Post-operative Care after Radical Prostatectomy

Enlisted below are a few points/tips that may help patients and family have a smoother post-operative course and may also help allay the anxiety associated after discharge from hospital, after radical prostatectomy.

Radical prostatectomy is the standard of care for an organ confined-localized- prostate cancer. Whilst this surgery is performed routinely, it is still a relatively major surgery that will take some time and effort to recover from.

A)  Leaving the Hospital:

•    Patients can generally be discharged from the hospital 3 - 4 days after surgery.
•    All patients will be discharged with a urinary catheter (foleys catheter) in place.  This catheter 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 the wound-anastomosis heals enough that it is no longer needed.

B)  When you Get Home:

Activity

•    Refrain from driving for atleast 2-3 weeks after your surgery.
•    Refrain from vigorous activities (running, exercising, motorcycles, bicycling) however, for atleast 6 weeks after surgery to give yourself time to heal.
•    Avoid climbing stairs as a form of exercise.
•    Avoid bathtubs, swimming pools, hot tubs or otherwise 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 2-4 weeks.

Medications

•    Most patients experience only minimal discomfort, and usually Paracetamol is effective. 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, contact your physician immediately.
•    Upon discharge from the hospital, you may also be prescribed an oral antibiotic.  This may be given to you, till your catheter is in situ.
•    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, carefully go through your discharge summary and ensure you understand all medications that need to be taken.

Clothing

•    Immediately after surgery, your abdomen may be slightly bloated so you may have trouble fitting into your regular clothes.  For comfort, wear lose fitting clothing such as sweat pants 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 start showering the day after your discharge. 
•    The catheter collection bag, is plastic, so there are no problems in case it gets wet. Ensure there is no tug/the bag doesn't get pulled whilst showering.
•    After showering, gently pad the suture sites (do not rub them) with a towel.
•    Sutures will have to be removed as planned by your surgeon. 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 large quantity to soak dressings, or redness should be reported to your physician immediately.

Catheter Care

•    The patient will be discharged with a foley catheter in-situ, which continuously drains urine from your bladder.  It must stay in place while your anastomosis heals.  Do not attempt to remove this on your own. 
•    If it accidentally falls out, immediately inform and reach out to your uro-surgeon/physician to have it replaced.  Do not allow a non-urologist (even if they are a nurse or a doctor) to replace it, as the catheter was carefully placed by your urologist with specific regard to your prostatectomy and cannot be replaced by just anyone.
•    The patient may use two urine collection bags of different sizes, a smaller bag (called as a leg 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. 
•    Alert the surgeon if the catheter does not drain well, or if you have any other serious problems with it.

Regaining Urinary Control

•    Most men have difficulty with urinary control after catheter removal.  The patient should bring an adult urinary pad (adult diapers) along, the day it is planned to remove the foley catheter. 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.  
•    Also, typically leakage is more whilst standing, moving, and straining, and less when lying down and sleeping.
•    Remember to do your kegel-exercises (pelvic floor exercises) regularly.  The operation removed the prostate and affected the secondary urinary control mechanism.  The external sphincter muscle must now take over all responsibility for control and it will take time and effort to strengthen this mechanism.
Regaining Sexual Function
•    The operation will affect sexual function in several ways. There are three components to sexual function in men: sexual drive, sensation, 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. 
•    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.

C)  Other Likely Symptoms after Surgery

Abdominal Distention, Constipation or Bloating

•    Make sure the patient is taking stool softeners as directed.  If there still is no bowel movement 24-48 hours after surgery, contact your doctor, who may advise a rectal 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.  If they still persist despite the discharge medications, 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 2-3 hours in your catheter, 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. 

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 tight underwear (briefs, not boxer shorts) is helpful.

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