Weill Medical College of Cornell University

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Post-Surgery Guidelines

What to Expect After Surgery

You will be transferred to your room after surgery. You will find six small bandages over the skin incisions, one drain on the side of the abdomen attached to a vacuum container, and a urine catheter (Foley) to drain urine from the bladder. The Foley catheter will be attached to a urine bag. An intravenous (IV) line will provide you with fluids. This IV and the drain will usually be discontinued the day after surgery. You will be allowed to have ice chips and sips of water. Pain is generally minimal but pain medication will be administered if necessary.

Once you are ready, you should sit up and attempt to walk a few steps. Early ambulation is key for faster recovery and a faster return of bowel activity. This also improves blood circulation in the legs and prevents clot formation. The morning following surgery, you may have a light breakfast and liquid diet thereafter. You may not have solid food until you pass gas and have a bowel movement. Most people do not pass intestinal gas for several days and do not have a bowel movement for 3-4 days.

Your major contribution comes on the day after surgery, where you are expected to walk in the hallways a total of 1 mile, 25 laps around the hospital wing (although not in one grand sprint).

You will also use a breathing device, called a spirometer, to help expand your lungs and prevent infection. You should use this device once every hour and take 10 consecutive deep breaths.

Generally, you will be able to go home the day after surgery.

Urine (Foley) Catheter

When you leave the hospital, you will still have the urinary catheter in place. The catheter will remain for approximately 7-10 days after the operation. The catheter will be attached to a leg bag that you can hide under your trousers. During the nighttime, we recommend that you switch to a regular urinary bag that you place on the side of the bed. This is a larger bag that will allow you to sleep the whole night without the necessity of emptying.

You may experience some bladder pain or cramps (spasms) associated with the catheter, but most people tolerate the catheter well. The occurrence of these spasms will usually decrease with time. You may also leak minimal amounts of urine around the catheter because of involuntary bladder contractions. You may want to wear a pull-up diaper over the catheter to prevent soiling your clothing. It is also not unusual to notice pink or red tinged urine after a walk or bowel movement. Do not be alarmed. Simply increase your fluid intake until the urine becomes clear again and lie down for some time. All of these events are considered within the normal range and you should not be concerned.

The day of your scheduled catheter removal you will come to the hospital to have a cystogram (only required if Dr. Tewari deems it necessary). The radiologist injects dye through the catheter and takes an X-Ray to make sure that there is no leakage at the level of the bladder/urethra connection. You will then come to Dr. Tewari's office (Starr 900) for removal of the catheter (relatively pain-free procedure). Right after the catheter is removed most men cannot control the urinary sphincter and leak for a few days to weeks thereafter. Bring diapers and protection pads with you the day of catheter removal.

A minority of patients (5%) may have delayed healing of the bladder/urethra connection and thus require longer catheterization. Another 5% of patients may require re-insertion of the catheter because of swelling at the connection.

Activity

You can return home by car from the hospital after discharge if your drive is within 2 hours, but you should not drive. If you come from out of state and are traveling by plane, make sure that you walk every half hour in the cabin to prevent blood clotting in the legs. It takes 3-4 weeks for the abdominal incisions to heal completely, so you should avoid heavy lifting during that time. You may have some swelling of the scrotum and penis after surgery, which will resolve with time. If this occurs, elevate your scrotum using a folded towel when you lie down, and wear mildly tight underpants when you ambulate.

You can shower anytime after surgery, but do not take a bath until after the urine catheter is removed. Leave the bandages on the skin incisions for 3-4 days.

You can start your daily activities, such as walking, climbing stairs, etc., immediately when you go back home. You should wait 3-4 weeks before beginning any heavy exercise, such as jogging, weight lifting, and bicycle riding. Generally, you can return to work after the operation usually in 2-3 weeks depending upon your type of work.

Diet

When you return home, you may resume your normal diet after you have a bowel movement. Before then you should only have a full liquid diet. You should drink a lot of fluids to keep the color of the urine clear. Take Metamucil (or other fibers) daily to help with bowel movements. Use stool softeners daily. It is important not to be constipated. Once you have a bowel movement, you can advance to a normal diet. This may take up to 3-4 days. Rule of thumb, if you can see through it, you can eat it.

Clear Liquid Diet includes:

• Water (still, seltzer, mineral water)
• Clear Broths, such as chicken or beef consume
• Apple Juice
• Cranberry Juice
• Tea (no milk)
• Jell-O (without fruit)
• Ginger Ale
• Popcicles and Italian Ices
• Gatorade

Things to Avoid:

• Dairy (milk, cream)
• Orange and Tomato Juices, juice with pulp
• Any sort of Roughage
• Starch, (crackers, breads)

Urinary Control

After prostatectomy most men leak urine after catheter removal. You will regain control gradually over the following weeks. By six months most men (96%) do not need any pads and some may prefer to wear just a liner for security even if they do not leak.

If you experience difficulty urinating call the office to reassess the situation. Your catheter may need to be re-inserted for several days. Members of the robotic team should do this.

To hasten the recovery of urine control we will teach you pelvic floor exercises to strengthen the urine sphincter. These exercises are known as Kegel exercises. Start doing these exercises several days after the urine catheter is removed. This basically consists of tightening the urine control muscle 10 to 20 times every hour in order to strengthen the muscle.

Sexual Function

After prostatectomy men continue to have normal desire and orgasm, but do not ejaculate. The major portion of the seminal fluid is produced in the seminal vesicle and prostate, which have been removed, therefore men who have had a prostatectomy are not able to father children.

From a sexual standpoint, erections are the main issue after prostatectomy. The return of erections is a continuous process that can take up to 24 months. If you had both erectile nerves preserved (bilateral nerve sparing) you have the best chances of return of erections. Erections usually improve with time. Younger men tend to recover sooner than older men and those with stronger erections before the operation have a better chance of recovery than those whose erections were weak.

You should be able to have a satisfactory sex life after robotic prostatectomy. If you are not satisfied with the erections that you have we can help you. There are several treatments available to improve erections. Generally, oral drugs, like Viagra, Cialis and Levitra will improve partial erections. Other treatments also exist if you do not recover any erections. At the Department of Urology we have a dedicated team of physicians and medical staff that specialize in erectile difficulties and can further assist you.