Prostatectomy

Leaving the Hospital

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

All patients will be discharged from 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 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 for 1-2 weeks after your surgery. After your catheter is removed, you can resume driving and most activities. Refrain from vigorous activity (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 using common sense.
• Avoid climbing stairs as a form of exercise.
• 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 2-4 weeks. 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 now 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 were utilized which will dissolve on their own, 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 removed.

Regaining Urinary Control

• Most men have difficulty with urinary control after catheter removal. You should bring an adult urinary pad (such as Depend Guards) with you the day your catheter is removed. You should be prepared to wear these pads for a while because normal urinary control will take time to gradually return. Remember, everyone is different. Some men regain control in a week, some 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.
• Some men may continue to have mild incontinence with straining even several years after surgery. You can avoid a problem in these situations by wearing a small pad. Rarely, urinary control will be unsatisfactory even after a year. If so, something can still be done.

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: 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. 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 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. While you are waiting for erections 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 able to father children.

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 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 two hours, 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. 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.