After Radical Prostatectomy
Radical prostatectomy is the surgical removal of the prostate gland. This page outlines what the patient might expect after the procedure.
Diet and exercise
It is normal to feel tired for several weeks after your surgery. Make sure someone drives you home from the hospital. Get plenty of rest, eat a well-balanced diet with plenty of protein and iron, and do some light exercise (such as walking) every day.
You should drink at least two to three litres of fluids each day, and monitor the colour of the urine in the catheter tubing (not the bag). The urine should be clear or light yellow. If the colour is dark yellow or light red you should drink more fluids.
Do not do any heavy lifting (more than 10 to 20 pounds) or strenuous exercise for two to four weeks following surgery. You can increase your exercise schedule gradually thereafter. All the exercises should be performed in incremental fashion starting with simple stretches, walking to brisk walking. Exercise such as brisk walking, jogging and heavy lifting should be avoided initially. Golf, bowling or tennis should be restricted for 4-6 weeks. If you feel comfortable, you can increase your activity. Heavy abdominal exercise, such as sit-ups as well as cycling on an upright bicycle, should be avoided for six weeks. It is important that you do exercise that you feel comfortable with. Any activity that causes pain should be avoided.
Driving
Driving is usually permitted after a week following your discharge. However it is advisable to be a passenger rather than a driver in the initial few weeks. Please avoid bumpy rides.
Caring for the incision
The incision for an open prostatectomy runs from above the base of the pubic area to well below the navel. The key words here are “clean” and “dry” — showering once a day should do it. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage (i.e. a teaspoon) or any pus or redness, notify your doctor right away.
Incisions from laparoscopic radical prostatectomy are smaller, but more numerous. They should be cared for similarly.
Going home with a catheter
You will be discharged from the hospital with a catheter in place to drain urine from the bladder into a bag.
The catheter would be removed by a Continence or a registered nurse in five to 14 days. No anaesthesia is required for catheter removal and only a little discomfort is experienced by most patients.
A large bag should be used at night and while at home to allow for better drainage. The leg bag should be used when out and about.
Be sure to clean the catheter where it exits your penis twice a day with soap and water, to apply a small amount of water-based lubricant (KY jelly, etc.) to the catheter at the tip of penis (meatus) to minimize irritation, and to empty the bag frequently.
The bag should always be positioned lower than your bladder (e.g. secured to your leg or on the floor at the side of the bed).
Should the catheter fall out or malfunction you should call your urologist and not allow an emergency department or other non-urology physician to replace or manipulate the catheter.
A small amount of redness at the tip of the penis and/or discharge around the catheter is usually a sign of mucosal irritation, not infection, and is a sign that the catheter should be cleaned and/or lubricated more often.
On occasion, the catheter may irritate the bladder, causing “bladder spasms” which can be quite uncomfortable. Some patients will be sent home with bladder spasm medication. Pain behind the pubic bone or the tip of the penis as well as leakage around the catheter may be signs of bladder spasm.
Leakage of urine around where the catheter exits the penis may also occur; if most of the urine is still draining into the bag this can be managed by wearing incontinence pads as described in the next section. However, if the urine is leaking and little or none is draining into the bag you should call your doctor.
It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This is also common. If passage of large clots, more than an inch in length, is noted or if the catheter becomes plugged, contact your physician.
Managing incontinence
After your bladder catheter is removed, you may have leakage of urine (”incontinence”). Initially, the leakage may be significant (leakage all the time). Your nurse will teach you exercises which you can do to strengthen your sphincter muscle. These are called Kegel exercises and they can be done anytime: when lying down, sitting, standing or walking. You should do 200 repetitions of five-second Kegel exercises per day. These exercises will tend to decrease the amount of time it takes you to recover continence. At your local pharmacy you can buy incontinence pads to protect your clothing, and waterproof underpads to protect bedding. These can be obtained without a prescription and are available in a variety of sizes and absorbencies.
Your ability to maintain bladder control should improve significantly with time. Normally, continence returns in three phases:
- Phase I – you are dry when lying down;
- Phase II – you are dry when walking;
- Phase III – you are dry when you rise from a seated position, cough or exercise.
Most patients regain very good control by three months. However, it may take more time for some patients. If you believe that the force or diameter of your urinary stream is slow or narrow, or if you have any difficulty or pain on urinating, notify your doctor immediately. Occasionally, scarring may cause blockage to the normal flow of urine. Most often, this can be treated easily by stretching or endoscopically incising the urethra.
Skin care
If you have any incontinence, your skin may become irritated (depending on the amount of urinary leakage). You may need to protect your skin with protective cream. If you develop a rash, notify your doctor.
Managing constipation
Constipation is a common side effect of pain and bladder spasm medications. During the time that you are taking them, be sure to increase your fluid intake (at least eight glasses of water a day), take stool softeners, and eat lots of roughage (whole grains, fruit and vegetables). Use laxatives only as a last resort. Diarrhoea may also occur in the first few days after surgery as your bowel function returns to normal. This usually fairly mild; if it is severe or not improving, contact your doctor.
Medications
You will go home with the following medications:
- An anti-inflammatory medication (e.g. Panadol or Digesic) which reduces both pain and inflammation. You should take this for at least a few days after you go home, or until you are free of significant pain. These should be taken with a full glass of water and ideally with food.
- A narcotic pain medication (e.g. oxycodone), which you should take, one to two tablets every six hours as needed. These can cause nausea and constipation.
- A medication for bladder spasm (e.g. Ditropan/oxybutynin), which you can take up to every eight hours as needed. This can also cause constipation and drowsiness, as well as dry mouth. Do not take Ditropan starting 24 hours before your catheter is due to be removed.
- A stool-softener (Coloxyl) which should be taken as long as you are taking narcotic pain or bladder spasm medication, unless you develop diarrhea.
- A medication for erectile restoration (Viagra, Levitra or Cialis). These medications work by increasing the flow of fresh blood to the penis, which in turn may facilitate nerve recovery. You should take a half a pill before bed two to three times a week starting immediately after surgery or after the catheter is removed. You should not expect to have erections, although they may occur. Taking these pills early after surgery is meant to improve the likelihood that you will have good recovery of function later.
- If you take aspirin or anti-platelet agents such as Plavix, these can be resumed seven days after surgery unless your physician informs you otherwise.
- If you take Coumadin (warfarin), it can be recommenced approximately 7 days after the surgery after confirming clear urine.
What about sex?
Some men find it difficult to have an erection after radical prostatectomy. The nerves and blood vessels (neurovascular bundles) that control erection are located on either side of the prostate. Sometimes one or both of these nerves and vessels can be preserved during surgery (”nerve-sparing” radical prostatectomy), thereby maintaining the ability to have an erection. However, depending on your age, your pre-operative ability to obtain and maintain an erection, and the extent of the cancer, natural erections may not return. In some cases, the neurovascular bundles need to be removed because cancer may extend close to them. Therefore, complete cancer excision may not be possible without removing them. Please feel free to discuss any concerns with your physician, who will provide information about alternative ways to manage impotence, such as oral drugs (Viagra/Levitra/Cialis), penile injections, vacuum pumps, and, rarely, penile implants.
Since the prostate has been removed, there will be no ejaculate (semen) released.
Whether or not you are able to obtain an erection, you should still be able to have an orgasm (climax) with stimulation to the penis.
Is there anything else I should know?
Swelling and bruising of the penis and scrotum occur commonly after radical prostatectomy. This is temporary and should resolve within four to seven days. Swelling of the feet or legs is uncommon and your doctor should be notified if this occurs.
