What should I expect after surgery?

Eating and drinking
Initial hospitalization time is approximately 2 to 3 days. You will begin to drink fluids in the evening after the procedure and will be given solid food or a regular diet as tolerated. As long as regular bowel function is maintained, there is no restriction of the type of food. Alcohol should be avoided while taking prescription pain medicines.

Drains and dressings
The surgical dressing is usually removed on the first or second day after surgery. Unless there is bodily fluid drainage from the incision(s), dressings will be left off, leaving the incision(s) open to air dry. Surgical drains are typically removed before discharge from the hospital. However, you will be sent home with a catheter (Foley) draining urine from your bladder into a bag. It is normal for the urine to look bloody after surgery. The catheter will be removed in your doctor's office in about 2 to 3 weeks from the day of surgery. Clips or staples on the skin incision are usually removed one week after hospital discharge.

Managing pain
It is normal to experience pain at the site of the incision after surgery. During the immediate time after the procedure, patients are given control of pain medication delivery using a specialized pump with a push of a button. Oral pain medications are also given on an as needed basis when a regular diet has been resumed. Soreness from the incision is often relieved with over the counter anti-inflammatory medications such as Advil, Motrin, Ibuprofen, and Aleve.

Bathing
Showers are permitted usually within 2 days after surgery. You may let water run over the incision and lightly apply soap. Pat the incision dry. The Foley catheter may be left attached to the drainage bag or temporarily detached during showering. Tub bathing is not recommended.

What can I do to help?

Complications can occur even after leaving the hospital. Pneumonia and blood clots are two potential serious problems. To lessen the risk of having these complications, you will be encouraged to do three things after surgery: walk, use an incentive spirometer (a device which encourages deep breathing), and do leg exercises. Instructions and assistance will be given during your hospital stay.

What can be expected at home?

Diet and exercise
Get plenty of rest, eat a well-balanced diet with plenty of protein and iron, and do light exercise (walking) every day. Recovery is not always a smooth process. There will be plenty of good days but there will also be a few bad days. It is normal to feel tired some days. Do not do any heavy lifting (more than 10 pounds) or strenuous exercise for 4 weeks following surgery. You can gradually increase your exercise schedule thereafter. Driving is usually permitted after the catheter is removed and pain medication is no longer needed.

Caring for the incision
The incision may get wet in the shower. Gentle soap may be used. If you notice extreme or increasing tenderness, progressive swelling, increasing drainage, or any pus, notify your doctor. Typically, no dressing or ointment is necessary.

Having and managing a urinary catheter
For healing, a catheter is required for 2 to 3 weeks. On occasion, the catheter may irritate the bladder, causing "bladder spasm" which can be quite uncomfortable. You may also see leakage of urine around the catheter. It is also normal for your urine to look cloudy for a few weeks after surgery, and occasionally, blood or bloody discharge can be seen around the catheter or in the urine. If bothersome, medication can be given to relieve these symptoms. If the catheter is obstructed or clogged, you may feel pain due to a full bladder or see more urine drainage around the catheter rather than through it. Notify your doctor immediately. When showering the catheter may be left attached to the drainage bag or may be temporarily detached.

Avoiding constipation
Constipation is a common side effect of pain medications. During the time that you are regularly taking them, be sure to increase your fluid intake, take stool softeners, and eat roughage (whole grains, fruit and vegetables). A tablespoon of Milk of Magnesia daily may also help avoid this problem.

Other things I should know
Swelling of the penis and scrotum may occur after surgery. This is temporary and should resolve in 1 to two weeks. Swelling in the feet or legs, especially when asymmetric or one-sided, should be reported to your doctor.

What occurs when the catheter is removed?

Most patients will experience some degree of urine leakage (incontinence). Initially, the leakage may be significant (all the time), especially when standing or walking. Your doctor will teach you exercises which you can do to strengthen your sphincter muscles. You will need to shop for incontinence pads and bring one or two pads to the doctor's office the day your catheter is to be removed. Normally, resolution of incontinence occurs in phases. In the first phage, you are dry when lying down or sitting; 2nd phase, you are dry when standing or walking; and 3rd phase, you are dry when you rise from a seated position, cough, or exercise. Most patients will see very good control by three months. However, it may take more time for some patients as gradual improvement is expected up to one year. You may need to protect your skin with a barrier such as Desitin or A&D ointment.

What about sex?

Natural ability to attain erections can be preserved by "nerve-sparing" during surgery. However, the extent of the cancer may not allow this option without jeopardizing cancer control and chance for cure. Natural erections may take months to return, and in some cases, may not return. Currently, there are several effective ways to manage impotence (lack of erection) including Viagra, penile injections, vacuum pumps, and 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 of the penis. It is important to realize that one can continue to be sexually active despite extensive cancer treatment. Be open-minded, seek treatment for impotence if it occurs and realize that sexual gratification can be achieved (for you and your partner) in many ways.

Will I need any additional treatment?

Most patients treated by radical prostatectomy will not need any additional treatment. From the pathology report (report of the microscopic analysis of the removed prostate), your doctor can assess your risk for recurrent disease. Important information from this report includes the extent of the cancer, its grading (low-high grade), and the status of the surgical margin. There are currently a lot of questions regarding the type and timing of any additional treatment for patients with high risk of recurrence. Some of these questions are actively being studied through clinical trials all over the world.

*  This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information.

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