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Advice for patients undergoing Radical Prostatectomy
under the care of Mr H Lewi, FRCS

On the second day following your operation, you will only be left with your urinary catheter and it may be possible for you to enjoy a general shower. As each day progresses you will begin to feel a lot better, and be looking forward to going home, which is normally on the fourth or fifth day following surgery. You will be given a supply of antibiotics and pain killers to take home with you and the nurse will again advise you regarding general care of your catheter. The nurse looking after you will provide an admission date for removal of your catheter, and a sick certificate if required.

Once at home you should mix periods of rest with gentle exercise, and as each day progresses you will feel like doing a little more. The body is very good at ‘informing’ you if you have done too much, and you will feel like resting. Please do not feel like you are alone at home, if you have any problems at ANY time of the day or night then please do not hesitate to ring Springfield Hospital or you could ring Sarah Buttle on 07905 428836.

If once at home you feel feverish, experience extreme pain, your wound begins to look red or feels hot, or if your catheter fails to drain any urine then please contact the ward at Springfield Hospital.

Because of the nature of your surgery is important that you ring Springfield Hospital or Sarah Buttle if your catheter falls out. Nobody, not even your GP must attempt to recatheterise you.

You are advised to take 6-8 weeks off work, and avoid heavy lifting and close contact sports at the same time. There is also a possibility that some urinary incontinence will follow this operation. This is stress incontinence and usually lasts a minimum of three months however this problem may continue for up to one year. During this time, there will be leakage of urine during exertion, exercise and change of posture, although the extent and severity varies. During this time, you may wish to wear some form of protective pads.

Removal of the prostate to eradicate your cancer will result in erectile dysfunction. There are however, treatments/ surgery that Mr Lewi can offer so that sexual relations can be resumed. He will be quite happy to discuss this with you at any time.

We hope that your stay with us at Springfield Hospital will be as pleasant as possible and ask you to convey any fears or questions to us straight away. Once home, we are available at any time of the day or night to assist you with any queries that you may have. Please contact Springfield Hospital on 01245-234080 and ask to speak with the Nurse in Charge on the Acute Unit or the Oncology Sister (Monday - Friday). You are to be admitted to Springfield Hospital for a radical prostatectomy. This operation involves total removal of the prostate gland for the eradication of localised prostate cancer.

Prior to your admission you will receive two appointments. One of which is to see the Consultant Anaesthetist who will be putting you to sleep for your operation and the other appointment is to attend the pre admission clinic, where you will meet Sarah Buttle, Mr Lewi's urology nurse. She will complete all your relevant paperwork and explain to you the operation. Please feel free to bring a list of questions with you that you need answering. You will also have blood test and an heart trace performed.

You will be expected to stay for approximately 5 nights so should bring toiletries and pajamas. Would you also pack a few flannels with your toiletries as these are required whilst washing in bed. It is also helpful to bring with you any medication that you are presently taking. Your room will have both a television and radio, but you may wish to bring some reading material with you to help fill your time both before and after your operation.

You will be admitted onto the ward the afternoon before your surgery. On arrival to Springfield Hospital you will be shown to your room by a member of our portering or administration staff, a nurse will come to see you shortly. The nurse will also take this time to show you and your relatives around our HOU (high observation unit) and explain all the equipment involved with your post-operative recovery. We feel it is of benefit to you if you spend the first and possibly second post operative night in this unit as it ensures that you get the best possible nursing care and attention as one nurse will be specifically assigned to look after you. Visiting whilst you are in HOU is restricted to close family only. A member of the administration staff will also see you on admission to go through all the necessary paperwork in relation to your health insurance. Both Mr Lewi and a consultant anaesthetist will also see you prior to surgery.

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After the operation
Once your operation is over, you will be returned to HOU. Listed below are the things that will be used to aid your recovery.

1. Additional oxygen
This is administered by using a face mask or by a small tube which lies just beneath your nostrils. This will cause no discomfort at all. This is normally discontinued on the first day following your operation.

2. Intravenous fluids
As you are not eating or drinking it is essential that your body still receives fluids. This is done by giving fluids via a small needle in the back of your hand. Once your condition allows, this will be removed. This normally occurs on the second day after your operation. You are allowed to start drinking as soon as you feel able, and you will normally enjoy a small breakfast the day after your operation.

3. Blood transfusion
The prostate region is very vascular and it not unusual for you to need a blood transfusion to replace the blood lost during surgery.

4. Pain relief infusion
All surgery involves some degree of pain and your anaesthetist will discuss the best way for this to be dealt with to make your recovery as comfortable as possible. Once you are able to take adequate pain killers by mouth this infusion can be discontinued. This is normally on the second day following surgery.

5. General monitoring
You will have a small needle inserted into your neck which enables us to monitor your condition. This is totally painless and is removed the morning after your surgery. You will also be connected to a cardiac monitor so that we can monitor the effect of the surgery and treatment in relation to your heart. You will also have a blood pressure cuff on your arm which will become firm on occasions so that we can monitor your blood pressure. A small white clip will also be placed on one of your fingers so that we can monitor how much oxygen is present in your body. This is all routine monitoring equipment and does not mean that anything has gone wrong with your surgery. In fact, they are purely advances in technology, and are removed at some time during your first post-operative day.

6. Wound
This is a straight incision from top to bottom and is normally 4 inches in length, finishing where your pubic hair starts. The stitches used are dissolvable, which means that they do not need to be removed. They can take up to 3 weeks to dissolve. It is not uncommon for the wound to ooze for the first few hours. The nurse will change the dressing as required. When you feel able, normally two/three days after your operation, the wound will be sprayed with a watertight dressing and you will be allowed to shower, in preference to bathing. You may also notice that your scrotum is bruised - this is quite normal.

7. Wound drain
When the prostate is been removed, this leaves a small cavity where, as part of the healing process, it will fill with fluid/blood. To remove this body fluid a small wound drain is inserted. This is a small tube which drains fluid into a small bottle which will hang on the side of the bed. This is normally removed on the second day after your operation, and does not normally cause discomfort.

8. Urinary catheter
This is a small tube inserted into your penis which will drain any urine that collects in your bladder, this will collect into a bag at the side of your bed. Do not be alarmed if the urine appears to be blood stained, this is quite normal. To prevent any ascending infection, you should wash the catheter tubing in a single downward stroke with soap and water at least twice a day or when you see any debris on the catheter tubing. The nurse can advise you on this. It is quite normal for the penis to also ooze a pale secretion in response to the catheter being present. You will go home with the catheter as it remains in place for fourteen days following surgery. You will be expected to return after discharge to have the catheter removed and stay for a few hours so that we can ensure that you are passing urine.

The morning after the operation
The morning after surgery you will be seen by Mr Lewi, and the anaesthetist. Further blood samples are taken to ensure your condition is progressing satisfactorily and you will slowly begin to feel more ‘with it’ as the general affects of the anaesthesia and analgesia begin to wear off. The nurse will give you a full wash in bed and you may even be sat out in a chair for a short period. Visiting should still be restricted to close family as rest is an important part of your recovery. The physiotherapist will instruct you regarding gentle general exercises you should be doing whilst your mobility is reduced.

It has been suggested that ‘Pelvic Floor Exercises’ performed both before and after surgery can improve control of your bladder and thus help reduce the problems associated with urinary incontinence after radical prostatectomy. The Physiotherapist will visit you at some time during your admission to ensure that you understand how to perform these exercises, and answer any other questions that you may have in relation to urinary incontinence.

Pelvic Floor Exercises
What is the pelvic floor?
The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front. A man’s pelvic floor supports the bladder and bowel. The urethra (bladder outlet) and the rectum (back passage) pass through the pelvic floor muscles. The pelvic floor muscles play an important part in bladder and bowel control.

How to control the pelvic floor Muscles
The first thing to do is to correctly identify the muscles that need to be exercised.

1) Sit or lie comfortably with the muscles of your thighs, buttocks and abdomen relaxed.

2) Tighten the ring of muscle around your back passage, as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks or tighten your thighs or tummy muscles.

3) Imagine you are passing urine, trying to stop the flow mid-stream, then restarting it. (You can do this for real if you wish, but do so only to learn which muscles are the correct ones to use and then do it no more than once each week to check on your progress, otherwise it may interfere with your normal bladder emptying process) If your technique is correct, then each time you tighten your pelvic floor muscles you may feel the base of your penis move up slightly towards your abdomen.

If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles, then please inform the physiotherapist on admission who will assist you with this.

Doing Pelvic Floor Exercises
Now that you can feel the muscles working you can start to exercise them:

1) Tighten and draw the strong muscles around the anus and the urethra all at once. Lift them up inside. Try and hold this contraction strongly as you count to 5, then release slowly and relax for a few seconds. You should have a definite feeling of letting go.

2) Repeat ‘squeeze and lift’ and relax. It is important to rest in between each contraction. If you find it easy to hold for 5 seconds then try to hold for longer, say up to 10 seconds.

3) Repeat this as many times as you are able to, up to a maximum of 8-10 squeezes. Make each tightening a strong slow and controlled action.

4) Now do five to ten short, fast, but strong contractions, pulling up but immediately letting go.

5) Do this whole exercise routine at least 4-5 times each day. You can do it in a variety of positions, lying, sitting, standing, and walking.

Whilst doing the exercises:
DO NOT hold your breath.
DO NOT push down instead of squeezing and lifting up.
DO NOT tighten your tummy, buttocks or thighs.

DO your exercises well. The quality is more important. Fewer good exercises are more beneficial than a many half-hearted ones!

Advice sheet for removal of Urethral Catheter
You have been asked to attend Springfield Hospital for removal of your urethral catheter. On arrival to the hospital please report to the main reception, where a member of the team will escort you to your room. If you have arranged to meet Sarah Buttle in outpatients for removal of your catheter, could you please report to outpatients reception.

The nurse looking after you will come in and introduce him/her self to you and explain what is going to happen.
As you are probably aware your catheter is held in place by a small balloon which is inflated with water. This stops the catheter from falling out of your bladder. To remove the catheter the nurse has to deflate the balloon with a syringe. This takes a few seconds and the nurse will then ask you to bear down as if you are passing water as she/he slowly removes the catheter from your bladder and urethra. This will feel a little uncomfortable but not painful.

You will then be given a jug of water to drink and a bottle to pass urine into. It is important that you only use the bottle once. Even if you only pass a dribble you must tell the nurse as she/he is recording everything that you pass. Please refrain from drinking tea/coffee at this stage as they both contain caffeine which will stimulate your bladder to pass urine before it is ready to.

Your length of stay will be approximately 3-4 hours. We need you to pass urine 3 times and each amount to be 200mls or over.
If at any stage you begin to feel that you want to pass water and you can’t or you feel that you are not emptying your bladder completely, please tell the nurse looking after you.

Helpful hints
Please ensure that your bowels are working properly prior to your catheter removal.
If you take diuretics refrain from taking them on the morning of your catheter removal. You can take them when you get home.
If you have a flip flo valve please ensure that the nurse empties this prior to removing your catheter.

If you have any queries please contact either Sarah Buttle on 07905 428836 or the ward on 01245 234080/081.

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