RADICAL PROSTATECTOMY DISCHARGE INSTRUCTIONS

You have undergone a major urological procedure (Radical Perineal Prostatectomy or Radical Retropubic Prostatectomy) and now comes the time for your discharge from the hospital. You will find here lots of useful information to help you know what you should or should not be doing when you are at home.

Activity:
For the next 6 weeks try to walk up to one mile a day. You may walk a longer distance if you feel like it but stop if you get tired. Avoid running, fast walking, walking on inclines and declines, heavy lifting (over 10 pounds), or any heavy exercise. Climb stairs slowly and carefully. These will put an extra strain on your incision, which is going to take 6-8 weeks to achieve complete healing. A good rule of thumb is that if anything unduly hurts your incision, and then avoid it. This way you will be the best judge.

Do not ride long distances in cars. If you must, then you should break your journey every 1-2 hr, get out of the car, stretch your legs, and walk around. It is also preferable to stretch your legs while in the car, maybe by lying on the back seat. Remember to do your calf exercises. Do not cross your legs. All these precautions will promote the venous circulation in your legs and prevent you from developing a clot.

Driving:
You should not drive a car until after your catheter comes out approximately 1 week after your operation. The discomfort from the catheter will make your reactions using the foot pedal suboptimal in case of emergency breaking, even though you may feel you can drive. For your safety and to maximize wound healing, you should not drive during this period. After the 2 weeks, you may drive, but limit this to short distances only for a further 2 weeks before you resume normal driving.

Bathing and Showers:
You may shower at home and wash your incision with soap and water. Avoid scrubbing the incision. It is permissible for your catheter and drainage bag to get wet in the shower, but do not submerge them in water. Avoid baths. After showering, dry the incision by dabbing with a dry towel. Secure the foley catheter connecting tube to the thigh with tape.

Diet:
There are no restrictions to your diet. Please note that constipation may result from taking pain medications and iron tablets. This will make you strain and put extra pressure onto the area of the surgery. By eating a balanced diet with high fiber, such as fresh fruits, vegetables, whole grain, and bran, you can help avoid constipation. You will also be given a stool softener (Surfak) to help regulate your bowels. Keep well hydrated by drinking 6-8 glasses of fluid each day. You may drink alcohol in moderation (1-2 drinks per day).

Foley Catheter:
You have a catheter inside your bladder to drain the urine. This catheter will stay in for 1 week from the day of surgery. It prevents your bladder from storing urine and distending during the period of healing of the new connection made between your bladder and urethra. The catheter is maintained in the bladder by a water-filled balloon at its end. Make sure that the catheter is well secured to the thigh by tape and avoid traction and tension on it. Clean the catheter with soap and water where it exits from your urethra at the end of the penis and apply antibiotic ointments on a daily basis in the same way that you were shown on the ward. Use your leg bag during the day and secure the bag by strapping it "snugly" but not too tightly to your thigh or calf. Tight strapping will obstruct the venous circulation and may cause swelling and a clot.

The urine may become intermittently blood-stained on walking or having a bowel movement. This is not unusual, and as long as the catheter is draining well and there are no blood clots, it is of no consequence. Also, with the presence of the retaining balloon inside, the bladder gets a false feeling of fullness and you may fell the urge to urinate even though your bladder is empty. The bladder may even go into spasm and you may feel uncomfortable contractions. Blood-stained urine may leak around the catheter when your bladder spasms. Do not panic; lie down and rest and within a short time your bladder will readjust and the discomfort will resolve.
Occasionally, the catheter may become blocked and stop draining due to a small clot. Within a few hours, you will start to get the feeling of your bladder distending. Call us if this occurs and we will instruct you on what to do next.

Drain:
You may be sent home with a drain in place. This is a small rubber tube about the diameter of a pencil and located next to your incision. It requires no special care; simply keep a light dressing inside your underwear to absorb any fluid leakage. In most cases,the drain will be removed in one week when the catheter comes out. If it falls out sooner, save it in a plastic bag and bring it with you to your next appointment.

Medications:
1. Septra or Cipro twice per day, until the Foley is removed. This is an antibacterial agent to prevent infection.
2. Percocet, 1-2 tablets every 6 hrs as required. This is a pain medication. With time, you may need only Tylenol for the discomfort associated with your incision.
3. Ferrous sulfate, 300 mg three times per day for 1 month. This is an iron tablet, which helps your body to reproduce new blood cells. It can be constipating, as mentioned earlier, and may make your stools black in color. You may not need this and your doctor will let you know.
4. Colace (Docusate Calcium) one capsule twice per day. This is a stool softener.
5. Metamucil, 1 teaspoon twice per day. This is a stool softener.
6. Mineral Oil- 15 cc’s (1 tablespoon) per day. This also keeps stools soft and aids in BM’s.

Return to Office:
You will be scheduled to return to our office 2 weeks after your surgery. Please call (301) 868-0202 between the hours of 8 AM and 5 PM to make an appointment. On your return you need to bring with you a pair of jockey shorts and some newborn diapers made for newborn babies. These can be obtained in any supermarket in your area. These will be used during the initial period when your bladder is regaining its control.

Any Further Questions?
Try to think of any further questions that you may have while you are still in the hospital and ask us. We will be delighted to answer any and all questions you may have. Don't be afraid to ask anything that comes to mind. Remember - sometimes the simplest questions are the most important. When you are at home and any questions arise or problems are encountered, please call us. There is always a urologist available 24 hrs a day, every day. In particular, call us if:

• Your incision gets red, breaks open, or drains fluid.
• The catheter is not draining urine.
• There are blood clots in the urine.
• You experience fevers, chills, and/or vomiting.