Post-Operative Instructions

After your Surgery

Patients are admitted to the hospital on the day of surgery.  Most patients will be able to go home the next day after lunch with a urinary catheter attached to a bag.  Patients are usually seen in the office about 1-2 weeks after surgery for an x-ray on the catheter.  Catheters are removed at this time if urethra has healed.

Diet

  • Eat a soft diet that contains easily digested food until you are regularly passing gas without difficulty or until you have a good bowel movement. You may then resume a regular diet.  Avoiding gas-producing foods, such as beans, broccoli, and soda
  • Eating smaller meals rather than 3 large meals per day is helpful.  Do not be alarmed if you experience some weight gain immediately after your surgery. This is temporary due to the gas and fluid shifts. Your weight will be back to your pre-operative weight in a few weeks.
  • Weight Gain: Do not be alarmed. This is temporary due to the gas and fluid shifts. Your weight will be back to your pre-operative weight in a few weeks.

Activity

  • Walking for exercise is generally a good activity.  Build up this activity gradually, and avoid straining or doing too much.  You can do as much walking and stair climbing as you can tolerate.  Begin slowly and gradually increase to your pre-surgery activity level.  You should not engage in strenuous activities such as exercise or heavy lifting for at least one month.
  • Avoid sitting still in one position for more than 45 minutes at a time.  You may also want to sit on a pillow since your rectal area will be very tender after your surgery.
  • Patients should be able to take daily quick showers about 48-72 hours after surgery.  You may remove band-aids or dressing from wound before you shower.  Have water run over wound, then pat dry.  There is no need to replace dressing unless wound is still draining fluid.  We will remove wound staples about 2 weeks after surgery.  Avoid tub baths or hot tubs for 4 weeks after surgery.
  • You should avoid driving for one week or until the Foley catheter for your urine is removed.  Please be sure you do not drive while you are taking your pain medication.
  • Refrain from sexual intercourse for one month.
  • You may return to work in 2-3 weeks if you have a job that involves sitting most of the time (like a desk job).  If your job is strenuous, you may usually return to work in 4 weeks.  Dr. Leung will take your occupation into consideration when determining when you may return to work.
  • After surgery, your abdomen may be bloated and it will be difficult to fit into your regular button pants such as jeans.  It is recommended that you wear pants with elastic waist for comfort.
  • Bruising around the incision sites is not uncommon.  This will go away over time.
  • If you experience swelling or bruising of your scrotum or penis, this is normal.  This may appear for 4 to 5 days after surgery.  You may try the following should you get any new swelling or bruising of your scrotum or penis
  1.  Prop up the swollen scrotum slightly to reduce swelling.  You can roll up a small towel or washcloth to elevate your scrotum when you are sitting or lying down.
  2. Wear snug-fitting underwear for support, even when the urinary catheter is in place.

Urinary Catheter (Foley catheter)

  • During surgery you will have a urinary catheter placed in your bladder.  A urinary catheter is a tube that carries urine from your bladder to the outside of your body into a bag.  This urinary catheter will stay in place for about 1 week to aid in the initial healing process where the bladder was sewn to the urethra
  • You may have bladder spasms while you have a catheter, or sometimes after the catheter is taken out.  You may feel mild to severe bladder pain or cramping, a sudden, urgent need to urinate, or a burning sensation when you urinate.  This problem is not uncommon.  Call to report if this problem persists without relief.
  • There is a balloon on the end of the catheter that prevents it from falling out of the penis. At home, the catheter should drain into a large bag.  When you want to go out, you can wear a smaller bag under your pant leg.  A separate information sheet in this packet details the care of this catheter.
  • Putting antibiotic ointment (ie. Neosporin) on the tip of your penis a few times a day while the catheter is in place can help to reduce the discomfort at the tip of the penis that some patients experience.
  • It is normal to have urine leak around and through the catheter so be sure to wear absorbent pads in your underwear even with the catheter in place
  • After activity or a bowel movement, you may have bloody drainage around the catheter or in your urine.  While this may cause you alarm, it is not uncommon.  Usually this drainage will lessen after you rest for a short period of time.   
  • It is normal, especially as you become more active, to have some blood in the urine. If you see blood in your urine be sure to hydrate yourself well to flush any clots out.
  • Perineal (area between your rectum and scrotum) pain and testicular discomfort may last for several weeks after surgery.  It will go away over time.  Call Dr. Leung’s office to report if the pain medication does not relieve the pain.

If you have pain when you have a bowel movement you may try any of the following to alleviate that pain:

  1. Elevate your feet on a small stool when you have a bowel movement.
  2. Try using Anusol ointment or a similar type of product.
  3. Try increasing the fiber and water intake in your diet.

Medications

  • When you are discharged from the hospital you will be prescribed Vicodin 1-2 tabs every 4 hours as needed for pain Colace 100 mg twice per day for 1 month to keep stool soft and avoid constipation.  An antibiotic such as Cipro 500 mg twice per day (or a similar antibiotics) will also be prescribed for 7-10 days to prevent infection.
  • Most often you may resume your daily medications as soon as you are discharged from the hospital.  Aspirin and blood thinning medicines like Coumadin can usually be resumed after the Foley catheter is removed.  Talk to your prescribing doctor about when you should restart this kind of medication.
  • When you are discharged from the hospital Dr. Leung will prescribe the antibiotic, Cipro, to be taken orally.  Remember; do not take these pills along with milk or dairy products. Follow the package directions.
  • Most people do not have a bowel movement for 2 to 4 days after surgery.  A prescription for a stool softener will be given to you the day of discharge.  This should be started when you get home.  Take it for at least 1 month to keep stool soft to avoid straining.

Important Recovery Information

  • You can return to light activity within 23 hours and will be cleared by Dr. Leung to return to unlimited activity generally 1 month after the surgery.
  • Most men have difficulty with urinary control at the beginning and will require some form of protection, such as an absorbent pad that fits inside your underwear.
  • You will be seen about 1 week after surgery back at Dr. Leung’s office to determine if the catheter will be removed at this visit. An x-ray (cystogram) will be done the morning of your appointment in our office to examine the bladder and suture site between the bladder and urethra. Remember that the prostate sits between the bladder and penis with a portion of the urethra running through it like a tunnel.  After the prostate is removed the bladder is re-attached to the urethra with sutures.  A contrast material will be dripped into the bladder through the Foley catheter.  After the x-rays have been taken, the liquid will be drained out of your bladder through the catheter.  Dr. Leung will review the results of the cystogram to determine if the suture site has healed enough for the catheter to be removed.  Your catheter can be removed after the first week 95% of the time.  Occasionally, the catheter will need to stay longer to allow complete healing of the urethra.
  • Kegel exercises should be started after the Foley catheter is removed.  These exercises help regain your urinary control or your ability to urinate.   More detailed information on doing Kegel exercises is provided for your convenience starting on page 27.
  • The recovery of potency after a prostatectomy can be slow and time-dependent. Even though the nerves to the penis can be spared, there is still some injury from trauma or stretching from the operation. These damaged nerves need time to heal. At each follow-up visit with Dr. Leung or your urologist, issues regarding sexual function will be discussed with you.

Associated Surgical Symptoms

Scrotal/Penile Swelling and Bruising
Swelling and bruising of the scrotal and penile area may appear immediately after surgery or may start a few days after surgery.  It should resolve on its own in about 7-14 days.  You may also try elevating your scrotum on a small towel or washcloth that you have rolled up when you are sitting or lying down to decrease the swelling.  It is also recommended to wear snug fitting underwear for support even with your catheter in place. 

Bloody drainage around the catheter or in the urine
This can be a frightening experience, but is not uncommon.  Usually, resting for a short period of time improves the drainage.  Please call Dr. Leung’s office if you see blood clots in your urine or if you have no urine output for 1-2 hours.

Bladder Spasms
It is not uncommon with the catheter in and even after the catheter comes out to have bladder spasms. You may feel mild to severe bladder pain or cramping, the sudden, urgent need to urinate, or a burning sensation when you urinate.

Perineal Pain (pain between your rectum and scrotum)
Perineal discomfort may last for several weeks after surgery, but it will resolve.  Please call Dr. Leung’s office if your pain medication does not alleviate the pain.

Lower leg/ankle swelling
This is not abnormal and should not alarm you.  It should resolve in about 7-14 days.  Elevating your legs while sitting will help.

Bruising around the incision sites
Many patients call our office frightened that their lower abdomen (site of the incisions) is bruised.  This is not uncommon and will resolve on its own over time.  Redness may also develop around staples in your skin.  Staples are frequently used to close your incisions, and will be removed 10-14 days after your surgery.