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Radical prostatectomy

At Mater Health Services we understand that having an operation can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients’ needs. It explains briefly what to expect before you come to hospital, the events that may occur during your visit and the things to expect when you are discharged from the hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please ask your doctor or nurse. Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

Radical prostatectomy

Radical prostatectomy is one of the treatment options for prostate cancer. This surgery involves the removal of the prostate gland and small glands located immediately above the prostate gland called seminal vesicles. Sometimes surgeons may need to remove the lymph nodes nearby during this procedure.

Patients in good health, who have a long life expectancy and with prostate cancer confined to the prostate gland are candidates for radical prostatectomy.

Radical prostatectomy is considered to be a cure for prostate cancer that is still confined to the prostate gland. However, no surgery is without risks. It is important to talk to the surgeon about the risks, benefits and limitations of radical prostatectomy before undergoing treatment.

The surgical risks that occur at or soon after the surgery may include:

  • bleeding: this may require a blood transfusion
  • infection: this may occur at the site of the wound, in the urinary tract or through your IV site "drip"
  • deep venous thrombosis: this is the formation of a blood clot. It can be life threatening if it dislodges and travels through the blood vessels to the lungs. Precautionary measures are taken to reduce this risk by the use on special stockings and also blood thinning medications
  • injury to nearby organs or structures: The rectum, bladder and ureters are close to the prostate and may be accidentally injured by surgical instruments. Further surgery may be necessary to repair any damage.

Possible side effects of surgery include:

  • impotence: the inability to get or keep an erection. The risk of developing impotence after the operation is related to the ability to gain and maintain erections before the operation
  • urinary incontinence: involuntary passing of urine. Radical prostatectomy may result in sphincter injury or nerve injury. In most cases, the incontinence improves with time and is not severe. Sometimes further surgery is necessary
  • urinary obstruction: scar tissue can form at the point where the urethra was joined to the neck of the bladder and this can interfere with the flow of urine. Further surgery may be necessary.

Our expectations

Prior to discharge:

  • you will be able to maintain an adequate oral intake 
  • you will understand how to manage your wound, catheter (and drain if applicable) 
  • your pain will be controlled with oral pain medication 
  • you will be walking comfortably without assistance.

Phase one—post-operative

Breathing exercises—every hour you are awake and while resting in bed take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs. Taking a deep breath may trigger a cough. Support your wound with your hands and forearms; perhaps use a pillow over your stomach to protect as you cough. Bent knees help to reduce further strain on your wound.

Circulation exercises—these exercises improve the blood circulation and may help prevent blood clots from forming in the legs. Start doing this exercise in bed and then once you start sitting out of bed:

  • move your feet up and down briskly from your anklescirculation exercise
  • while your leg is straight, push your knee gently into the bed and pull your toes towards your head. Hold this stretch for a few seconds and then relax. Repeat five times with each leg if comfortable 
  • squeeze your buttocks tightly and then relax. Repeat a few times.

After your operation

  • You will stay in the recovery room within the theatre suite after the operation while you waken from anaesthetic. You will be transferred on your bed to your room in the ward.
  • It is important that you remain on bedrest following your surgery until the next morning. Reducing your activity allows your body to recover from the anaesthetic and reduces the possibility of bleeding. 
  • You will have a urinary catheter in place. Your urine output and catheter will be checked regularly.
  • Your nurse will take frequent observations of your vital signs (e.g. pulse and blood pressure), your dressing and drains and that the catheter is draining freely.
  • Your nurse will assist you to have a wash sometime after you return to the ward.
  • You will have IV fluids to help rehydrate you.
  • It is best to introduce food and fluids slowly following your surgery as the anaesthetic can cause you to feel nauseated. Begin with sips of water and ice then progress gradually to fluids only as ordered by your doctor.
  • Please tell your nurse if you have pain or nausea. There are treatments that can be given to relieve this.

Discharge planning

Your discharge needs will be discussed and reviewed.

Teaching and emotional support

A nurse will discuss this booklet with you and ensure you understand the information contained in it. A member of our Pastoral Care team may visit you and are available on request.

Tests and procedures

A blood sample will be taken.

Mobility

You will be assisted to both sit out of bed and walk.

Hygiene

The nurse will assist you to have a sponge in bed or shower.

Nutrition

You may progress from a free fluid to light diet as ordered by your doctor.

Observations

Nurses will record your observations regularly. You will also be weighed daily (if ordered by your doctor). The output from your catheter and drains will be measured and recorded. The catheter must remain securely taped to your leg to avoid being pulled.

Medication

Your regular medications will be given to you. Relief for pain, nausea and vomiting will continue as ordered by your doctor. Your patient controlled analgesia may be removed. When it’s removed please let the nursing staff know when you have pain so they can provide pain relief. The drip in your arm will remain in place.

Treatment

One of the drains may be removed. Your wound will be checked regularly. Continue with your deep breathing and leg exercises. Please continue to wear your therapeutic stockings and reapply after showering.

Phase two—post-operative

Teaching and emotional support

Your nurse will discuss with you this patient information booklet and answer any questions you may have. A member of the pastoral care team may visit you.

Mobility

Nursing staff will continue to encourage you to mobilise independently and take regular short walks around the ward at least four times a day.

Hygiene

Your nurse will assist you with your shower if required.

Nutrition

You may progress from a light to normal diet as ordered by your doctor.

Continence state

Your urinary catheter will remain in place. The drainage bag will be changed to a leg bag during the day. You will be encouraged to care for your catheter under supervision.

Observations

Your observations will be recorded regularly. The output from your drain and catheter will be measured and recorded daily.

Medications

Your regular medications will be given to you plus any required for pain relief. If your patient controlled analgesia has not already been removed it will be removed. Please let the nurses know when you have pain. If your IV is still in place it may be removed.

Treatments

Your wound and dressing will be checked. Please continue to wear your therapeutic stockings and reapply after showering.

Discharge planning

The nurse will give you a discharge advice form and discuss it with you. Arrangements for the removal of your catheter will be made. It is preferable that you arrange to be ready for discharge by 10 am. Please inform staff of approximate time.

In preparation for your discharge

  • The condition of your wound or dressing and catheter will be noted prior to your discharge. 
  • If your dressing is removed you may leave your wound exposed. 
  • If your dressing is intact instructions will be given to you as to when you can remove your dressing. 
  • You will receive information and written instruction on the care of your catheter. 
  • Arrangements for the removal of your catheter will be made. 
  • Your doctor will visit you. 
  • You will be independent with your mobilisation.
  • You will be independent with your showering and hygiene needs.
  • You will be eating normally. 
  • You will be given your medications and advised when to recommence those that have been stopped. 
  • Your drain will be removed prior to going home.

Emotions after surgery

The experience of surgery and what follows can affect individuals deeply. It can even cause a change in the way that people think about things in their lives and how they value them. It may lead to the sorting out of what is now important to the individual.

This change in thinking may affect all aspects of life from the most profound to the very simple and could cause feelings of surprise or even alarm. Those close to the person may also be surprised and challenged by the change in them, especially during the "sorting out" period. Some people manage to do the sorting out on their own, but others find it beneficial to seek help.
The role of the Pastoral Care team at Mater Health Services is simply to be there to listen and to provide the companionship necessary to help people make sense of these issues. They are skilled at being supportive without intruding, and their aim would be to help people find their own ways of adjusting.

A member of Pastoral Care is available to you while you are in hospital. While in hospital, ask a staff member to contact the Pastoral Care Service or if you would like to talk to someone.

Phone numbers that may be of assistance

  • Queensland Cancer Fund Helpline (written information and booklets, prostate cancer support groups and individual counselling) 13 11 20 
  • National Continence Helpline 1800 33 00 66

Information and advice on caring for your wound and catheter at home

Care and advice for wound and recovery post surgery

You may have a waterproof dressing in place when you are discharged. If so, remove it within two to three days of discharge. You may wash the wound in the shower and cover it only if it is oozing. All stitches are internal so there are no clips or stitches to be removed.

Swelling of the scrotum is common after this surgery so wearing firm but comfortable cotton underwear can prevent this. A small amount of blood may be present in your urine and this is normal following this surgery. If a large amount of blood is present or it appears bright red then seek advice from the nurse or doctor.

It is very important to avoid heavy lifting or straining particularly from constipation. The bowel motions can be kept soft and easy to pass by maintaining a high fibre diet, drinking plenty of fluids and also taking a gentle stool softener such as Coloxyl, pear juice or Agarol.

Caring for the catheter

After a radical prostatectomy, the catheter usually stays in place for about 10 days. The catheter will firstly drain into a bag that hangs on the bedside. Once you are up walking around a smaller drainage bag is fitted and strapped to your leg. This leg-bag remains in place until the catheter is removed.

  • Empty your bag at least four times a day or whenever it is ¾ full or becoming heavy.
  • It does not require cleaning but needs to be changed every seven days.

Please note, it is very important to ensure that the leg-bag is positioned so that it does not pull on the catheter. The leg straps need to be comfortable but securely applied so the leg bag remains high on your thigh with no tension or traction on the catheter. This may mean that you need to adjust the leg-bag straps regularly to ensure that there is a comfortable loop of catheter between you and the bag.

Strategies that will reduce the risk of infection

Anytime a person has a catheter inserted into their bladder, there is a risk of an infection occurring. There are several strategies that you can implement which will minimise this risk:

  • Careful hand washing before and after emptying or handling the catheter or bag 
  • Five simple steps to emptying a urine drainage bag
    • wash your hands with soap and water 
    • place the drainage bag over the toilet ensuring that the valve does not touch the toilet 
    • open the valve and let the urine drain into the toilet 
    • close the valve 
    • wash your hands. 
  • Attaching the two litre night bag onto the leg bag
    • wash your hands with soap and water 
    • check that the night drainage bag is closed 
    • wipe the tapered end of the night bag with an Alcowipe (avoid touching the end once you have wiped it) 
    • connect the night bag to the lower end of the leg bag (test to make sure the connection is secure) 
    • open the leg bag valve to allow drainage into the night bag 
    • wash your hands 
    • once in bed, the lower end of the leg bag and straps can be adjusted to improve the flow of urine (in a downward direction towards the night bag) 
    • hang the night bag on a bedside drawer or knob. Ensure that it is below the level of your bladder to promote drainage. It should not touch the floor. In the morning, empty the night bag and clean as directed.
  • Daily cleaning of the night bag
    • rinse the bag with tap water 
    • wash with soap and water and rinse well (soap with low suds such as woolmix is good) 
    • add half a cup of white vinegar to the final rinse water to reduce odour 
    • leave the valve open and hang the bag out to dry. 
  • Increasing your intake of fluids to approximately two to three litres
    • This is to ensure that the urine is pale in colour and that it is constantly flushing through the catheter. If the urine is dark and appears concentrated then you may not be drinking an adequate amount of fluid.
    • Important: If you have a heart or medical condition that restricts the amount you can drink, please check with your specialist before increasing your intake of fluids 
  • Clean around where the catheter enters the body
  • Ensure that any blood or secretions are washed away rather than drying and encrusting on the catheter. This can be done two to three times a day, depending on the amount of secretions and using your preference of:
    • a clean washer with plain water
    • a small amount of soap and water 
    • a baby wipe. 
  • It is not unusual for a small amount of blood and/or urine to leak out around the catheter, at the tip of the penis while having a bowel motion. 
  • Taking antibiotics if directed by your doctor.

Removing your catheter

Before you leave hospital an appointment will be made for you to have your catheter removed. Your catheter will be removed around ten days after your surgery.

Appointment date and time: ……………………………………………………………………………...........

Appointment place: …………………………………………………………………………………….................

Important points:

  • It is beneficial in making it easier to pass urine, in the early stages after your catheter has been removed, if your bowel motions are soft and easy to pass. Continue laxatives as needed. 
  • If you develop any difficulties passing urine at home after the catheter is removed please contact your doctor or go to the nearest emergency centre.

Day of your catheter removal

Arrive at appointment time given to you. Your catheter will be removed after you see the doctor.

The nursing staff will check your observations and then remove your catheter. If there are any special instructions from your doctor, please tell the staff before they remove your catheter.

Ensure your bowels are functioning well and bring a supply of pads with you.

Once the catheter is removed you will be given a bottle to use when you pass urine. You will need to call the staff each time you pass urine and they will measure the volume left in your bladder using a portable bladder scanner.

After the catheter is removed, you can cut back your drinking of fluids to a moderate amount.

Usually after passing urine several times with less than 100 mls left in your bladder the trial of void is complete. This process takes approximately six to eight hours.

Contacts

Please contact either your Specialist doctor, general practitioner (GP) or your closest Emergency Department if you notice any of the following:

  • Your catheter is dislodged or falls out
  • To avoid pulling or dislodging the catheter, ensure that the leg straps are securely applied. Your catheter does not appear to be draining after completing the following steps.
  • If you feel a sensation of "fullness" and suspect that your catheter may be blocked then:
    • Immediately empty the drainage bag. 
    • Use the unblocking technique of placing you finger over the non-return valve and "pumping" at the soft spot near the catheter’s Y-connection (the nurses will demonstrate this technique).
    • Change your position (e.g. stand, sit or lie on your side) 
  • If urine still does not appear to be draining out seek medical advice as soon as possible.
  • You have an elevated temperature, are feeling unwell or lethargic or feeling hot (fever) or cold (shivers). Notify urgently any temperature over 38° C.
  • There are signs of a urinary infection; such as smelly or cloudy urine, pain or a dull ache around the lower back or kidney region, stinging or burning when you pass urine (once your catheter is out).
  • There are signs of a wound infection; such as increased redness and heat at wound or drain site, fluid or pus leaking or oozing from the wound or uneven swelling near wound. 
  • You experience an increase in pain that is not relieved by the analgesia you have at home.

Mater Private Hospital Redland

Mater Private Hospital Redland was established in September 2000 as an extension of the mission of the Sisters of Mercy to provide the highest quality health care services for the people of the Bayside region. With a growing community in the Bayside districts, Mater Private Hospital Redland offers patients exceptional care close to their families and friends.

Collocated with the Redland Public Hospital, Mater Private Hospital Redland features a three level main hospital building incorporating 60 inpatient beds, two operating theatres, endoscopy procedure room, three obstetric birthing suites and day procedure unit. It is combined with a single-level building housing a specialist medical centre, radiology and pathology services.

Mater Private Hospital Redland

Weippin Street, Cleveland, Q, 4163

Telephone: 07 3821 9444

Acknowledgements

Staff of Clinical Safety Quality Unit, Mater Health Services, Mater Adult Hospital and Mater Private Hospital Redland.

Reference: Milliman CareGuidelines: Inpatient and Surgical Care/Ambulatory surgery/Home Care 1990–2013 

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 13/11/2015.
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