HIFU

Traveling to Austin, Texas for HIFU

We will start with a phone or video consultation to review your case. This includes review of your PSA, your prostate biopsy results, family, medical, and surgical history, and your continence and potency expectations.

If you are found to be a good surgical candidate, we will reserve you a surgical date, typically performed on Tuesdays. We will have you fly or drive into Austin on a Friday before your surgery for an in-person visit, as well as coordinating MRI imaging studies if needed, which will assist us with intraoperative mapping of the prostate to optimize nerve sparing for preservation of continence, potency, and optimizing a cancer-free outcome.

If flying into Austin, we are happy to coordinate car-service from the airport to one of several nearby hotels within three miles of the Austin Urology Institute, with whom we have negotiated affordable rates.

We typically remove the foley catheter that is placed intra-operatively 5 after surgery. The first PSA check should be done with us, or in the patient’s home town, six weeks postoperatively. Using our telemedicine capabilities, we can also perform postoperative checks and follow ups remotely.

We often recommend use of daily 5mg Cialis postoperatively to help with accelerated recovery of the nerves for regaining erectile function.

About Dr. Shaw

Dr. Koushik Shaw has practiced for more than 15 years, having taken care of thousands of prostate cancer patients.

Dr. Shaw is proud to be part of the St. David’s North Austin Medical Center and the Texas Institute for Robotics Surgery, one of the largest centers for daVinci Robotic Surgery in the world and winner of the prestigious Malcolm Baldridge Award for operational excellence. We are also proud to have been Austin Monthly’s “Urologist of the Year” for several years. That, along with our 5-star rated, world-class Austin Urology Institute facilities, recognized for friendly, patient-centered care, is the reason that patients find us to be the doctor and facility of choice for treatment of their prostate cancer.

Leaving the Hospital

Most patients report minimal pain. Minor discomfort is associated with a catheter, which is placed into the bladder under anesthesia.

The catheter 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 stay in place until you heal enough that it is no longer needed.

Since you will not be cleared to drive yourself, you will need someone to drive you home.

Activity

• Please refrain from driving until the catheter is removed. After your catheter is removed, you can resume driving and most activities. Refrain from vigorous activity (running, golf, exercising, horseback riding, motorcycles, bicycling) for four weeks after surgery to give yourself time to heal.
• After six weeks you may resume full activities using common sense.
• 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 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 1 weeks after your catheter is removed. Use common sense.

Medication

• Most of our patients experience only minimal discomfort, and we recommend that you try ibuprofen or Tylenol (acetaminophen) for pain first, as they usually suffice. 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 despite Motrin or Tylenol, use a stronger prescribed pain medication.
• Upon discharge from the hospital, you will also be prescribed an oral antibiotic, which you will begin taking the day after discharge, until the prescription is finished.
• You may resume any of the usual daily medications you had been taking before surgery for other medical conditions, as soon as you are discharged. Aspirin or blood thinners can generally be restarted 2-4 weeks post-operatively.
• We recommend that you take stool softener as needed to combat constipation once you get home.
• On occasion you may develop bladder spasms while the catheter is still inserted. 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. Let us know if this is a significant issue.

Food

• To make it easier on you immediately out of the hospital, you may initially want to stick to a bland diet. Some patients prefer a mostly liquid diet. Avoid carbonated beverages.
• Once 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, broccoli.
• Try to spread out eating throughout the day with snacks and small meals and to avoid eating large meals at once for a few days after surgery.

Clothing

Immediately after surgery, your abdomen will be slightly bloated so 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 probably need to do so initially anyway to accommodate the catheter and collection bag.

Wound Care

You may start showering the day of your discharge. 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.

The sutures utilized will dissolve on their own, so there is no need to have them removed. Skin glue is often used, and should gradually flake off like a sunburn. 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

• 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 the connection between the bladder and urethra heals. Do not attempt to remove this 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) replace it. The catheter was carefully placed by your urologist with specific regard to your prostatectomy and cannot be replaced by just anyone.
• You can use a petroleum jelly or antibiotic cream such as Neosporin to lubricate the outside catheter where it enters the tip of your penis (the urethral meatus). Apply the ointment as needed.
• You will be provided with a “stat-lock” (a plastic clip or strap) which will be placed on your thigh to hold 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 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. Remove, 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 until your scheduled follow-up appointment, at which point pathology/results will be discussed and the catheter will be removed.

Regaining Urinary Control

Some men may have mild slowness of urination immediately after HIFU. You will be given a medication such as Flomax/Alfuzosin/Uroxatral/Tamsulosin to take for one month postoperatively to help with this. You will NOT experience incontinence as a result of HIFU.

Regaining Sexual Function

HIFU may result in a transient decrease in erectile function, if any change is noted at all, but it should not prevent you from having a fulfilling sex life when you recover. There are three components to sexual function in men: sexual drive, sensation, and erection/climax (orgasm). We often will start patients on a sexual rehabilitation program to ensure that erectile function is maintained. This may also involve optimizing Testosterone levels when needed.

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 48 hours after surgery, you may take an over-the-counter suppository such as Dulcolax.

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 are a big problem, contact the office, as we can prescribe a medication for you.

Bloody Drainage Around The Foley Catheter Or In 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 two hours, contact your physician.

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 when you have a bowel movement, applying hemorrhoid ointment, and increasing the fiber and water intake in your diet.

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 underwear (briefs, not boxer shorts) is advisable.