The following are commonly asked questions for a radical prostatectomy. When you talk to a clinician at the pre-admission clinic, they will direct you as to any specific instructions from your surgeon and anesthesiologist.
7 days. It is okay to take Tylenol.
7 to 10 days.
Do not take any vitamins, supplements, or over-the-counter medications 10 days prior to surgery, unless approved by your surgeon’s office. Some of these supplements may have anticoagulant effects and result in bleeding during surgery.
You must stop coumadin prior to surgery. The scheduling of holding the coumadin is an individualized decision that your primary care physician will make with you. Typically, patients are asked to stop taking coumadin 5 days prior to surgery. Please consult your primary physician to determine the exact timing of holding the coumadin in your circumstance.
You will meet with our anesthesia service in the days preceding your surgery. They will instruct you in the management of your additional medications.
Less than 5% of patients require blood transfusions. The risk of acquiring a transmittable disease after a transfusion is less than 1/ 300,000 and your surgeon would prefer that you not begin the surgery in an anemic state. Therefore, it is not standard procedure at VGH to bank your own blood prior to surgery.
The day before surgery, you will be asked to stop solid foods after breakfast.
Depending on the type of surgery and your previous medical history a bowel preparation will be used. You will receive either 2 Fleets enemas (to be taken the evening prior to surgery) or 1-2 bottles of Magnesium Citrate (to be taken in the afternoon prior to surgery). Your surgeon will tell you which of the preparations you will need. In the morning of surgery, you may only have a sip of water to swallow any medications you are told to take, otherwise nothing to drink for 6 hours prior to arriving in the hospital.
If your surgery is at Vancouver General Hospital:
For surgeries on Monday or following a holiday, please call the VGH Admitting Department (604.875.4937) between 11:00am and 2:00pm on Sunday or statutory holiday to find out when you should come to the hospital.
For all other days, please call your surgeon’s office after 2 pm the day before your surgery and they will tell you what time to come to the Jim Pattison Pavilion Admitting Department on the morning of your surgery. If you can not get in touch with your surgeon’s office by 3 pm on the day before your surgery, please call the VGH Admitting Department (604.875.4300) between 3:00pm and 4:00pm
If your surgery is at University of British Columbia Hospital:
If your surgery is on a Monday or following a statutory holiday, please call the surgeon’s office on Friday after 2:00pm For all other days (Tuesday to Friday), you should call your surgeon’s office after 2:00pm the day before your surgery. The surgeon’s office will confirm the date of your surgery and tell you what time to report to the UBCH Koerner Pavillion Admitting Department on the morning of your surgery.
If you cannot get in touch with your surgeon’s office please call the UBCH Admitting Department at (604.822.7033) between 4:00pm and 10:00pm
Please bring all the medications that you take at home (in the original containers), comfortable clothing and toiletries, and your BC Care Card or other proof of medical insurance. Leave all valuables at home including wedding rings and watches. Bring reading glasses if you wear them. Do not wear contact lenses.
Constipation is a common side effect of pain medications. It may be several days after surgery before you have a normal bowel movement. Keep your fluid intake up as water helps to keep your stools soft. You may take prunes, mineral oil, warm prune juice or milk of magnesia for relief. Do not take any rectal suppositories or enemas.
Until you have a normal bowel movement, we recommend that you take primarily liquids. Gradually increase your diet from fluids to soft foods and finally regular food.
You should call you physician’s office after arriving home. Your surgeon will make arrangements for the catheter removal and further follow-up according to his individual pattern of practice.
Prior to discharge, your nurse will show you and family how to take appropriate care of the catheter.
When out in public, remember to use the leg bag and fasten it comfortably under loose fitting pants such as sweat pants or loose running pants. Prevent rubbing of the catheter against the opening of your penis by securing the leg bag on your lower leg in a way that the tubing doesn’t catch or move with each step. You should remember to drink lots of fluid while your catheter is in place. Also, it is normal for your catheter to leak when having bowel movements. There may be small amounts of blood around the catheter at times.
The balloon on the tip of the catheter can irritate the bladder causing some bleeding. Usually, the bleeding will resolve with hydration and rest. If the color of the urine looks like tomato juice, or if the urine stops flowing out of the catheter, you should visit your surgeon’s office immediately.
Any fluid is acceptable to drink. Water is usually best.
You will use both. The nurse will show you how to use a leg bag when you are walking about, and the larger “bedside bag” when you are ready to go to sleep. Make sure to hook the bedside bag on to something (i.e. a chair or the drawer of a bedside table) so that it doesn’t pull on your catheter. You will learn how to change from one bag to another.
Yes! No matter how active and fit you were prior to surgery, you will experience reduced strength and be limited in your level of activity following your prostate removal. To return to normal activity, you will need to follow a sensible exercise program, adapted to your level of health and fitness. Realistically it will be 6-8 weeks before you are back to your pre-surgical stamina and strength. However, you will be surprised that by employing a basic exercise program, how good you will feel in just a few weeks.
You should begin almost immediately. By the late afternoon or early evening following surgery, the nursing staff will assist you in getting up at the side of your bed or into a chair. This is the first form of exercise that you will perform on the road to recovery, so your understanding and participation is important.
You will be asked to stand and walk very soon following surgery. To stand, you will need someone to support you under your arm. With a nurse’s help, stand and walk to a chair. When comfortable you may begin to walk in the hallway. During your hospital stay, you should plan on walking a short distance several times a day.
Weakness, dizziness, fatigue, nausea and feeling flushed are some feelings associated with doing too much. There may also be pain in the incision. You will notice that you will tire sooner with less exercise than before. You may also feel some discomfort, warmth, or stretch down in the pelvic area. When you exercise you should try to stop and rest before these symptoms become too severe. Push yourself, but be sensible. It is better to do several shorter periods of exercise rather than a few longer ones. You may also see blood in your urine if you overdo it.
Whether it is in the hospital or home, you will need pain medication to allow you to move around easily for the first week or so. Anticipate when you will be doing something active and pre-medicate yourself. Oral pain medications take about 20-30 minutes to take effect. Slowly work yourself off the narcotic pain medication and use Tylenol instead.
When you get home, continue your program of rehab and recovery by developing a plan of exercising, and keep to it. The foundation for this program should be frequent short periods of walking. As you feel comfortable, or as you need to get out of the house, move your walks outdoors. At first keep to the back yard, then slowly move to walks along the street. In time, you will be walking a block, then two, then a mile, and so forth.
You may drive after the catheter has been removed, as long as you have stopped taking narcotic pain medications.
You may return to work without restrictions 6 weeks after surgery.
Stretching can also be started almost immediately, even while in the hospital. Again it is important to start very gently and sensibly by listening to your body. If you feel pulling or it hurts, STOP.
Walking - The day after surgery.
Treadmill - Level treadmill is OK (walking pace).
Walking up stairs - You may walk up stairs in your home to get to your destination, but do not do so for exercise for 6 weeks.
Golf - Putting only for 6 weeks.
Bicycle Riding/ Motorcycle riding - 3 months following surgery.
Lifting >10 pounds - 6 weeks.
Minimize the use of narcotic pain medicines (Vicodin, Codeine, Percocet, Tylenol #3), drink lots of water, and take stool softeners. If needed, prune juice or a teaspoon of mineral oil can help as well. Until you have a normal bowel movement, which often does not occur until 4-5 days after surgery, you should plan on eating primarily liquids.
This is usually related to bladder spasms. This is an inconvenience, but not a long-term problem. If the leakage around the catheter becomes bothersome, call your doctor’s office to consider taking an anti-spasmodic agent (Ditropan or Detrol). Leaking may also occur when having bowel movements.
This period of time varies. A few people never require a pad; most will use pads for 3-4 months, others for longer periods of time. Your use of pads depends on the volume and duration of leakage.
Each surgeon has slightly different approaches or ‘formulas’ for postoperative penile rehabilitation. Your surgeon may suggest that you begin using one of the above three agents within the first few days after your catheter has been removed. You do not need to attempt intercourse (masturbation is acceptable). You should discuss the use of these medications with your surgeon.
You may have intercourse as soon as you are comfortable to do so. Remember that you may not lift anything heavier than a laptop computer for 6 weeks following surgery. Intercourse, therefore, should be appropriately tailored.
Your post-operative recovery of sexual function has many variables including: your pre-operative level of function, your age, whether you underwent a nerve sparing procedure. You should ask your physician how soon and to what degree you should expect recovery.
The bladder fills the space where your prostate used to reside. Your penis may be approximately 1 cm shorter following surgery. Some men may also develop a curvature of the penis known as Peyronie’s disease.
The catheter is removed approximately 7-10 days after either a Radical Retropubic Prostatectomy or the Laparoscopic (Robotic) Radical Prostatectomy.
It may be removed by your family physician, or during your follow-up appointment by your urologist or clinic nurse. It may also be removed in the xray department after a test called a Cystogram shows total healing.
You will receive instructions on Kegel exercises, designed to strengthen the external continence muscle and control of urinary flow.
Most patients note significant resolution of urinary incontinence by 12 weeks following surgery. Improvement will continue for a full year after surgery.
Comfortable clothes with jockey shorts (not boxers).
Yes, your bladder will begin to feel full and you will have the sensation of needing to urinate.