What to expect before and after surgery

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General Recommendations: consult with your physician or surgeon for individual recommendations:  Each patient is unique and every patient’s anatomy and recovery may vary; general guidelines provided below.

Months before surgery:

• Balanced diet that your body is      used to is best
• Sleep and exercise can help your      immune system
• Continue your normal sexual      relations (the longer you are not active, the harder it will be to get the      erections back)
• Kegel exercises 3-4x/day
• Inform your regular doctor of your      planned surgery
• Go to physical therapy 1-2x/wk to      learn pelvic floor exercise and control

A Week before surgery:

• Meet with your regular doctor for      preop evaluation, laboratories studies, imaging, and a discussion of      your medications pre and post op.
• Stop all aspirin and NSAIDS      (ibuprofen) products a week before surgery

1 Day Prior to surgery

• A Call from the operating room (in      the afternoon), confirming your arrival time for surgery (usually 6am for      first case and 11am for the 2nd case of the day); We want      you there a 1 ½-2 hrs before surgery.
• You may eat a regular breakfast a      day prior to surgery.
• At noon, you will stop eating food      or any solids:  you may drink      anything clear (that you can see through; broth, juice, tea)
• If directed, Drink your mg citrate
• Do not eat or drink anything after      11pm the night before your surgery (diabetics, consult with your physician      regarding management of blood sugars, meds,  and intake)
• I try to call you the day before      to answer any questions, but you’ll see me before the surgery as well

Morning of Surgery:

• Take your normal morning      medications that your regular physician has recommended you take on the      day of the surgery with a small sip of water
• Report to the Operating Room 
• You and your family will be led to      a preop holding room.  You’ll meet the nurses and anesthesia      personal; I will see you around 15 minutes before your surgery to answer      any questions.  They will place an IV.
• Your family will be led to the      family waiting area while you have your surgery

1. Most surgeries take around 2-½      hrs, however, I like you to plan on around 3-4 hrs.  My nurses will      call you when we start the case.  It takes around 60 minutes for us      to get you into the operating room, asleep and positioned prior to      starting surgery (therefore, the time always seems longer to the      family).  It also takes some time to have you wake up from surgery and get transferred to the waiting room

• I will talk to your family      immediately after surgery

General Recommendations: consult with your physician or surgeon for individual recommendations:  Each patient is unique and every patient’s anatomy and recovery may vary; general guidelines provided below.  

Recovery Room

• You will awake from surgery in the      recovery room.  
• They will observe you for about      1-2 hrs
• You will have a Foley catheter      draining your bladder and this will make you feel like you have to urinate      or have a bowel movement.  
• You will have a small drainage      tube out one of your openings (this is called a JP drain and is      removed 

Floor Room:

• You will be transferred to our      floor and a private room
• Your family can meet up with you      at this room.  The volunteers in the family waiting room can tell you      what room you will be transferred after surgery

Recovery the day/night of Surgery

• You can start to drink fluids and      eat the evening of surgery or the following day; Eat and drink what you      feel like, but don’t over eat.
• The nurses will work on some deep      breathing with the help of an incentive spirometer. You want to take some deep breaths to      get your lungs expanded.
• Move your legs in bed (move the      feet back and forth and bend the knees) to keep blood flowing: You will      have leg squeezers on your legs to help the blood flow.
• You should get out of your bed and      sit in the chair the evening after surgery; you may even walk, if you feel      strong enough.
• You will have pain medications (IV      pain meds) for breakthrough pain; most of the time we can add a medicine called Toradol to help with pain.  Once you’re taking food, we will      try you on oral pain medications.  The less pain medications you      take, the faster your recovery, but take the medicine if you have      significant pain that limits your movement or breathing.
• When you move, make sure your      catheter does not get pulled; There is a balloon to keep it from      being easily pulled out and it is taped, but avoid pulling on the catheter
• As you heal, you will see some      blood and urine leak out around the catheter; as long as the catheter is      draining, this is normal part of the healing process.

Morning After Surgery

• You will have pain at the places      the small ports were placed and near the umbilicus (belly-button) where      the prostate was removed.   These sights are similar to bruises and      hurt for 1-2 days. 
• You may have some pain in the pelvis      , often from bladder spasms from the catheter
• You may feel bloated for 2-4 days      and typically don’t have a bowel movement until 3-4 days after surgery      (this is completely normal)
• You should be able to have a      regular breakfast, but eat whatever you feel like (coffee, juice, toast,      or regular breakfast)
• My staff will teach you how to      care for your Foley catheter.  You typically have the catheter for 1      week after you leave the hospital.  The catheter is NEVER removed      before 1 week.
• The urine may be red, pink, or      clear.  As long as the catheter is draining, this is normal.  If      the catheter stops draining, call your doctor or report to the emergency      room.  Do not let anyone remove the catheter without speaking with Dr.       Johnston.  The catheter may be      gently flushed to remove a clot.
• Begin walking

Day After the Surgery

• Learn Foley catheter care; learn      to use the leg bag
• JP drain is often removed
• Home with the Foley if cleared by      the surgeon and pain controlled. Every      patient is unique, but most patients stay 1-3 days. 
• Usually resume most of your preop      medications (consult with your surgeon or doctor)
• NO aspirin until 1-2 wks after      surgery (discuss with your doctors)
• WE AVOID OR MINIMIZE NARCOTICS      (NORCO, VICODIN). NEW DATA SHOWS      PATIENTS GET MORE INTESTINAL PAIN FROM NARCOTIC THAN FROM SURGERY. YOU CAN USE TYLENOL OR NSAIDS FOR PAIN.

2 Days After Surgery

• Usually Home
• Keep up your deep breathing      (incentive spirometry) and move the legs often; keep moving/walking
• Still have some pain around the      incisions
• Urine may become red/pink with      some movement
• Bloated and some abdominal aches      are not uncommon.
• May shower (should shower!); this      helps keep things clean; allow water to run over tubing

Days 2-7 After Surgery

• Increase walking
• Wean off of pain medications and      try to only take Tylenol
• When you are not taking pain      medications, inhibited, or having pain, you may drive
• Regular diet, but increase fiber      and foods to help avoid constipation (prunes, fruit juices)
• Maintain good fluid intake with      water and juice

Day 7-10

• Meet with  me or my nurse to have your Foley      catheter removed.   The length of catherization is determined prior      to you leaving the hospital, but always is at least 1 week
• The first few days after the      catheter is removed, you are usually continuously leaky (“like a leaky      faucet)
• Over the first week, you’ll start      to notice some control of the leakage
• Pain should be almost gone; just      pain from the catheter

2- Weeks After surgery

• Pain should be resolved,      occasional bladder pains and abdominal pain
• You may have less energy than      normal as your body dedicates energy to healing
• You may start to notice some      control of urine leakage, especially at night
• Around 2-4 weeks, you can get some      pain between the scrotum and the rectum that is most often inflammation      from healing.  You may take some ibuprofen, but call if this pain      gets more severe.
• We will discuss starting Cialis      daily to aid in blood flow to the penis if cleared by your doctor.

Goals:  Social Continence by 3 months (0-1 pads/day)*

Dry at night by 1 month

Dry while sitting by 2 months

Dry when moving by 3 months

(1/2 the patients can meets these goals in 1/2 the time)

1 Month After Catheter Removed:

• Goal: Be generally dry at night , when      sleeping
• You may get up at night more often      to urinate
• Leakage when sitting around should      start to improve
• Still get leakage with heavy      activity
• AT 5 wks after surgery, you can      resume all activities, but not bicycle riding for 3 months.
• May try stimulation to the penis      with the aid of oral medications if cleared by your doctor. Return of      erections are highly dependent on multiple factors; consult with Dr      Johnston for questions.

2 Months After Catheter Removed:

• Goal: Be generally dry at night      and when sitting during the day
• Pain should be resolved
• Get your psa blood test and meet      with Dr. Johnston.  There will be a psa blood test order in the      computer system; show up at any Designated lab to give a sample at least      48hr prior to your 2 month visit with Dr.  Johnston

3 Months After Catheter Removed.

• Goal: Be generally dry at night,      during day with sitting, and with most activities.  (may always be      certain activities that can cause you to have some stress incontinence.       
• You should be down to 0-1 pad/day      be 3 months for most patients, but patient/cancer variable may alter this      goal.
• Dr Johnston may prescribe      medicines to help with continence if you haven’t reached this milestone by      3 months.

Every 3-6 months after surgery:

• Get your psa every 3-6 months      (discuss with Dr. Johnston for planned frequency based on your pathology)

*General Recommendations: consult with your physician or surgeon for individual recommendations:  Each patient is unique and every patient’s anatomy and recovery may vary; general guidelines provided below.