2014 Radical Prostatectomy
Radical Prostatectomy What is a radical prostatectomy? During a radical prostatectomy, the entire prostate gland, the part of the urethra that it surrounds, and the seminal vesicles are removed. The tissue is sent to the lab for testing. Your doctor will talk about the results with you a few weeks after the surgery. What is a prostate gland? The prostate makes a fluid that helps sperm move and 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 (tube that carries urine (pee) out of the bladder). Bladder Prostate gland Urethra Testicle 1
Before your surgery We will teach you deep breathing, leg, and Kegel exercises. We will teach you how to use an incentive spirometer. This tool is used after your surgery to help prevent breathing problems. You will have a catheter (hollow tube to drain urine) in place for up to 3 weeks. We will teach you how to care for your catheter. You will have an incision (cut) in your lower abdomen (stomach). Hair will be shaved from this area in the Operating Room. This hair will grow back in a few months. Your stomach must be empty before your surgery. The night before your surgery, you should only drink clear fluids (fluids you can see through, no milk or cream in your tea or coffee) between supper and midnight. After midnight, you should not eat or drink anything. Please tell your doctor or nurse at least 1 week before your surgery if you are taking Aspirin, anti-inflammatory medication (medication usually used for arthritis), warfarin, vitamin E, garlic extracts, and any other medication that might be a blood thinner. Please read the pamphlet Planning for Your Hospital Stay After Surgery. 2
After your surgery Control of discomfort and/or pain You will feel soreness or pain, but this is OK. Pain medication will be given to you regularly. Stronger medication is available if you need it. Ask your nurse for medication before the pain becomes severe (too much to handle). Your nurse will encourage you to get up and walk every day, even on the day of your surgery. This is very important because it will help you heal faster and will help prevent complications. Nutrition You will get clear fluids after your surgery. An intravenous (IV) will give the extra fluids you need. The doctor or nurse will tell you when you can start eating a regular diet. Most patients are able to eat their usual diet the first day after surgery. Your IV will be removed when you are drinking well. Incision (cut) A small bandage will cover the incision. It will be changed during your hospital stay as needed. You may have a special drain beside the incision for a few days. The doctor or nurse will take it out in 1-2 days. Your staples or stitches will be removed in 7-10 days. If you do not have a follow up appointment with your urologist within this time, you will need to make an appointment with your family doctor to have the staples removed. 3
You may shower when you feel stronger, but not until the drain is removed. Do not let the water pound on your incision. Do not soak in a bath for about a week after surgery or until your staples are removed. You may see some swelling and bruising on your penis and scrotum. This is normal. The swelling will go down over the next few weeks. Catheter You will have a catheter (hollow tube to drain urine). It will be connected to a drainage bag. The bag can hang on the side of your bed or be carried when you are walking. You will get a smaller drainage bag (called a leg bag) to use when you are walking. This leg bag straps to your leg and fits neatly under your pants. 4
You will go home with your catheter in place. It will be connected to the leg bag. Your nurse will give you a larger bag to use overnight. Your nurse will teach you how to care for your catheter and drainage bags. It is OK to see some blood in the urine. Do not worry as this is not dangerous. It is also OK to see some urine, blood, or discharge (sometimes looking like pus) coming from between the catheter and the urine tube. This is a sign that the area of the bladder and urethra is healing. Sometimes, patients have bladder spasms (muscle gets tight and does not relax) with squirts of urine coming out through the same area. This is your bladder reacting to the catheter. There are usually not any problems with the catheter. Rarely, it may become blocked by blood clots. If this happens, you will have to go to an Emergency Department to have it flushed. Your nurse will give you a pamphlet, Care of Your Urinary Catheter at Home to refer to for reassurance. 5
If you do have to go to the Emergency Department and the nurse or doctor has any trouble helping you, he/she should call the urology resident on call before removing or trying to replace the catheter: QEII 902-473-2220 Dartmouth General 902-465-8300 Length of stay in hospital You can expect to be in hospital for 2 days after your surgery if you do not have any problems. Before you go home, you will get instructions as to when your staples and catheter should be removed. Care at home Healthy eating It may take a while for your appetite to return to normal. During this time, it will help to eat smaller meals more often. Eating healthy meals will help you heal faster. Eat foods high in fibre (such as bran cereals, whole wheat bread, green leafy vegetables, and fresh fruit). 6
Drink plenty of water. Watch for constipation. It is important not to strain with bowel movements. Do not get an enema. Remember, you do not need to have a bowel movement every day to be healthy. Activity Take it easy the first few days at home. Don t try to do too much. Over time, walk farther distances, from around the yard, to around the block, and finally around your community. You may find that you get tired easily and may need extra rest. Your energy will come back with time. For the next 6 weeks: Do not lift anything over 10 pounds. Avoid strenuous (hard) activities (such as sports, mowing the lawn, and shoveling snow). Your doctor will let you know when it is safe to drive your car again. This is usually within a few weeks. Returning to work will depend on your general health and recovery, as well as what type of work you do. Talk about this with your doctor. 7
Medication Take your medication as told by your doctor. Do not drink alcohol while taking pain pills. Common questions Will I be incontinent? Incontinence is the loss of control of your bladder. It is OK to have this after the catheter is removed 2-3 weeks after your surgery. When your catheter is taken out, you can expect dribbling or even constant leakage of urine. You should take some incontinence pads (such as Depends, or Tena pads) with you for your trip home. At first, you will need a big pad. Over the next few days to several weeks, you should be able to switch to smaller pads. Your nurse or pharmacist will be able to give you information on the types of pads to buy. Try to exercise the muscles that help you hold your urine. This may help you get back control of your urine more quickly. The muscles that need to be exercised are those that you use to give those last few squirts of urine or to stop from passing gas. Repeatedly squeezing and relaxing these muscles (Kegel exercises) will make them stronger over time. 8
It will take time for you to get back the control of your urine. Typically, a man will be incontinent during the week or two after the catheter is removed. The expected pattern of urinary incontinence is as follows: First, at rest and with any movement. Second, leakage with movement but dry at night or at rest. Third, loss of urine with exertion or coughing. Finally, complete control of your urine. The length of time for a man to go through these stages is different for everyone. It ranges from several weeks to 6 months or more. Will I be impotent or have erectile dysfunction (ED)? Impotence or ED is when a man has trouble getting or keeping an erection. This is a common problem after this type of surgery. If often gets better on its own but if it does not, there are treatments available. Your doctor and/or nurse can talk about this with you. 9
Prostate cancer information and/or support groups There is a Hospital Visitation Coordinator available. if you would like to speak the Coordinator before leaving the hospital, please ask your nurse. Support group - Halifax Region Prostate Cancer Canada - Atlantic Region Meetings: This group meets on the 3rd Thursday of every month (except July and August) at 7 p.m. You are invited to come and bring a friend or family member. Location: 5121 Sackville Street, Halifax, N.S. For more information, contact Prostate Cancer Canada - Atlantic Region at 902-420-1444 or visit their website at www.prostatecancer.ca Support groups outside Halifax There are several support groups around the province. Visit www.prostatecancer.ca to find a contact person and the location of meetings in your area. Additional support Canadian Cancer Society, N.S. Division 1-800-639-0222 Cancer Information Service of the Canadian Cancer Society 1-888-939-3333 10
Report these symptoms to your doctor: Fever and/or chills. Redness, swelling, or warmth around the incision. Drainage from the incision. Separation of the edges of the incision. Increasing pain and tenderness around the incision. Increased blood with clots in the urine and no drainage from the catheter. 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. 11
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 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 Illustrations by: LifeART Super Anatomy 1 Images, Copyright 1994, TechPool Studios Corp. USA; Staff at Capital Health 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. WJ85-0245 Revised August 2014 The information in this pamphlet is to be updated every 3 years.