Cryoablation of the Prostate

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If you have elected to have cryotherapy, these are some general guidelines regarding pre-operative and post-operative instructions.

Four Weeks Before Surgery:
Stop any herbal medicines and excessive dosages of Vitamin E. Start kegel exercises - contract your urinary sphincter 20-30 times per day and hold for 5-10 seconds. This will feel like you are trying to hold back urine or hold back a bowel movement. This will strengthen your sphincter muscle and help in post-operative continence. Start Avodart or Proscar if recommended by your doctor.

Two Weeks Before Surgery:
Stop any Aspirin use and also do not take any over-the-counter pain relievers. This includes Ibuprofen (Advil), Aleve, Motrin, etc. The only over the counter pain reliever that is alright to take is Tylenol (Acetaminophen) and this can be taken up until the day before surgery. You should also stop any other non-steroidal anti-inflammatory drugs. If you are on any other blood thinners, such as Coumadin (Warfarin) or Plavix, you will need to stop these as well. Your doctor will discuss the timing of this with you.

Two Days Prior to Surgery:

Start a LIQUID diet (clear liquids preferred) and take no solid foods until after the procedure.

One Day Prior to Surgery:
On the day before surgery, continue only clear liquids (no solid foods) and take nothing after midnight. Sometime in the early afternoon take one bottle of Magnesium of Citrate which you can purchase at a pharmacy without a prescription. This is a rapid acting laxative and will usually work within 4-6 hours. Continue to drink clear fluids until bedtime or midnight to avoid dehydration.

The Day of Surgery:
Remember not to eat or drink anything with one exception. If you take blood pressure or heart medications, you may take these with a very small sip of water prior to 5:00 a.m. If you have questions regarding certain medications, please inquire ahead of time. Check in at the hospital is 2 hours prior to surgery. The hospital will send you separate information regarding check-in procedures. Your surgery will likely be done under general anesthesia and usually takes between 2 and 3 hours. After surgery there is usually a 1-2 hour stay in the recovery room and then you will be transferred to your room. The rooms are private and semi-private and we will
request a private room for you but they are limited and this determination can only be made on an availability basis the day of surgery.

After surgery you will likely have a suprapubic catheter in the bladder, and possibly a urethral catheter as well. You may have a strong urge to pass urine. This is a normal sensation but be sure and tell the nursing staff if this is excessive or painful. You will have pain medication and medication for bladder spasms prescribed and be able to use it as necessary.

After Surgery:
Generally, you will be discharged from the hospital on the morning after surgery (post-op day #1) with the suprapubic catheter and possibly a urethral foley catheter. You will be given instructions regarding catheter care. You can resume a normal diet at that time, and will be placed on a stool softener to avoid constipation. You will be maintained on antibiotics.

After Hospital Discharge:

It is MOST IMPORTANT that NOTHING be placed in the rectum
for several months following surgery. Therefore you must avoid
enemas, suppositories, rectal thermometers, sigmoidoscopy,
colonoscopy, etc. If you have any questions in this regard,
please ask your physician.
It is very common not to have a bowel movement for a number
of days following treatment. If necessary, you may use any over
the counter laxative TAKEN BY MOUTH. If mild laxatives do not
work, you can use Magnesium of Citrate but this is rarely necessary.
The suprapubic bladder catheter can be left to "straight
drainage" (continuously open and draining into a urine collection
bag), or may be closed and opened intermittently as needed.
Instructions and demonstrations will be provided prior to discharge.
When you are able to pass urine well, the catheter will be
removed in the office.
Please note that blood in the urine or blood coming out of the
urethra is common after this procedure. Activity, such as walking,
may make this worse at times. When there is blood in the
urine, it is advisable to drink plenty of fluids and it will usually
clear. If the catheter stops draining you should call your
doctor promptly.
It is very common to have bloody discharge from the urethra
after treatment. Using a protective pad may be necessary.
You may begin showering the day after surgery, but should
avoid tub baths, swimming pools, Jacuzzi's, etc. until your
catheter is removed.
It is very common to have swelling and ecchymosis (bruising /
black & blue) on the penis, scrotum and perineum after surgery.
If necessary, an ice pack used intermittently (30 minutes on - 30
minutes off) and a scrotal supporter may be helpful. When lying
down, scrotal elevation with a rolled towel under the scrotum
may be helpful.
Bladder spasms are common after surgery. This may be painful
and urine may come out the penis or around the catheter.
Medication will be provided for this. As long as your catheter is
draining well, this is NOT harmful.
It is possible that there may be some numbness in the penis
after treatment. This is not harmful, but may take weeks to
months to gradually improve.

Activity After Surgery:
Walking is fine after surgery, but avoid strenuous activities for about 3 weeks. You should not drive home from the hospital, but may resume driving when your reaction time is not impaired by pain, swelling, the catheter, etc. Remember not to drive if taking any narcotic pain medication.

Discharge Medications:

Colace (stool softener) - This is over the counter (non-prescription) and you should take 100 mg, 3-times a day for at least a month. A "generic" is fine.

Pain Medication - You will be given a prescription for a narcotic pain medication. It is fine to use if needed but remember: It may cause constipation, so use Tylenol if or when appropriate.
NOTE: Most patients are off narcotic pain medication by post-op day 1 or 2

Antibiotic - Usually Levaquin 500 mg daily for 5 days then Bactrim DS-1 twice a day until your catheter is removed. This may vary depending on allergies, etc., and your doctor will explain.

Bladder Spasm Medication - Bladder spasm medication can be used when necessary. You will have a prescription for this and can fill it if needed. It should be stopped 1 or 2 days prior to catheter removal. In some cases this medication may make your mouth dry.

You may resume your usual medications after surgery, with the exception of Aspirin or other blood thinners. These can usually be resumed after your catheter is removed. Please inquire if there are specific questions in this regard.

Catheter Removal:
Your physician will remove the catheter when you are able to pass urine adequately on your own. Voiding trials will be explained.

Please notify us promptly if any of the following occur:

Catheter not draining
High fever (generally above 102° F)
Severe nausea or vomiting
Shortness of breath or chest pain
Leg pain or leg swelling
Diarrhea after urination or foul smelling urine

This information is a general guideline for most patients. As with anything in medicine your case may vary or need to be individualized. We will be happy to answer any questions and assist you with perioperative care.