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Post operative care

What to expect after surgery

Following your surgery, you will be taken from the operating room to recovery, an area in the operating theatre where patients are monitored very carefully immediately following a surgical procedure. Your first memory after the surgery will be waking up in recovery.

You will have a catheter in your bladder draining urine into a bag, and the amount of urine you pass will be measured over the first night to make sure you are receiving adequate fluids. The urine is often blood-stained. During your hospital visit, the urine will clear to yellow but you may have some blood in the urine intermittently for some weeks after the procedure.

You will have a wound drain that exits from the abdomen. This is usually kept in for one day following the surgery, preventing build-up of pressure from any wound ooze. It also avoids the body reabsorbing any excess fluids.

Until you are drinking adequately, you will receive intravenous fluids (usually the next day). You will also receive antibiotics through the drip to prevent any infection.

Once you are mobilising safely, are able to care for your catheter and your pain is well controlled on appropriate tablets taken by mouth, you will be able to go home. Your bowels may be slow to recover normal function after the surgery and occasionally you will be allowed to go home without having passed a bowel motion in hospital.

The following can be expected after a Robotic Prostatectomy:

Shoulder pain

This is very common and occurs in most patients for the first 24 hours after the procedure. It occurs as a result of the distension of the abdomen caused by the gases during the operation. It is usually relieved by simple analgesia i.e. Panadol or anti-inflammatory medications such as Celebrex.

Scrotal and penile swelling

Together with bruising, this may appear immediately after surgery or within 4 – 5 days. Any scrotal swelling will resolve in 7 -14 days. If scrotal swelling occurs, it can reduced by elevating the scrotum on a small towel that you have rolled up when you are sitting or lying. Even with the catheter in place, it is recommended that you wear supportive underwear.

Bloody drainage

It is not uncommon to have bloody drainage around the catheter or in the urine, especially after increasing activity or following a bowel movement. Resting for a short period usually improves the colour of the urine. Sometimes there can be intermittent bleeding in the urine even after the catheter is removed. This should be pale red and fairly clear, however if you have any concerns, please contact Dr Swindle. It is important to drink more fluids if there is blood in the urine to help keep it diluted.

Leaking

Leaking around the catheter is fairly common, especially on straining or with a bowel movement. If this happens, you may need to wear a small pad inside your underwear for protection.

Bladder spasms

These present as mild to severe pain or cramping in the lower abdomen and the sudden need to urinate. These are infrequent and are caused by irritation of the bladder from the surgery and by the catheter resting against the bladder wall. Let the nursing staff know if you have these troubles as mostly these can be relieved with appropriate medications and will lessen in time.

If the spasms remain bothersome, a bladder relaxant medication such as Detrusitol or Ditropan pills may be used. These pills often cause a dry mouth and if used in excess, can make it difficult to focus your vision. These symptoms disappear when you lower the dose or stop the medication.

Perineal pain

This occurs between your scrotum and your rectum or in your testicles and may last for several weeks after surgery, though it will resolve. Simple pain medications such as Paracetamol or Celebrex should relieve the discomfort, however please contact Dr Swindle if the pain medication does not alleviate the problem.

Swelling

Swelling pertaining to the lower legs or ankles can occur in both legs and should resolve in around 7 – 14 days. It will help if you are able to elevate your legs while sitting. Should swelling in the legs be uneven, and associated with redness or pain, please contact Dr Swindle quickly as this can be a symptom of a blood clot in the leg.

Weight gain

Weight gain is temporary and due to shifts in gas and fluid. Your weight should be back to your pre-operative weight in approximately 5 – 7 days.

Frequent urination

For some men frequent urination is common for the first few months after the operation. The bladder takes time to fill out again after it has been kept empty by the catheter for a week or so. As the bladder is able to hold more urine at lower pressure, your control will improve. Sometimes a prescribed medicine helps the bladder relax and hold more urine.

Post operative care

When you leave the hospital, you will be given a prescription for several different medications. This prescription will be dispensed before you leave hospital and the nurses will go over the instructions with you.

Coloxyl: One tablet (100 mg) three times a day – this is a stool softener that you will take for 30 days after the operation. It is important not to become constipated or strain while moving your bowels immediately after the surgery.

Celebrex: One tablet (100 mg) twice a day for 5 days – this is an anti-inflammatory medication that is very useful for pain relief after the operation (if you have a history of heart disease this should not be taken).

Panadol: 2 tablets as required each 4-6 hours – will be used for pain relief when you leave hospital.

Trimethoprim: One tablet daily for 14 days – this medication is to be started when you leave hospital and is to be continued for a week after the catheter is removed. It is to prevent a urinary tract infection occurring around the time the catheter is removed.

Regular medications

You can restart your regular medications once you start eating and drinking after the operation. However, if you are taking Warfarin, other blood thinners or medications that predispose you to bleeding, such as anti-inflammatory medications or aspirin, you will need to discuss this with Dr Swindle prior to recommencing them. These must be ceased while in hospital.

If you were taking anti-coagulant medications Dr Swindle will advise you when to recommence them.

Catheter

When you leave the hospital (either the day after surgery or the following day), you will still have the urinary catheter in place. This can be uncomfortable but is generally well tolerated.

Prior to discharge, you will be educated by the nursing staff on the Ward on how to care for the catheter and the leg bag when you are home. Dr Swindle’s office will make arrangements for the catheter to be removed 7 days after the operation. Occasionally the catheter may be left in for longer but this is rare. The catheter, which is held in place by a water-filled balloon on its tip, is left in for 7 days after the operation, allowing the anastomosis, or union between the bladder and the urethra, time to heal completely.

You can wear a urinary leg bag during the day – it allows you to move around more easily but it must be emptied every 3 hours or when it gets full. This stays on the whole time your catheter is in. It should be fixed in place with a strap around the upper thigh to prevent it pulling down on the bladder and penis.

The catheter and its balloon can rest on the bladder wall and irritate the bladder resulting in bladder spasms. These present as mild to severe pain or cramping in the lower abdomen and the sudden need to urinate. These are infrequent however if they occur you should contact Dr Swindle immediately. The pain can be relieved by appropriate medications.

At night, a larger bedside bag is better. You will be shown how to connect it onto the end of the day bag. This does not need to be emptied as often and should last through the night when a lot of urine is produced. It will not overfill and allow the urine to back up into the bladder while you are asleep.

When you get into bed, be sure that the leg bag tap is ON and the night bag tap is OFF. You will need to arrange the tubing so that it does not pull on the leg bag or kink.

Some leakage of urine or blood-stained fluid around the catheter is not unusual. It is also not unusual to notice a pink or red tinge to the urine after you have been walking or after you have had a bowel movement. Avoid being alarmed, simply increase your fluid intake until the urine becomes clear again.

Summary of catheter care

It is very important to always wash your hands before and after emptying your catheter to avoid discomfort or infection. To disconnect the overnight bag, turn the leg bag tap to OFF, pull the night bag off the end of the leg bag and empty into toilet. You will be shown how to work the tap on the bag before you leave hospital.

  • Always keep the drainage bag below the level of the bladder.
  • Use soapy water to wash the area around the catheter at least twice a day as debris and mucous will collect at the tip of the penis.
  • Even when showering, keep the bag attached to the catheter at all times. You should also keep your catheter strapped to your thigh for comfort as this prevents it pulling in the bladder.
  • Keep the drainage bags free of kinks and loops.
  • Drink at least 8 glasses or water a day to keep urine a clear, pale yellow colour.

Occasionally when the bag is emptied, an airlock may form – caused by all the air emptying out of the drainage system. This can cause urine to stop draining, but is easily fixed. If the sides of the bag look sucked hard together and no urine has drained, just allow a small amount of air back into the system after emptying your bag by pulling the front and back of the bag slightly apart while the tap is open.

Changing your collection bag is only required if you have your catheter in for longer than usual – ask if you are not sure. Ensure that your hands are washed before and after this procedure. Prepare the new bag ready to be connected but without the tip of the bag tube touching anything. Empty the collection bag.

Carefully, without pulling on the catheter, disconnect the catheter end from the bag drainage tube. Connect new bag to catheter. DO NOT TOUCH THE OPEN END OF THE CATHETER OR NEW DRAINAGE TUBE TIP. Hold the tube at the base of where it would connect to the catheter to push it firmly into place.

Wound care and activity

After a robotic prostatectomy there will be 6 small incisions where the robotic instruments were placed, the small incisions will be covered by waterproof dressings. Bruising around these incisions and the abdomen is not uncommon and should not alarm you. This will resolve over time.

The sutures that hold the incision together are under the skin and do not need to be removed as they will dissolve. Occasionally the wound sites may ooze blood stained fluid. If this occurs the dressings can be removed and the wounds washed in the shower. The wounds can then be dried with a clean pad or towel and a clean dressing reapplied.

You may also shower with these waterproof dressings and they can eventually be removed 3 days after the procedure. Once the dressings are removed, the wounds need to be kept clean by showering. Do not take a bath for 1 week after the procedure.

It takes 4-6 weeks for the incisions to heal completely, so you should avoid heavy lifting (over 10kg) or straining during that time. Daily exercises such as walking, climbing stairs, or swimming (do not start for 1 week after the operation) will help you recover faster, but wait 4-6 weeks before beginning heavy exercise such as jogging, weight lifting, or golf with a full swing.

Your perineum (the area between the scrotum and anus) may be tender for several weeks or months, so avoid sitting on anything hard or pointed like a bicycle seat, and do not ride a motorcycle or a horse until the tenderness is gone.

Some men feel fullness or tenderness in the rectum, as though they have to have a bowel movement. The prostate gland lies just above the rectum, so this sensation is to be expected and usually will go away with time. It is normal to experience tenderness and swelling of the testicles after the surgery and for the penis to be retracted and shortened for a time after the surgery.

You may return home in a car or aeroplane, but you should not drive as long as you have any pain or you are taking pain medications stronger than Tylenol, aspirin, Advil, Vioxx, or Celebrex.

Avoid sitting with your feet on the floor for more than 15 minutes at a time. Get up and walk, stretch your legs, or keep your feet propped on a stool as much as possible. If you return home by aeroplane, walk in the cabin area every half hour. Avoid standing still for more than a few minutes at a time.

Sitting and standing still slow the circulation in your legs and predispose you to a blood clot. Notify your doctor or contact our office immediately if you notice swelling in your feet or ankles or tenderness in your calves or thighs or if you become short of breath or cough up blood. These symptoms may signify a deep vein thrombosis or pulmonary embolus (blood clot in the lungs).

Generally, you can return to work about 1-6 weeks after the operation. If your work requires heavy physical activity, you may need a longer period of recovery until all the soreness disappears from the incision and the urinary control is satisfactory.

You should be comfortable with desk or office work within 1-3 weeks—once the catheter is out and you feel confident with the urinary pads. After your return home, do not plan any long trips for 6 weeks after the operation to avoid prolonged sitting.

Bowels and intestinal function

After the operation, you can have ice chips and water as soon as you are fully awake, progressing to a liquid diet that evening or the next morning. You can try solid food 24-36 hours after the operation, when your intestinal activity begins to recover.

Most people do not pass flatus (intestinal gas) for 1-2 days and do not have a bowel movement for 4-5 days. It is common to have abdominal bloating after the procedure but this should resolve once your bowels return to normal function.

When you return home, you may resume your normal diet. It is important to avoid constipation by taking a stool softener, such as Coloxyl, three times a day for 30 days after the procedure and by drinking plenty of fluids.

Your bowels may be loose initially when they first start to work after the operation. Increasing the fibre and water intake in your diet should help to keep stools soft.

Metamucil is an excellent natural stool softener as well. Use a gentle laxative, such as Agarol 30mls at bedtime, if you begin to feel constipated.

A major operation can predispose you to heartburn and indigestion from excess stomach acid. Let Dr Swindle know before the operation if you have a tendency to these problems and do not hesitate to take medications to control heartburn should it occur after the operation.

 

When to contact Dr Swindle post surgery

Dr Swindle can be contacted anytime on 0409 103 333 if you are concerned or have any specific issues. If for any reason Dr Swindle can not be contacted go to your nearest emergency department.

Dr Swindle definitely needs to be contacted if you have any of the following:

  • Fevers
  • Passage of blood clots in the catheter.
  • Abdominal pain that is increasing or not settling.
  • Swelling of the abdomen.
  • Swelling of the legs.
  • Significant leakage of urine around the outside of the catheter.

Follow up after a Robotic Prostatectomy

When you leave hospital arrangements will have been made for you to have the catheter removed 7 days after the operation. Please check with the nursing staff prior to discharge to confirm these arrangements.

For the catheter removal, you will be admitted as a day patient to the hospital. Please bring supportive underwear with you as it will need to hold a pad in place once your catheter is removed. Your catheter will be removed in the morning and you will be able to go once we ensure you are passing your urine satisfactorily.

Allow around four hours for this visit as the nursing staff like to gauge how well your bladder is emptying. It helps if you can drink 1 – 2 litres over the morning. When you are discharged from hospital arrangements will be made for follow up in Dr Swindle’s rooms 6-8 weeks after the procedure.

A program of regular checkups will be necessary for the rest of your life. Your PSA will first be tested 6-8 weeks after the operation and Dr Swindle will arrange a request form for this to be performed.

The PSA level should be undetectable (less than 0.01 ng/ml) if the cancer has been completely removed. Your PSA is then checked every 3 months for the first year, then every 6 months for years 2 to 3, and annually thereafter.

Dr Swindle will usually discharge you from his care back to your general practitioner around 2 years post operatively if everything is stable. Your GP will then need to do regular PSA checks. Dr Swindle only needs to see you again should your PSA become detectable.

Please let Dr Swindle know if things are not going well. The best way to reach him during the day is to contact his office on 07 3010 3333 or Dr Swindle directly on 0409 103 333.

If you have any queries regarding robotic surgery please contact Dr Swindle’s office directly on above phone number or by email at appointments@qprostate.com.

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