Radical Prostatectomy

Download a Copy of this Page

If you have elected to have a radical prostatectomy, 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. You may take a multivitamin with Vitamin E. If your doctor advises it, arrange for autologous blood donation. Our staff at Prostate Solutions of Arizona will assist you in scheduling this. During blood donation and up until three days before surgery, take an Iron Supplement such as Ferrous Sulfate 325 mg. Take it three times per day, preferably with food. Iron may make your stool dark or black in color and this is not harmful. If the Iron is not well tolerated, you may stop it at any time.

Start kegel exercises - contract your urinary sphincter 20 - 30 times per day and hold it 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.

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.

One Day Prior to Surgery:
On the day before surgery, take 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.

Do NOT do any shaving in the lower abdomen or on the genitalia. The pre-operative shave will be done when you are under anesthesia. Shaving ahead of time could increase the risk of post-operative infection.

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 be done under general anesthesia and usually takes between 2 and 4 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 catheter in the bladder and sense an 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. You will also have a small drain coming out of the skin and the nursing staff will attend to this.

It is helpful to have a loose fitting pair of shorts (not full length pants) to wear home from the hospital. This will be easier with your catheter taped to your leg.

After Surgery:
Generally by the first day after surgery you will be eating and drinking around the floor (with assistance when necessary). It is likely that you will be discharged from the hospital on the first day after surgery. The drain will probably be removed before discharge, but if necessary, may be left in for you to go home with. Instructions on management will be provided.

When you are discharged, these are important informational items:

You will go home with the catheter. It is removed in the office generally 7 - 10 days after surgery. The exact number of days is variable and will be determined by your physician. Catheter management is quite simple and the nursing staff will give you instructions prior to discharge. Here are some basic instructions regarding catheter care.
You may use a "leg-bag" when desired, for convenience, but you should always use the regular drainage bag when sleeping and keep it below bed level so urine will not "back up" during sleep. When you change back and forth between drainage bags, you should use alcohol to swab the connection point to help prevent infection. It is very common to have some blood in the urine after surgery and this may vary from time to time. If there is blood, it is advisable to drink plenty of fluids and this will usually clear.

You may also find that walking causes the urine to turn pink or red at times. This is quite normal and you do not need to limit activity for this. On occasion, the bladder may contract involuntarily -- this is called a bladder spasm. This often occurs when walking or when having a bowel movement. When this occurs, you may notice urine coming out of the penis around the catheter. THIS IS NOT HARMFUL as long as the catheter continues to drain well. If the catheter ever completely stops draining, call your doctor for advice.

Never let an emergency room staff or anyone else manipulate the catheter without first talking to your doctor. Please note this would be a very rare occurrence. You will probably notice a discharge which can be bloody or brown in color coming through the urethra and this may cause a build up of a coating on the catheter -- this can be gently washed away while in the shower. It is imperative that the catheter be secured to your leg at all times! This is best done with tape and this will be demonstrated to you prior to discharge. There are also Velcro catheter straps but these usually do not secure the catheter as well as tape.
You may shower on the second post-op day and can re-tape the catheter whenever desired. The incision can get wet at that time and need not be covered. You can shower with either the leg-bag or regular drainage bag. It is common to have irritation,
redness or soreness at the urethral meatus (where the catheter comes out of the penis) after surgery. If desired you may apply any ointment (such as K-Y, Vaseline, Bacitracin, Neosporin, etc.), to this area as needed. The steri-strips on your incision will usually remain for 1-2 weeks and can be pulled off when loose or hanging. You will not have any sutures that need to be removed (they are under the skin and will dissolve).
After surgery you may eat and drink anything that you want. It is very common not to have a bowel movement for up to 5-7 days for some people. If necessary, you may use any over the counter laxative taken by mouth. Do not do an enema after surgery. If mild laxatives do not work, you can use Magnesium of Citrate but this is rarely necessary. You should take a stool softener (Colace 100 mg 3 times a day, at least until your catheter
is removed).
It is common to have swelling and/or ecchymosis ("black & blue") on the penis and scrotum after surgery. This may be excessive at times. You should not worry about this. It usually resolves within 2 - 3 weeks.

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. You will likely be given 8 pills. Take 1 a day for 5 days then save the last 3 pills and start taking them again (1 a day) the day the catheter is removed. If you have an allergy to this antibiotic, or if the doctor decides to use something else, he will explain it to you.

You may resume your usual medications after surgery, with the exception of Aspirin or other blood thinners. Aspirin can be resumed after your catheter is removed. Please inquire regarding other medications.

Catheter Removal:
Your physician will remove your catheter. Please bring a pad (such as a "Depend") to the office so you can wear it home after the catheter removal. Remember, urinary incontinence is very common after catheter removal and may take weeks to months to improve or resolve. It is not possible to predict if incontinence will occur after catheter removal, or to what degree; therefore, it is best to bring a heavier pad or diaper rather than a thin "liner". The type of pad/diaper that is used is personal preference but it is usally easiest to start with a diaper type pad that you step through rather than one with straps or tape. This type of diaper is like a pair of jockey shorts or briefs.

Pathology Report:
The pathology report usually takes 1-2 weeks to return so this will usually be discussed at the time of your appointment for catheter removal.

Activity After Surgery:
You may walk as much as you want but that is all. Do not walk steep grades and do not do anything strenuous. No lifting (limit 10 pounds) or straining. After 6 weeks, you may resume normal activities including exercise, golf, etc. It is best not to drive for 3-4 weeks after surgery, or until your "reaction time" is normal and not impaired by pain, etc. The timing of returning to work depends on what you do; please discuss this with your doctor.

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 with you peri-operative care.