2014 Retropubic Prostatectomy
Retropubic Prostatectomy What is the prostate? The prostate is a gland that makes a fluid that helps sperm move. It also gives nourishment for the sperm. It is about the size of a walnut. The prostate gland is found just under the bladder. It surrounds the urethra. The urethra is the tube that carries urine (pee) out of the bladder. By the age of 50, a man may have an enlarged (bigger) prostate gland. The prostate may get bigger in a way that does not cause problems when urinating (peeing). However, if the prostate gets too big, it can block the urethra. Urine then builds up in the bladder, causing pressure. Urination may be more difficult and you may feel like your bladder never completely empties. A retropubic prostatectomy may be needed to take out the blockage. Bladder Prostate gland Urethra Testicle 1
What is a retropubic prostatectomy? The doctor makes an incision (cut) in the lower abdomen and removes the inside of the prostate. The outer shell (capsule) of the prostate stays in place. Before surgery You will be asked to stop eating and drinking at midnight the night before surgery. Please read the pamphlet Planning for Your Hospital Stay After Surgery for more information about getting ready and what to expect. Just before surgery You will have some tests before you go to the Operating Room (OR). These tests may include blood and urine tests, a chest X-ray, and an electrocardiogram (ECG). Your lower abdomen (stomach) will be shaved before your surgery. Your incision will be in this area. 2
After your surgery You will go to a special recovery area. Your breathing, pulse, and blood pressure will be checked often. You will be taken to your hospital room when you are stable. You will have an intravenous (IV) for about 24-48 hours (1-2 days). Your IV is taken out when you are able to eat and drink again. Incision (cut) The incision is usually held together with staples. The bandage covering the incision will be changed every day. The staples are usually taken out after 7-10 days. Drainage tube You may have a drainage tube in or near your incision. This drains any fluid that collects in the area. It will be taken out in a few days depending on how much fluid is draining from the tube. 3
Catheter and continuous bladder irrigation You will have a catheter (a tube through your penis into your bladder). It will be connected to 2 large bags of fluid that will flush your bladder continuously to prevent blood clots from forming in your bladder. This is called continuous bladder irrigation (CBI). The fluid will drain out through the catheter into a collection bag. It is OK if the fluid draining out is red. Over time the fluid will get lighter. Your catheter can get blocked with clots. If this happens, you may have abdominal (stomach) pain, abdominal distension (bloating), and your tube might not be draining well. Let your nurse know so that they can flush your catheter. This problem happens in some patients, but not everyone. Spasms It is OK if you feel the urge to pee and fluid comes out around the catheter. This is called a bladder spasm. Call your nurse, who can give you some medication for this, if it is bothering you. 4
When will my catheter be taken out? Your catheter will usually be taken out a few days after surgery. At first, you may not have your usual control when urinating. You may have dribbling and pass your urine more often. This will get better in a few days. It is very important that you drink lots of fluid (at least one glass of water an hour). This will dilute (water down) the amount of blood in your urine and lower the chance of clots forming. If you can t urinate within 6-8 hours after the catheter is taken out, the nurse will drain your bladder with a new catheter. The catheter may be left in for an extra day or two if there are problems with blood clots. Controlling discomfort People differ in the amount of pain they will have. Your nurses and doctors will make sure that you are as comfortable as possible. There are many methods for controlling pain. You should talk about these with your doctor and/or nurse. Fluids and food An IV will give you fluids and nutrition. You will not be able to eat or drink right away after surgery because your bowels are not ready. The nurses and doctors will listen to your abdomen for bowel sounds with a stethoscope. When you have bowel sounds and are passing gas, you will move slowly from having clear fluids to then going back to your usual diet. 5
Deep breathing and coughing It is important to take deep breaths in and out and to try to cough up any phlegm (mucus). Your nurse will give you a machine called an incentive spirometer that will help you breathe deeply. Activity It is important to start moving as soon as possible. A nurse should be with you the first time you get up. Activity will help prevent blood clots from forming and get rid of gas in your abdomen. Being active will also help get rid of any phlegm in your lungs. While you are lying in bed, try to move your legs around and flex your feet. Your nurse(s) will help you do more activity. At home Your stitches or staples will be taken out before you go home. You may have little pieces of tape called Steri- Strips on your incision to reinforce (strengthen) it. Leave them on until they fall off on their own. It is OK to bathe or shower with Steri-Strips on. Do not soak too long. Do not direct the spray of the shower at your incision or let the water pound on it. 6
Fluids You may see blood in your urine off and on for the next couple of weeks. This is normal. If your urine is pale yellow, drink your usual amount of fluid. If your urine is red or brown-tinged, you should drink 8-10 glasses of fluid every day. This washes out your bladder and helps prevent infection. Alcohol Alcohol slows down healing. Do not drink any alcohol for at least one month so you can heal. Healthy eating You may eat the same foods as before your surgery. Eat food high in fibre such as bran cereals, whole wheat bread, green leafy vegetables, and fresh fruit to help prevent constipation. Bowel care Your surgery was done in an area right in front of your rectum so do not force or strain to have a bowel movement. This could cause bleeding. Remember that you have an incision on the inside and outside and both need time to heal. Try to prevent constipation. Enemas should be avoided unless talked about with your doctor. 7
Activity Do not do vigorous (hard) exercise for at least 6 weeks. You can lift up to 5 pounds, not more. Walking short distances is OK. Ask your doctor if you are not sure about any activity. Car rides Do not go for long drives. Avoid bumpy roads for 6 weeks. Sitting for a long time, or going over a bump could cause bleeding from the prostate area. Your response time may be slower than usual while taking pain pills. Do not drive for at least 1 week. Please talk about this with your doctor. Sex You can have sex after about 4-6 weeks, when you feel ready. You may have mild discomfort when you go back to having sex. This will soon go away. Sexual sensation, desire and erections should be the same as before your surgery, but the amount of semen may be less or none. 8
Medications Take all prescribed medications as told by your doctor. Check with your doctor before taking ASA (Aspirin ) or blood thinners. Going back to work You can usually go back to work 4-6 weeks after your surgery. Talk about this with you doctor. Please note: You will probably have some blood in your urine when you go home (off and on for the next couple of weeks). This should completely disappear after 3-4 weeks. 9
Call your doctor right away if you have: Fever and/or chills. Are unable to urinate. Have a sudden onset of pain. Have swelling, redness, or pus in your incision. Follow-up Before you leave the hospital, you will get an appointment to see your urologist. It is very important to keep this appointment so your urologist can make sure you are healing properly. If you need to see a doctor, please contact your family doctor or go to the nearest Emergency Department unless otherwise instructed by your Urologist. If you have any questions, please ask. We are here to help you. 10
Notes: Looking for more health information? Contact your local public library for books, videos, magazines, and other resources. For more information go to http://library.novascotia.ca Capital Health promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Urology Nursing Education Committee, QEII, Halifax Revised by: Urology Practice Council Illustration by: LifeART Super Anatomy 1 Images, Copyright 1994, TechPool Studios Corp. USA; Capital Health staff. Designed by: Capital Health Library Services, Patient Education Team Printed by: Dalhousie University Print Centre The information in this brochure is provided for informational and educational purposes only. The information is not intended to be and does not constitute healthcare or medical advice. If you have any questions, please ask your healthcare provider. WJ85-0475 Revised September 2014 The information in this pamphlet is to be updated every 3 years.