Radical prostatectomy Radical prostatectomy This leaflet gives you information on the operation you aree due to have. It should cover most of your questions, but if you need further information please do nott hesitatee to ask either your GP or a member of the hospital team. What is the operation? The operation you are goingg to have is called a radical or total prostatectomy. It involves removing the whole prostate through an incision made in the lower abdomen. This operation is becomingg a more common treatment in the UK forr cancer which is confined to the prostate gland, affecting men with ann otherwisee normal life expectancy. Benefits The purpose of the operation is for thee treatment and curee of prostate cancer. What happens before the operation? Before you are admitted forr your operation, you will be asked to attend a pre- who assessment clinic. Here you will be seen by urology healthcare professionals, will examine you before you are admitted for surgery. In addition to confirming some details about yourself and your y past medical history, there will also be some routine tests too complete. You will have blood tests, any relevant X-rays and an ECG (an electrical tracing of your heart). h The operation will be explained to you, and you will have the t opportunity to ask any questions you may have at this stage. You will be asked to sign a consent form for your operation now, or when you are admitted to hospital. You will be instructed on pelvic floor exercises, which will help you regain bladder control after your operation. You should practise them before surgery in order to identify the muscle groups used youu may find them difficult to use after the operation. You will be visited by the anaesthetistt either at your pre-assessmentt clinic appointment or on the ward. You will have the opportunity y to discusss with yourr anaesthetist past medical history, the operation you are going to have, plus pain control for after the operation. Page 1 of 7 Leaflet name Leaflet number Created Reviewed Next review Radical prostatectomy 262n77 9 Mayy 2003 Marchh 2017 Marchh 2019
What happens when I am admitted to the ward? Usually, you are admitted to the ward on the day of your operation. Ward staff will ensure that you settle in. Should you have any questions, staff are there to help you, so please ask. Before the operation You will have the opportunity to speak to your consultant and members of the hospital team before your operation. They will be happy to answer any questions you may have. You will be able to have a light diet and fluids on the day before your operation. Staff will advise you when you should be nil by mouth' (NBM) and stop taking food or fluids. You will be measured for support stockings (called TEDS). You need to wear them as a preventative measure against blood clots forming. You will also be given daily injections to help prevent clots. The operation In addition to this written information, there are illustrations at the end of this section. You will be taken to the operating theatre by a member of staff from the ward and a hospital porter. A small catheter may be placed in your back for administering pain relief after the operation this is called an epidural. When you have had your anaesthetic, you will be taken through to the operating theatre. Here the surgeon will make an incision from the base of your penis to just below your navel. The surgeon may take samples from the lymph glands that drain the prostate. These will be looked at in frozen sections under a microscope and if the cancer affects them the surgeon will not continue with the operation as other forms of treatment may be better for you in that case. The prostate is removed, together with the seminal vesicles (where sperm is stored). The neck of the bladder is then repaired and stitched to the urethra, and the incision closed using stitches. The operation can take around 2½ hours or more, and you will stay in the theatre recovery room until you are comfortable enough to return to the ward or high dependency unit. After the operation When you wake up from the operation you may be wearing a small plastic tube placed under the nose to provide oxygen called a nasal cannula. You will have a drip in your arm or hand, attached to a bag of fluid. This is to prevent you from becoming dehydrated. You may also have a drip in one of the big veins of your neck (CVP line), to assess if your body is dehydrated or not. This is usually removed after a couple of days. Page 2 of 7
You will have a wound on the front of your abdomen. There will be one or two plastic tubes (called drains) inserted to remove any blood which collects at the operation site. These are usually removed after two to four days. The wound will be covered with a dressing. You should expect to have some swelling and bruising of the legs, penis and scrotum. There will be a tube (catheter) in your penis, going up to your bladder. Sometimes there is also a tube over your pubic bone (a supra-pubic catheter). Attached to the catheter will be a bag that your urine will drain into. The volume of urine you produce will be measured. This catheter also protects the join' between the bladder and the area where the prostate has been removed. Whether you have one or two catheters, it will be necessary for you to go home with the supra-pubic catheter still in place. You will be called back to the ward to have it removed, usually two to three weeks after surgery. While you are in hospital, you will be taught how to look after your catheter and we will inform the district nurses when you are going home in case you need further assistance. You will be given a leaflet about the care of your catheter. Page 3 of 7
While you are on the ward, your blood pressure, temperature and wound site will be checked regularly. This is standard procedure and is nothing to worry about. To keep you comfortable, you will have either an epidural infusion or patient controlled analgesia (PCA). It is important that you report any pain to staff, as your medication may need adjusting. When you are able to take oral fluids oral pain killers may be given, and the epidural or PCA will be removed. You will be seen regularly by the physiotherapists, who will teach you breathing exercises to help prevent a chest infection. You will also be shown leg exercises to help stop clots forming. When you are comfortable enough to do so, staff will encourage you to sit in your chair. This may be as soon as the day after your operation. When will I be able to go home? The average hospital stay is three to five days but you will only be allowed home when the medical team is happy with your condition and you show no signs of infection. Discharge instructions Activity When you get home you may feel tired and will need to rest for up to six weeks after your operation. You should avoid heavy lifting, pushing, straining or any strenuous activity. Walking for short periods is recommended. Other activities should be discussed with your consultant. Please continue to practice your pelvic floor exercises regularly. If you need advice regarding this please contact the number at the end of this leaflet. Driving You should not drive for three to six weeks after your operation to allow your wound to heal. It is advisable to be assessed and deemed fit to drive at your first consultant appointment after your operation. You should check with your insurance company regarding cover after your operation. Diet You may eat and drink whatever you wish. If you are prone to constipation, eat plenty of fruit and vegetables. You may take oral laxatives but do not use a suppository. It is important that you drink plenty while your catheter is in place. Try to drink 2-3 litres of fluid a day. Once the catheter has been removed you may find that drinks containing caffeine (tea, coffee or hot chocolate), fizzy drinks and alcohol may aggravate the bladder and are best avoided. Bathing/showering It is quite safe to get your wound wet and you can bathe or shower with the catheter in place. Page 4 of 7
Wound care When you leave hospital you will be given a district nurse letter with contact details. Please contact them if you have any concerns regarding your wound. Catheter care Please keep the catheter attached to a bag at all times. You may use a leg-bag if you wish, but do not allow it to become too full. It is not uncommon for urine to leak from around the catheter when you either get out of bed, or get up from a chair. This is normal and should not cause alarm. You may also notice leakage or bleeding when you have your bowels open. You can use disposable pads to control the leakage if it is a real problem, and the district nurse will be able to advise you on obtaining supplies of the pads. He or she should be contacted if you have any concerns regarding your catheter. Risks Bleeding If you notice a little blood in the catheter bag, please drink plenty of fluids. The blood usually disappears then, but if it does not or if it becomes thick or heavy, please contact either your GP, district nurse or Mersea Ward at the hospital, on 01206 742038. If the catheter becomes blocked and stops draining urine it is important that the blockage is cleared. Once again, you must contact your GP, a district nurse or Mersea Ward. Do not try to unblock the catheter yourself, as this must only be carried out by trained professionals. Pain Aches and pains in your stomach are common. Some people have pain around the lower back, in the hips or legs. These pains pass with time, but you should take painkillers regularly. If your pain is not controlled, please contact your GP. Blood Clots One of the major complications after this operation is a deep vein thrombosis (DVT). Although only a small percentage of men are affected, this usually occurs between one and six weeks after the operation. A DVT can cause pain and swelling of your leg. Sometimes a clot will break away from the blood vessel in your leg, travel up the body and lodge in your lung. This is called a pulmonary embolism (PE) and causes pain in your chest and breathing difficulties. If you develop any of these symptoms you must contact your GP straight away, or go directly to the hospital. Do not put this off, as the result could be serious. Urinary Infection It is common for urine to become infected when you have had a catheter in for a number of weeks. You may feel quite unwell and experience shivering, vomiting and a raised temperature. To treat this you will need antibiotics and should contact your GP. Sometimes you will feel well, but your urine appears cloudy or has a foul smell. In this case, increase the amount of fluid you are taking, but contact your GP if this has not cleared up within 24 hours. Page 5 of 7
Urinary Control When the catheter is removed, you may have some loss of control of your urine at first. This may be when you cough, sneeze or laugh and is called stress incontinence. This often settles after a time, especially if you are performing your pelvic floor exercises regularly. The amount of time it takes to be regained varies from person to person, so do not be discouraged if it takes a while. On very rare occasions men may need further support or treatment to help regain their continence. It is advisable to avoid too much caffeine and limit the amount of alcohol you drink, as it can irritate the bladder lining and make you pass water more frequently. You should not drink alcohol when taking pain-killers and/or antibiotics. Sexual Relations Your operation is likely to have damaged the nerves running alongside the prostate, and your ability to have an erection may be impaired. In some men, erections do return, but this can take up to 18 months, although the amount of time can depend on the age of the man, the extent of the tumour as well as the extent of the damage to the nerve supply. Some men recover potency two years after the operation. If this does not occur it can be overcome using an injection, suction pump or medication. Your consultant will be able to advise you about this. You should be able to experience an orgasm even if you do not have a full erection. There will be no emission (ejaculation), however, because the prostate and seminal vesicles have been removed. You are likely to be offered medication such as Viagra or Cialis at your first consultant appointment after your operation as research has shown that by taking this medication at an early stage and regularly, the blood flow is improved in the area and therefore helps in the repair of the nerve tissue giving a greater chance of regaining erections. Follow-up appointments You will be seen by the consultant a few weeks after your catheter has been removed. You will be notified of the date before you are discharged, or through the post. At that appointment your consultant will discuss whether you require any further treatment and you can ask any questions you may have. Returning to work You will need to get a signed doctor's certificate to cover your time off work. Your consultant will tell you when you can return. This is usually about three months, depending on your job, but can be earlier. Page 6 of 7
Contact details In the event of any problems or for further information, please use any of the contact numbers providedd to get advice. Mersea Ward: 01206 746251 Main Hospital Switchboard: 01206 7474744 District Nurses: To contact your district nurse, please ringg your GP Please do not hesitate to call. practice. Your views If you or a family member has recentlyy been in Colchester r General Hospital, you can tell us about your experience by searching for Colchester on the NHS Choices websitee (www.nhs.uk), by writing to the addresss on the front of this eaflet, by emailing your comments to info@colchesterhospital.nhs.uk or by filling in a Friends & Family questionnaire at the t hospital, telling us if you would recommend our service to a friend or family member. Urology Department Colchester General Hospital Turner Road Colchester CO4 5JL Tel: 01206 742964 Page 7 of 7 Leaflet name Leaflet number Created Reviewed Next review Radical prostatectomy 262n77 9 Mayy 2003 Marchh 2017 Marchh 2019