A DESCRIPTION OF THE HOSPITAL STAY FOR RADICAL PROSTATECTOMY

Introduction

You and your doctor have decided to proceed with removal of your prostate (along with the regional lymph nodes) for the treatment of your prostate cancer. The hospital stay usually lasts 2-3 days, but everyone and every operation is different. In order to go home you must be eating, having good pain control, walking in the halls, and able to take care of normal activities of daily living.

Hopefully, this web page will answer most of your questions about your hospital stay. Perhaps not every question will be answered, so feel free to call us if more information is needed.

Preparation for the Operation

Any surgical procedure of this magnitude is done in a hospital. Unless there are some extraordinary circumstances, you will probably be admitted on the day of surgery. You may need blood tests, an electrocardiogram (EKG), and other tests done prior to your surgical date, or on the morning of admission. It is very important that you refrain from eating or drinking anything for at least eight hours prior to your scheduled operation time. In most circumstances this means nothing should pass your lips after midnight before your surgical procedure. If you have been on a special bowel preparation or diet, adhere to the diet until midnight before the surgery. You may take you regular medications until midnight. Any other medications should be checked out with us. You should NOT be taking any aspirin or aspirin products for 7-10 days before the surgery.

On the morning of your surgery you will be admitted to the hospital through the admitting office. You will then change into a hospital gown and placed into a bed in the preop area. An intravenous line may be started to replenish your body's fluids. The anesthesiologist will talk to you about the anesthesia and answer any questions about anesthesia and postop pain relief. Over the past 5 years we have developed a routine for the anesthesia that allows patients to recover very quickly with minimal post-op pain. The first part of the anesthesia is a spinal injection of a long-acting pain reliever, which usually gives very good pain control until the next morning. After the spinal injection you will go to sleep, a process called general anesthesia. While under general anesthesia you will have a breathing tube in your throat which will deliver oxygen and the anesthetic gases that keep you asleep. Because of this tube you may have a mild sore throat for 1-2 days after surgery. You will wake up in the operating room, but your first memories will most likely be in the recovery room after surgery.

The Operation and Recovery Room

You will be transported into the operating room when the room, the surgeons and anesthetists are ready. Special inflatable stockings to prevent blood clots in the legs may be put on before you are asleep. Monitor electrodes for the EKG and a blood pressure cuff will also be put on. Spinal anesthesia is then performed, usually with the patient in a sitting position. The anesthetic is then started and the surgery is completed within 2-3 hours. After the surgery is completed the anesthetic will be discontinued and you will be taken to a recovery room.

In the recovery room nurses will watch you very carefully until your anesthetic effects have worn off. The nurses will apply an oxygen tube or mask to your face and start checking your blood pressure and pulse frequently. Most patients have only a small amount of pain in the lower abdomen, but pain medication will be given to you as needed. You will note that the nurses are constantly watching the rubber tube, or catheter, that leads from your penis to a drainage bag on the side of the bed. This tube has been placed through your penis (or urethra to be more exact), into your bladder, and drains the urine during the healing process. The catheter is held in position by a small balloon at the end which is inflated after it is placed. The catheter will drain urine from the bladder, and the urine may be bloody for several days after surgery. Occasionally clots will form and the tube will stop draining. The nurses will then use a special syringe with water to hand irrigate the catheter to free it of clots. Hand irrigation might be somewhat uncomfortable, but necessary, to clear any plugging of the channel and allow the urine to flow. Once your anesthetic has worn off and the urine is draining satisfactorily, you will be transported to a hospital room.

Postoperative Care

Once in your hospital room, the floor nurses will check your 'vital signs' (blood pressure, pulse and respiration) and set up your inflatable stockings, your urinary drainage bags, and your intra-venous lines (IV). After this operation we use a pain medication called Toradol, which is given in your IV every 6 hours for the first 2 days. You do not have to ask for Toradol, the nurses will give it according to a set schedule. If you are still in pain the first night after surgery you should tell the nurse, and they will give you a dose of narcotic into your IV as often as necessary. The next morning after surgery pain pills will be given.

You will not be able to eat a regular diet on the day of surgery, but you may be able to have sips of water that first evening. Usually the next morning you will be started on a light diet and by the evening of the first day after surgery most patients are able to eat a regular diet. Your will most likely not have a bowel movement for 3-5 days after surgery, although most patients are passing gas sooner. Laxatives are not usually necessary, and your bowels will usually go back to normal within a week.

You will probably stay at bed rest until the evening of surgery when the nurses will help you dangle your legs at the bedside or help you up to a chair. By the next morning the nurses will begin to get you out of bed. It is very important that you are able to get up out of bed and walk in the halls starting the day after surgery. This requires good pain control, and you must notify the nurses if your pain control is not adequate. There is no risk of becoming addicted to the pain medications, and there is no extra credit for "toughing it out." You may be a little sore at first, but walking will help your bowel function return to normal, prevents blood clots from forming in the veins of your legs, and makes the pain go away faster.

The nurses on the floor will continue to observe your catheter drainage, and a leg bag will be placed on the first post-operative day. This bag can be worn under loose fitting pants, and will be used most of the time while you are home before the catheter is removed. The nurses will teach you how to care for the catheter and leg bag before discharge. Your regular medications will usually be restarted the day after surgery. Once the intravenous line is no longer needed and you are eating normally, you will be ready to go home.

You will also notice a plastic tube or drain that exits the abdomen to the side of the incision. This is to help remove the fluids that collect internally around the surgical site. This tube and drain are removed usually on the second or third day when the drainage is stopped.

Your incision has been closed with steel staples. These will be removed in the office one week after surgery and replaced with small pieces of tape or 'steri-strips' to keep the incision together. These will start to peel and fall off 7-10 days later and can be removed at that time.

Getting Ready for Discharge to Home

We feel strongly that patients should go home as soon as they are ready for several reasons. Most patients rest better at home once they no longer need nursing care, and patients are usually more comfortable in their own surroundings. The most important reason, however, is that the longer you spend in the hospital the higher your chance of getting a wound or urinary tract infection. This is because hospitals are full of sick patients and many visitors and staff. The hospital is the best place for patients as long as they need to be there, but you are better off going home when you are ready. We will not send someone home before we believe they are ready to go home. You will be taught how to take care of your catheter and the various types of drainage bags. You will probably be discharged from the hospital with various medications, which may include pain pills, stool softeners, and antibiotics. The nurses will explain all instructions prior to discharge

Post Operative Home Expectations

Most patients recover remarkably well after this surgery, and by 2 weeks are 80-90% back to normal strength. Radical prostatectomy is a major surgery, however, and you may not feel 100% back to normal for 6-8 weeks. You may shower and walk immediately after getting home. The only restrictions at that time are no heavy lifting (more than 10 lbs.) for 4 weeks after surgery, no driving for 3 weeks, and no swimming or soaking in a bath until the catheter is removed. After one month there are no restrictions at all and we encourage you to resume normal activities as quickly as possible.

Some patients will experience bladder spasms after surgery, which may last until the catheter is removed. Bladder spasms are caused by the bladder squeezing on the catheter, and will give a strong urge to urinate that lasts about one minute. At the same time a small amount of urine may leak around the catheter. Bladder spasms are less common the first week after surgery but are common the second week. If bladder spasms become frequent and bothersome you may start a medication called oxybutinin to prevent them. You will be given a prescription for oxybutinin at the time of discharge or when you return to the office one week postop.

You will be seen two weeks after the discharge to have your catheter removed. The day before the catheter removal you should start antibiotic tablets to ensure that there is no urinary infection and also start a medication for bladder spasms if you have not yet started. You should bring an incontinence pad to that visit since most patients will have some urinary incontinence after the catheter is removed. A common brand is Depends Pads for men, but there are similar store brands that are less expensive.

BOWEL PREP FOR RADICAL PROSTATECTOMY

Although small, the risk of infection with abdominal surgery is real. In order to reduce the risk of infection you will be on a special bowel preparation program. This will clear out your colon before surgery, and you will not have a bowel movement for 3-5 days after surgery.

ONE DAY BEFORE SURGERY DAY: ___________________________

DATE: _________/_________/_______

Take your regular medications (except aspirin or aspirin products), unless otherwise informed. You may have a regular breakfast and a light lunch.

After lunch between 1 and 3 PM you should take 3 Dulcolax tablets (available over-the-counter, generic name docusate sodium). This may cause some lower abdominal cramping and should cause you to have a bowel movement.

After lunch you must limit your diet to clear liquids. This is most important!! NO SOLID FOODS, NO MILK OR DAIRY PRODUCTS...please!

At 4 PM please drink one 8 ounce bottle of Magnesium Citrate (available over-the-counter). This will cause you to have several loose bowel movements and ensure that you don't have stool in the colon at the time of surgery.

In the evening please drink 3 eight ounce glasses of water, tea, or clear juice.

Nothing to eat or drink after midnight.

Remember -- no Aspirin products 7-10 days before surgery!!!!!!