during a spasm and are
common during a bowel movement. Should bladder spasms become a problem, advise your
doctor. There are medications to reduce the frequency of spasms.
Activity Restrictions
It is expected that you will resume regular activity around your home when you are discharged
from the hospital.
Showering/Bathing
You may begin showering or bathing 3 days after surgery. There will be white tape strips called
“Steri-strips” on the incision which will fall off during a shower. Do not pull off.
If you have surgical staples they will be removed 1 week after surgery.
Diet
Return to normal eating habits; although small meals are better tolerated at first. Allow your
appetite to determine how much you eat; do not force food if you feel full or if your stomach is
unsettled. In the first week after surgery, it may be best to avoid spicy or fatty foods.
Walking
Walking soon after surgery encourages early return of bowel function, promotes effective
breathing, mobilizes secretions, improves circulation, prevents stiffness of joints, and relieves
pressure. The morning after surgery, you will be instructed to be out of bed with assistance.
SPECIAL CONSIDERATIONS AFTER FOLEY CATHETER REMOVAL Urinary Recovery
The catheter will be removed in the cystoscopy unit (7th floor) after no leakage is seen on your
Xray. The Xray is called a cystogram and involves the placement of contrast fluid through the
catheter to fill the bladder.
You will be given a prescription for antibiotics to start the morning before the catheter is to be removed. You will continue with the antibiotic for 3 days. The process of removing the Foley catheter is simple. There is a small balloon filled with water that keeps the Foley in place. The water is removed with a syringe and the Foley is taken out. When the Foley is taken out, you may experience minimal discomfort for a few seconds. Problems with urinary control are common once the catheter is removed. It is normal to experience leaking at first. Do not become discouraged! Until urine control returns completely, it may be helpful to wear a protective pad. These pads can be purchased at your local pharmacy. Please bring 2 or 3 such pads with you when you return for Foley removal. Sexual Activity
Sexual recovery is typically more gradual than urinary recovery. The return of sexual function
varies depending on your age, previous function, and the extent of the tumor. For those men who
have return of erections, it is a gradual process. Most men do not have erections sufficient for
vaginal penetration immediately after catheter removal. Erectile recovery can take up to 6-18
months. During this period, medications (Viagra, Cialis, Levitra) can be prescrived to improve
your erections. In addition, you should be able to have an orgasm even if you do not have an
erection. With orgasm, there will not be an emission of semen because the prostate and seminal
vesicles have been removed.
Cancer Follow-up
After the first return clinic visit, your doctor will determine how often it will be necessary for you to
return. For your follow-up, you should have a PSA test done.
REASONS TO CALL YOUR UROLOGIST WITHOUT DELAY • Any signs of pulmonary embolus (blood clot from pelvis which has gotten into the blood Difficulty breathing or shortness of breath THE ABOVE SYMPTOMS REQUIRE IMMEDIATE ATTENTION AND IF YOU ARE UNABLE TO REACH YOUR UROLOGIST YOU SHOULD PRESENT IMMEDIATELY TO THE EMERGENCY ROOM • Signs of a blood clot in the legs or pelvis (Deep Venous Thrombosis) Pain in the back of the thigh, calf, or groin. THIS CONDITION REQUIRES THE IMMEDIATE REPLACEMENT OF A FOLEY
CATHETER. A UROLOGIST SHOULD BE THE ONLY PERSON TO ATTEMPT
THIS TECHNIQUE.
Fever with temperature by mouth greater than 101 °F / 38.5 °C Nausea, vomiting or severe abdominal pain Pain not relieved by prescribed medications Prepared by Dr. Kevin C. Zorn
Chief Urology Resident
CANMEDs project - January 2005

Source: http://urology.mcgill.ca/patients/pdf/post-operative_care.pdf