University College Hospital. Discharge information for patients after HIFU (High Intensity Focused Ultrasound) Urology Directorate

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1 University College Hospital Discharge information for patients after HIFU (High Intensity Focused Ultrasound) Urology Directorate

2 2

3 If you would like this document in another language or format, or require the services of an interpreter, contact us on We will do our best to meet your needs. Contents 1 Introduction 5 2 Why do I need a suprapubic catheter? 5 3 What is a suprapubic catheter? 5 4 Urethral catheters 5 5 How do I care for my catheter? 6 6 Emptying your catheter 7 7 Using an overnight bag 7 8 Going home with your catheter 9 9 Having your catheter removed Common problems you may experience Checklist prior to discharge Contact Details Where can I get more information? How to find us 18 3

4 4

5 1 Introduction In this information leaflet we have tried to address the common problems patients may experience after HIFU (High Intensity Focused Ultrasound) treatment. 2 Why do I need a suprapubic catheter inserted after HIFU? After HIFU your prostate may be swollen or inflamed which can interfere with your ability to pass urine normally. Your suprapubic catheter is there to ensure your bladder can empty fully until normal urination is established. This generally takes 1-2 weeks after HIFU but it is normal to have a slow urine flow (stream) for several weeks after. 3 What is a suprapubic catheter? This is a hollow tube to drain urine from your bladder that has been inserted through your abdomen (lower tummy). This is done during your HIFU procedure. To prevent the catheter from falling out, a small balloon at the catheter tip is inflated inside the bladder. 4 Urethral Catheters Most men will have a suprapubic catheter inserted for HIFU treatment. If you are unsuitable for a suprapubic catheter then 5

6 you will have a urethral catheter instead. The catheter will be passed through the urethra (water pipe) into the bladder. You will be able to empty and manage your urethral catheter in the same way you would a suprapubic catheter. 5 How do I care for my catheter? If possible bath or shower daily. Otherwise wash the skin around the catheter once a day. If you have a supra pubic catheter dry the area thoroughly. Do not use talcum powder or creams. A small dry dressing can be applied to the area which you can do yourself, or your District Nurse or Practice Nurse may do this. 6 Always wash and dry your hands with soap and water before and after handling any part of your catheter or drainage bag If you have a urethral catheter make sure you clean around the entry site of the catheter, and also clean the catheter itself using downward strokes away from the catheter. This should be done morning and night and after opening your bowels. If you have a urethral catheter and you are uncircumcised pay particular attention to washing under the foreskin. After washing be sure to replace the foreskin in its usual position.

7 Whenever emptying your drainage bag, always clean around the tap before and after emptying it. When emptying your catheter make sure that the end of the bag does not touch the toilet bowl or seat. If there is any discharge from where the catheter enters the body this area may need to be cleansed more often Always be sure to change your leg bag or catheter valve every 7 days or sooner, if they become soiled 6 Emptying your catheter There are two methods of emptying the catheter, either by attaching a catheter bag or by using a catheter valve. Remember always to wash your hands, before and after emptying your catheter. 7 Using an overnight bag If you use a night bag, simply connect directly to your leg bag or catheter valve, as this will help protect you from infection. Before you go to sleep ensure the catheter tap or valve is open, the drainage tap on the night bag is closed and that urine is draining. 7

8 Here is a step by step guide how to do so: Always wash your hands with soap and water first and dry hands well. Remove the cap from the night bag and attach to the end of leg bag. Open the leg bag outlet tap or catheter valve as you would for emptying and allow urine to drain freely into the night bag. Wash hands thoroughly again. On removal of the bag always make sure that the leg bag tap is closed first. Empty the night drainage bag into the toilet, rinse through with water, then keep for the next night. The night drainage bag can be used for 1 week. Dispose of the catheter bags by emptying urine into toilet and putting the bag in household rubbish. Wash hands with soap and water 8

9 8 Going home with your catheter For the first 24 hours you should allow your catheter to drain freely into the catheter bag (leg bag). At night you may choose to attach it to a larger night bag. After 24 hours disconnect the bag from the catheter and attach a catheter valve. Your ward nurse may have already attached this, in which case remove the catheter bag from the valve. When the valve is switched off (ie. in the up position) your bladder will fill with urine. If you have a supra pubic catheter: When you feel the need to pass urine try to pass it in the normal way through your penis. Some men are able to pass urine normally straight away, for others it can take a few days. When you return to passing urine through your penis the urine flow may be slow to start with but will gradually improve over a period of several weeks following your HIFU treatment. If you are unable to pass urine or if you feel that you haven t emptied your bladder completely then open the catheter valve to empty the residual (remaining) urine from your bladder. If you have a urethral catheter: Do not try to pass urine through your penis. Drain your bladder by opening the catheter valve and allowing the urine to drain out via the catheter. 9

10 Drinking Unless advised otherwise, to help prevent blockage of your catheter with debris try to drink 1.5 to 2 litres (7-10 cups) of fluid per day. Activity Having a supra-pubic catheter should not limit your social activities. It should not prevent you going away from home, just remember to carry spare supplies if you will be away from home for an extended period of time. Bowel Habit After your HIFU treatment it is important that you do not become constipated in order not to put any pressure on the bowel wall. You may be given some laxatives to take home. If you become constipated while at home please see your GP for advice. 9 Having your catheter removed If you have a supra pubic catheter: Once normal urination has been established which generally takes 1-2 weeks, your catheter can be removed. Your catheter will normally be removed in our designated clinic at University College London Hospital 1-2 weeks after your HIFU treatment. If you are having salvage HIFU (HIFU after another treatment for your prostate cancer such as radiotherapy) you will need to keep your supra pubic catheter in for 6-8 weeks. If you live a long distance from the hospital it 10

11 may be possible, with the agreement of your GP, to have it removed locally. If you are still having trouble passing urine normally when your catheter is due to be removed this appointment may need to be delayed and you should contact a member of Professor Emberton s team (see contact numbers further on in this booklet). Before you catheter is removed the nurse will want to check your bladder is emptying. The day before your catheter is due to be removed we will ask you to record your residual urine on three occasions. The residual urine is the urine left behind in the bladder after urinating. To measure this: Pass urine normally (via your penis) into a plastic measuring jug. Record this amount and discard the urine. This is the Voided' volume. Open the catheter valve and drain any remaining urine into the plastic measuring jug. Record this amount and discard the urine. This is the Residual volume. Do this three times over 24 hours. Generally we would expect the residual volume to be under 100mls. For some men we may accept urine residuals of over 100mls as this amount is only a guide. 11

12 If your nurse is concerned about your ability to pass urine normally they may advise delaying the removal of your catheter. If you have a urethral catheter: If you have a urethral catheter please ignore all of the above. Your bladder emptying will be assessed once the catheter has been removed in clinic. If you are taking part in a clinical trial the arrangements for removing your catheter should be made with your research team. 10 Common problems you may experience 12 Urine Infection While you have a catheter in place it is usual to have a harmless increase in the number of bacteria in your urine, this does not need treatment. However if you experience one or more of the following new symptoms you should contact your GP: New Lower back pain, High temperature and feeling generally unwell, Cloudy offensive urine, worsening bladder pain or spasm. Blood in your urine This is common after HIFU treatment and may continue for up to 2 months after HIFU treatment. It is not a cause for temperature or fever, or if the bleeding is persistent or heavy. If you are concerned please contact your GP, district nurse or a

13 member of Professor Emberton s team (the contact numbers are at the back of this booklet. Debris or sediment in the urine You may see some tissue, debris or sediment in your urine this is common after HIFU treatment. You should aim to drink 2 litres (3-4 pints) daily. This will encourage catheter drainage and should prevent your catheter from blocking. Urine leakage This may occur from around the catheter site or the urethra (water pipe). If this occurs you should check that your catheter is not blocked or release your catheter valve to empty the bladder. If leakage is associated with a strong sensation of urgency, you may be experiencing bladder spasms. Blockage of Catheter This can be partial or total. If you think your catheter is blocked you should check it is not kinked and try changing your position. If no urine continues to drain or you experience abdominal discomfort your catheter may need to be changed. You should seek immediate medical attention with your GP or local Accident and Emergency department. Bladder spasms - Having a urinary catheter in place can sometimes give rise to "bladder spasms". This may be felt as a strong or urgent sensation of the need to pass urine before the bladder is full. This occurs because both the catheter, and the catheter balloon (which holds 13

14 the catheter in place) irritates the bladder. Occasionally you may experience leakage of urine when you have a bladder spasm. This is because the spasm can cause a strong contraction of the bladder muscle which in turn can force urine out in an uncontrolled manner. The urine leakage may be around the catheter or catheter entry site, or via the urethra (water pipe). Sometimes the spasm may give rise to a sensation of discomfort or pain in the tip of the penis particularly after urinating. (This sensation can also occur at the end of emptying the bladder via the catheter valve.) Not all men will experience bladder spasms and severity of these can vary. It is important to remember that this will settle once the catheter is removed but in the meantime you may find it helpful to try not to force urine out when you have a spasm but rather try to relax and focus on deep breathing until the spasm passes. If the bladder spasms are frequent and very troublesome then contact your GP practice or medical team for further advice. It may also be helpful to check that you do not have a urine infection if the spasms are very severe. You may experience discomfort or stinging when you start to pass urine normally (via your urethra or water pipe) again. This will subside. Make sure you continue to drink 1.5 to 2 litres (7-10 cups) of fluid per day. 14

15 11 Checklist prior to discharge Please check you have all the following items and are able to do the following prior to your discharge from the hospital: You have been given your catheter supplies (leg bag, night bag, catheter valve) A nurse has checked your supra-pubic catheter site and given you spare dressings. You have had your catheter care and hygiene explained You have been shown how to connect and disconnect your leg bag, night bag and valve and understand how to do so. You are able to use your catheter valve You have been given your antibiotics and laxatives to take home A catheter removal appointment has been arranged 15

16 12 Contact details Please contact a member of Professor Emberton s team if you have any questions or any difficulties. Jane Coe (Nurse Specialist) Direct line Voic ext: bleep 2119 jane.coe@uclh.nhs.uk Victor Abu (Nurse Specialist Prostate Care) Direct line: Voic ext: Mobile victor.abu@uclh.nhs.uk Helena Stone ((Research Nurse) Mobile helena.stone@uclh.nhs.uk Rebecca Scott (Research Nurse) Mobile Rebecca.scott@uclh.nhs.uk 16

17 PA for Professor Emberton Neil McCartan (HIFU Trials Co-ordinator) or Where can I get more information? Cancerbackup Tel: The Prostate Cancer Charity Tel: UCL Hospitals cannot accept responsibility for information provided by external organisations. 17

18 14 How to find us 18

19 Space for notes and questions 19

20 First published: Aug 2012 Date last reviewed: Jan 2014 Date next review due: Jan 2016 Leaflet code: UCLH/S&C/SURG/UROL/HIFU-DISCHRG/1 University College London Hospitals NHS Foundation Trust 20

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