How to look after the port wounds?
- You will have absorbable stitches to your wound which will fall off 2-4 weeks after your operation.
- Ideally, any dressings should remain in place for 24 hours; do not be tempted to look underneath the dressings since this may increase the risk of infection.
- If a wound becomes tender, red, smelly or discharges a lot of fluid, you should contact your District Nurse or GP for advice about possible infection.
What is the purpose of the catheter?
The catheter is a soft, silicone tube which drains urine directly from the inside of your bladder. It is passed along the water pipe (urethra) into the bladder during the operation. At the tip of the catheter is a small, inflatable balloon, filled with sterile water, which holds it in place and prevents it from falling out.
The purpose of the catheter is to act as a “stent” (support) in your urethra (water pipe) so that the area where the urethra has been re-joined to the bladder during your surgery can heal without formation of scar tissue, which may result in a stricture (narrowing) forming.
How do I look after the catheter?
While at home, you will need to care for the catheter and drainage system. The different component parts of this are:
You need to keep the catheter clean on the outside by washing your penis, under the foreskin (unless circumcised) and the catheter tube itself. You do not need anything special to do this, just use normal hot soapy water as part of your daily hygiene routine. Ensure that the end of your penis and foreskin are dried gently and thoroughly to prevent soreness. You should be shown how to do this prior to leaving the ward.
The leg-bag for daytime use
This is attached directly to the catheter tube and will collect all the urine produced during the day. It will become heavier as it fills so do not allow it to become too full as this carries the risk of pulling out the catheter. Always wash your hands before and after emptying. Use the tap on the end of the bag to empty urine into the toilet
The thigh catheter support.
This prevents the catheter from being pulled. It has a clip around the catheter and your leg to hold the catheter firmly in position.
The night drainage bag
This is connected directly to your leg-bag at night without disconnecting the leg-bag from the catheter.
To connect the night drainage bag:
- Wash your hands
- Empty the leg-bag and, with the tap still open, push the end of the night bag into the small piece of tubing at the end of the tap. This should form a direct link for urine to drain into the night bag
- If you have been given a night stand attach the night bag to its stand. Alternatively, the bag can be left to lie on the floor by the side of your bed
- In the morning, turn off the tap at the bottom of the leg-bag. Disconnect the night bag, empty the urine into the toilet and rinse the night bag through with warm water. It is then ready to be used again the next night
You will be sent home with a small supply of leg and night bags. These should be changed only once a week unless there is a problem with one of them. If you have to dispose of your bag, it should be rinsed out with water, put into a plastic bag and put out with your normal household waste.
How much fluid should I drink?
You need to ensure that you are drinking at least 2 litres (8-10 cups) of fluid each day. Try to include plenty of water and it may help to drink at least 200ml (one glass) of cranberry juice every day. Cranberry juice seems to reduce the risk of getting a urinary infection in some individuals. However, if you are on Warfarin therapy it is not recommended that you drink cranberry juice as this may interact with the Warfarin and make you more at risk of bleeding. Cranberry juice also contains sugar so is not always suitable for diabetic patients. Cranberry tablets are available from health food stores and have proven to have an equal affect. Once your catheter is removed you may find it beneficial to cut down on drinks with caffeine in or switch to a caffeine free version. This is because some people find that caffeine also irritates the bladder and may give you bladder spasms.
What if I get bladder spasms?
Bladder spasms (which feel like abdominal cramps) are quite common when you have a catheter in your bladder. The catheter with the balloon at its tip irritates the inside of the bladder. The bladder clamps down as it tries to squeeze out the catheter and this causes the spasm. Although this can be uncomfortable, it is not a cause for concern. You may require an anticholinergic, a medicine that reduces bladder spasm, which should be continued until the catheter is removed.
- What happens if I leak around the catheter? Urine leakage around the outside of the catheter is called ‘by-passing’. It is sometimes the result of bladder spasms, the catheter is blocked or can take place when you open your bowels. If it does happen, please check that urine is still draining into your leg-bag; if it is not, you need to contact your District Nurse, GP or named nurse.
How do I control my pain?
If you have any pain when you go home, take the pain killers that you have been prescribed as per the instructions. Some men experience pain and bruising in the areas where the cuts in the abdomen were made to insert the ports. Others may get swelling and bruising in the scrotum. This will settle naturally and should not stop you from moving around. Rarely, men experience a sore throat which is caused from the anaesthetic tube. If you experience pain or numbness that lasts for more than 5 days please let your GP know.
The tip of the penis can also become sore as a result of the catheter rubbing on this sensitive area. Please ensure that it is clean and dry. You may like to ask your GP for a prescription for some local anaesthetic gel (e.g. Instillal gel) which may ease the discomfort.
What if I see blood in my urine?
This is a common occurrence after a radical prostatectomy. When you are at home and becoming more mobile, the catheter can cause irritation in the bladder and this may lead to blood staining in the urine. This is only of concern if you can see large clots or solid pieces of debris passing down the catheter. If this happens, please contact your Named Nurse or GP for advice. It is important that the catheter continues to drain.
How do I control my bowel?
Due to a combination of factors, you are likely to require laxatives. Normally, lactulose syrup and senna tablets are commenced in hospital. You may be discharged with these. In the event you feel constipated, they can be purchased from your pharmacy or via your GP. Please keep yourself well hydrated and keep active to avoid constipation.
What if the catheter blocks?
If you notice that urine has not been draining into your catheter bag, check that:
- The drainage bag is below the level of your bladder
- The catheter has no kinks or twists in it
- You have been drinking enough fluid
- You are not constipated
This will become an emergency situation if not dealt with in a timely fashion. Contact your District Nurse, GP or Named Nurse immediately. They may need to do a bladder washout (using a syringe of fluid to release the blockage). Do not allow anyone other than a trained urologist to remove your catheter at this stage because re-insertion can be very difficult and may require X-ray guidance.
What if I get a urine infection?
A urine infection can cause any of the following symptoms:
- Cloudy urine
- A burning sensation when you pass urine (dysuria)
- Strong, unpleasant smelling urine
- A high temperature and feeling unwell
- Loin or flank pain
If you notice one or more of these symptoms, contact your GP to determine whether you need some antibiotics.
How and when is the catheter removed?
After a robotic assisted laparoscopic prostatectomy, the catheter needs to stay in place for 7-14 days for the urethra (water pipe) to heal. Your surgeon may request that your catheter remains in for a longer period. This is a decision that will be made during surgery if it becomes apparent you will need a longer period to aid healing. You will have to come back to your local hospital for it to be removed. This is called a trial of voiding (TOV).
In a small number of patients, a cystogram may be required prior to catheter removal. This is a test done with the patient awake and involves injection of some contrast via the catheter, followed by an x-ray to ensure internal healing between the urethra and the bladder has occurred. If the cystogram shows a small leak (suggestive of ongoing healing) you will be discharged and brought back the week after for catheter removal. If healing has occurred, then you will be sent to the ward for a TOV.
Catheter removal takes about 15 seconds and feels peculiar but is not painful. Once the catheter is out you will be asked to drink some fluid to allow your bladder to start to fill with urine. The nurse will ask you to empty your bladder into a flow-rate monitor and you will then have a bladder scan to make sure that you have emptied your bladder completely. Occasionally the urethra (water pipe) may go into spasm and as a result you will be unable to pass urine. Should this happen the catheter will need to be reinserted by a urology doctor using a flexible telescope and remain in place for one more week.
Will I be continent?
After the catheter is removed, remember that your bladder has not been filled with urine for a while and that the outlet has been kept open artificially. The body tissues at the site of the surgery are affected by swelling and temporarily lose their elasticity. As a result, you may not have full control of the flow of urine and you will have some leakage for the first few days or weeks. It is important to carry out your pelvic floor exercises several times a day to regain control of your sphincter muscles (the muscles which control continence).
A very small minority of patients may experience total incontinence following removal of the catheter (i.e. a continuous flow of urine), necessitating the use of pads or condom sheath
-type urine collecting devices (e.g. such as Conveens) for a few weeks or months. If this occurs, additional support can be provided by the Community Continence Advisers (contact details available via District Nurses). If you need to contact your District Nurse and do not have a telephone contact number, your GP practice will be able to supply this. Alternatively, your specialist nurse or the physiotherapy team may be able to help with incontinence devices.
To be prepared for your catheter removal, and any potential temporary urine leakage, you should ensure that you have a small supply of bladder weakness products (pads designed for male underwear) at home, prior to the TOV appointment.
The pads can be obtained from various sources:
- Your local pharmacy or supermarket – they may need to be specially
- All of the major suppliers have telephone and on line ordering facilities if you prefer. The Bladder and Bowel Foundation website also has a list of contact information (www.bladderandbowelfoundation.org).
Will pelvic floor exercises help me?
Many patients find these help their symptoms improve. These should have been explained to you before your operation but if you are unsure what to do please ask your named nurse or visit http://www.yourpelvicfloor.co.uk/ or www.bladderandbowelfoundation.org for further advice.
It is very important to do these exercises once an hour every day. In addition, you should also perform 20 rapid pelvic floor contractions each day. Try to perform these exercises in a variety of positions i.e. sitting, standing and lying down.
It is likely that several weeks of regular exercise will be needed before you see an improvement. You should try and continue the exercises even after you start to notice the improvement. Try to make the exercises part of your daily routine by scheduling them to accompany a particular activity. Please do not become disheartened if you are not dry immediately.
Do not let your bladder become too full, as the extra pressure can make it harder to control your sphincter muscle. Equally, you should not empty your bladder even if you do not feel like you need to “just in case”. You need to allow your bladder time to fill and you need to learn the feeling of really needing to pass urine. Moderate your intake of alcohol, tea, coffee, cocoa and cola since these can all cause irritation of your bladder (as they contain caffeine) and make you want to pass urine more often.
How quickly can I expect to recover?
Bladder and penile discomfort
Once the catheter is removed, you will feel more comfortable, and any pain at the tip of the penis should subside.
You may find that you tire more easily than expected, and you will need to allow at least four weeks before you return to your normal routine.
Ideally, it is advisable to try to begin with gentle exercise such as walking or swimming for a maximum of about 15 minutes every day. Listen to your body and always rest when you feel particularly tired. Your body needs time to heal. After 4 weeks, you can attempt more vigorous activities but again, do not overdo it and we recommend avoiding cycling for the first 3 months after your operation as this will put pressure on the area that has been operated on.
We normally advise patients that you can drive after about 2 weeks following robotic surgery, providing you feel confident about controlling the car and performing an emergency stop. It is worth informing your insurance company of your surgery and confirming with them that they are happy for you to be driving again.
We do encourage you to resume sexual activity when you feel able. Resuming sexual activity will depend on whether a nerve- sparing procedure was possible at the time of surgery. This will have been discussed with you. If the nerves were preserved, we will normally prescribe drugs to help erectile function. Please be aware that the return of erectile function can take up to 2 years and may not be as good as it was prior to surgery. If you find that your erections are less than perfect, do not hesitate to use the tablets that have been prescribed for you and, if these do not work satisfactorily, please contact either your GP or your Named Nurse so that alternative treatments and help can be offered.
Most patients are ready to return to work after four to six weeks at home but some jobs requiring heavy lifting mean that you may need to discuss with your employer a suitable way to ease yourself back into work more gradually.
There is no reason why you should not fly 6 weeks after surgery. If you fly any earlier, you may be at increased risk of developing a DVT (deep vein thrombosis). You must mention that you have had prostate surgery for insurance purposes but there should be no additional premium because of this. If you need a letter for the insurance company explaining your circumstances, we would be happy to write this for you – please contact your Named Nurse or your Consultant’s secretary.
Deep Vein Thrombosis:
To reduce the chance of a DVT, you should continue to wear the stockings that you had in hospital for six weeks after your surgery. You (and/or a family member) will be taught how to inject yourself with an anti blood clotting medication before you leave hospital. Please complete the full course of injections once you get home. Your needles and syringes should be placed in the yellow sharps box you will be given and disposed of.
What if I feel that something is wrong in the first few weeks after surgery?
If you feel unwell or are concerned about your health you should contact us straight away. During office hours, you should contact your Named Specialist Nurse or the Consultant’s secretary via the main switchboard or via your GP.
What outpatient follow-up will I have?
You will receive an appointment to return to the outpatient clinic at 4-6 weeks after surgery. This is to allow the Consultant or Specialist Registrar to find out how you are getting on with your recovery and to discuss with you the findings of the pathology report on your prostate specimen and check your PSA blood test post-operatively.
Will I need further treatment?
The purpose of the operation is to remove the prostate and all the prostate cancer. Occasionally, the prostate cancer has spread microscopically outside the specimen that was removed. In this case, your Consultant will advise you about having further treatment (usually radiotherapy but, occasionally, hormone therapy) to ensure the complete eradication of any remaining cancer cells.
After your outpatient appointment, you will be followed-up at 3- monthly intervals for the first year. You will need to have a PSA (prostate specific antigen) blood test at your GP surgery or hospital about 10 days before each appointment, so that a record can be kept of your PSA levels. If you have any queries about your clinical management, please talk to your Urologist or Named Nurse.
It is important that your follow-up appointments are scheduled around the times outlined in the above information. In most instances, after the 4-6 week appointment at QEUH, follow up will be at your local hospital.
Useful Contact numbers
Before your operation, please make a note of your named specialist nurse, and prior to discharge, the phone numbers of Ward 11C and of your Consultant’s secretary.
Prior to TOV, please contact the ward directly for any issues. If there are any issues, requiring admission, you should be admitted straight back to the Urology Ward.
Following TOV, the Specialist Nurses should be your first point of contact and can be contacted during normal working hours. Please leave a message if you cannot get through to them directly. If you are worried about your health please contact your GP practice