You and your doctor have decided to proceed with removal of your prostate (along with the regional lymph nodes) for the treatment of your prostate cancer. The hospital stay usually lasts two to four days, but everyone is different and every operation is different. You will not be able to go home until you are able to eat and the intravenous feedings have been discontinued.
You have developed a cancer in the prostate gland which we feel is localized to just the prostate. (That is, no spread from the prostate has been found.) This means that removal of the prostate has a good chance of curing the cancer by removing all of the cancer.
Preparation for the operation
Any surgical procedure of this magnitude is done in a hospital. Unless there are some extraordinary circumstances, you will probably be admitted on the day of surgery. You may need blood tests, an electrocardiogram (EKG), and other tests done prior to your surgical date or on the morning of admission. It is very important that you refrain from eating or drinking anything for at least eight hours prior to your scheduled operation time. In most circumstances this means nothing should pass your lips after midnight before your surgical procedure. If you have been on a special bowel preparation or diet, adhere to the diet until midnight before the surgery. You may take your regular medications until midnight. Check with us about any other medications. You should NOT take any aspirin or aspirin products for seven to 10 days before the surgery.
After coming through the admitting area and, perhaps, the blood drawing area, you will arrive at the nursing station on one of the floors and be given a bed and hospital gown. You may or may not be given an enema and an intravenous line to replenish your body's fluids.. You will be brought down to a surgical holding area where an anesthesiologist will talk to you about the anesthesia, usually general anesthesia. General anesthesia means you are completely asleep. This is usually induced by a fast-acting barbiturate, essentially an intravenous sleeping pill. Once asleep, you will be kept asleep by breathing an anesthetic agent, of which there are many kinds. Spinal anesthesia is not usually used with radical prostate surgery.
The operation and recovery room
You will be transported into the operating room when the room, the surgeons and anesthetists are ready. Before you are asleep, special inflatable stockings to prevent blood clots in the legs may be put on you. . Monitor electrodes for the EKG and a blood pressure cuff will also be put on. The anesthetic is then started and the surgery is completed within two to three hours. After the surgery is completed the anesthetic will be discontinued and you will be taken to a recovery room.
In the recovery room, nurses will watch you very carefully until your anesthetic effects have worn off. The nurses will apply an oxygen tube or mask to your face and start checking your blood pressure and pulse frequently. While asleep, the anesthetist may have inserted a special intravenous line into your neck. This line helps measure the blood pressure directly from your heart and usually will stay in place for two days or so. Your lower abdomen or belly will hurt from the incision. Pain medication will be given to you as needed. You will note that the nurses are constantly watching the rubber tube (catheter) that leads from your penis to a drainage bag on the side of the bed. This tube has been placed through your penis (or urethra, to be more exact) into your bladder, acting as a splint for the new connection between bladder and urethra now that the prostate is absent. It is held in position by a small balloon at the end of the tube, which is inflated after it is placed. The nurses will be carefully watching the tube drainage. It will contain urine from the bladder and any bloody drainage from the operative site. The catheter is very important for your postoperative recovery. Occasionally, clots will form and the tube will stop draining. The nurses will then use a special syringe with water to hand-irrigate the catheter to free it of clots. Hand-irrigation might be somewhat uncomfortable, but it is necessary to clear any plugging of the channel and to allow the urine to flow. Once your anesthetic has worn off and the urine is draining satisfactorily, you will be transported to a hospital room.
Once in your hospital room, the floor nurses will check your vital signs (blood pressure, pulse and respiration) and set up your inflatable stockings and perhaps your oxygen tubes. Most often we use a PCA (patient controlled analgesia) for post-operative pain control. This means you will have a push button at your bedside to allow you to give yourself a small amount of pain medication intravenously for relief. The push button is controlled so you cannot give yourself too much. In some circumstances if you do not get enough narcotic to control your pain, we will consider raising the amount delivered by the PCA.
You will not be able to eat a regular diet on the day of surgery, but you may be able to have sips of water that first evening. By the next morning or day after you will usually be started on a light diet, which will be advanced slowly over the next one to two days. You cannot be fed until we believe your bowels are ready to move the fluids and food along. Otherwise the stomach will become distended, and nausea and vomiting can result. The intravenous will be removed once you are taking in enough fluids by mouth (usually the second or third day).
You will probably stay at bed rest until the evening of surgery, at which time the nurses will help you dangle your legs at the bedside. By the next morning the nurses will begin to get you out of bed. You will be sore, perhaps even sorer than the day of surgery, but you need to get out of bed to allow the lungs to fully expand. You may also be given a special breathing apparatus that encourages you to breath deeply in order to keep your lungs well-expanded and prevent pneumonia. The nurses or respiratory therapists will instruct you on the proper use of the "incentive spirometer."
The nurses on the floor will continue to observe your catheter drainage. You may be started on antibiotics, pain medications and stool softeners when you can tolerate oral medication. Your usual other medications will be restarted (except aspirin-containing products). Once the intravenous line is no longer needed and you are eating normally, you will be ready to go home.
You will also notice a plastic tube or drain that exits the abdomen to the side of the incision. This is to help remove the fluids that collect internally around the surgical site. This tube and drain are usually removed on the second or third day when the drainage is stopped.
Your incision has been closed with steel staples. These will be removed by the nurse at the time of discharge and replaced with small pieces of tape, or "steri-strips," to keep the incision together. These will start to peel and fall off after the seventh to 10th day. You can remove them, if you like, after the seventh post-operative day.
Getting ready for discharge
We have been particularly eager to have patients take care of themselves at home as soon as the need for intravenous feeding and monitoring are not necessary. There are many reasons for this, including the sky-rocketing costs of medical care. Also, bacterial infections generated in the hospital are much more difficult to treat than infections that occur as an outpatient. You will be taught how to take care of your catheter and the various types of drainage bags. You will probably be discharged from the hospital with various medications, including pain pills and antibiotics. You will receive stool softeners to keep the stool from becoming too hard, which will prevent your having to strain to have a bowel movement.
Post-operative home expectations
You will be weak for a couple months after a surgery of this magnitude. Expect to be tired often and to become easily fatigued. You may shower and walk some immediately after getting home. Every week you will be a little stronger and be able to do more and more. Figure on six weeks before you can do heavy lifting and three weeks before you can drive. You will be seen about two weeks after the discharge to have your catheter removed. Remember to bring diapers, as your control will not be good when the catheter is initially removed. (Attends or Depends diapers; not a shield or liners.)
Your catheter is very important to allow healing of the bladder and the urethra. You may use either leg bags or external bags. Drain before the bags get too full. The tip of the penis may get sore from the catheter rubbing. Use plain soap and water to wash this area daily (or more often if needed). You may see some blood in the drainage tubing or bag on and off during the time the catheter is in place. As long as the catheter is draining well, a little blood is normal and requires no treatment.
You may return to your normal diet immediately. Because of the raw surface, alcohol, spicy foods and drinks with caffeine may cause some irritation, or cause a sense needing to void despite the fact the catheter is emptying the bladder. If these foods don't bother you, there is no reason to avoid them completely, but eat them in moderation. To keep your urine flowing freely, drink plenty of fluids during the day (eight to 10 glasses). The type of fluid (except alcohol) is not as important as the amount. Water is best, but juices, coffee, tea and soda are all acceptable.
Your physical activity is to be restricted, especially during the first two weeks home. During this time use the following guidelines:
- No lifting heavy objects (anything greater that 10 pounds).
- No driving a car and limit long car rides.
- No strenuous exercise; limit stair climbing to a minimum.
The rectum and the prostate are next to each other and any very large and hard stools that require straining to pass can cause bleeding. You will usually be given stool softeners but these are not laxatives. A bowel movement every other day is reasonable. Use a mild laxative, if needed (two to three tablespoons of Milk of Magnesia or two Dulcolax tablets, for example),and call if you are having problems.
You should resume your pre-surgery medication unless told not to. You may be discharged with iron tablets to build up your blood count and stool softeners to keep the stool soft. Pain pills (Tylox or Tylenol with codeine) may also be given to help with wound and catheter discomfort. Tylenol (acetaminophen) or Advil (ibuprofen), which has no narcotics, is better for you if the pain is not too bad (and if you can tolerate those medications).
You may shower or bathe as soon as you get home.
Problems you should report to us
- Fever over 100.5 Fahrenheit
- Heavy bleeding or clots
- Drug reactions (hives, rash, nausea, vomiting, diarrhea)
- ALL IMMEDIATELY IF THE CATHETER FALLS OUT OR STOPS DRAINING.
You will need a follow-up appointment to monitor your progress. Call for this appointment at the above number when you get home or from the phone in your hospital room before leaving. The first appointment (to remove the catheter) will usually be about 21 days after your surgery. Most people will not have good urinary control at first. Come to the office with a small supply of adult diapers (Attends or Depends). These can be purchased at any drug store.